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Profile: Surgical Oncology Team

August 14, 2017 | Lindsay Morgan

UC San Diego's Surgical Oncology team, part of the Department of Surgery, offers clinical programs that draw patients from across the nation and internationally. The Division is part of the Moores Cancer Center, one of only 47 National Cancer Institute (NCI)-designated Comprehensive Cancer Centers in the United States, and the only one in the San Diego region.

Headed by Dr. Andrew Lowy, the division is at the forefront of treatment for patients with breast, GI stromal tumor, hepatobiliary-pancreatic, and peritoneal malignancies. As part of multidisciplinary cancer treatment units, the division's surgeons work side-by-side with medical oncologists, radiation oncologists, pathologists, radiologists, plastic/reconstructive surgeons, genetic counselors, oncology nursing staff and social workers to provide comprehensive care.

A Growing Team

The Division's faculty has grown over the years—from 3 in 2007, when Dr. Lowy arrived, to 10 today. Dr. Rebekah White, a surgical oncologist who specializes in treating tumors of the pancreas, liver, bile duct, and upper gastrointestinal tract, joined the team in August 2016. She was recently awarded $75,000 by the Salk Institute Cancer Center to study irreversible electroporation as an In Situ vaccine for pancreatic cancer. And this month, Dr. Jula Veerapong joined the Division. His practice will focus on the treatment of patients with appendix and colon cancers that have metastasized to the peritoneum as well as peritoneal mesothelioma. He will also lead divisional efforts in enhanced recovery after surgery and quality.

"My vision was to have a division of people who are great doctors," says Lowy, "who have superb technical skill, outstanding ability to communicate with patients and are also passionate about creating new knowledge, while committed to being excellent educators. We've recruited people with those capabilities and have given them opportunity to do what they are passionate about and growth has happened organically."

Measures of Performance

UCSD performs more complex cancer surgeries than any other health center in San Diego County, maintaining high surgery volume for all 11 cancer types. Studies strongly suggest that for procedures such as lung, pancreas, esophageal or rectal cancer surgeries, higher volume hospitals have better outcomes and lower mortality. U.S. News & World Report recently released their 2017-2018 "Best Hospitals" rankings, and UC San Diego Health has been recognized for extraordinary medical and surgical care, including #40 in cancer and #46 in gastrointestinal surgery.

On quality metrics, the division is doing better than ever: readmits are down; average length of stay is down; the percent of new visits scheduled within 7 days is up; and the division is doing well on most all patient safety indicators.

Patient satisfaction is also increasing. During FY17, patient's likelihood to recommend the division's services increased to 84.4, up 2 points from FY16, a significant improvement.

A Motivated Team Delivers the Best Patient Care

The patient experience is shaped, not only by their relationships with surgeons, but also with nurses, nurse practitioners, administrative assistants, and other team members. Nurses administer therapies, monitor treatment, watch out for side effects, educate patients and their families, and offer emotional support. They are often the members of the treatment team with whom patients have the most contact.

Debbie Soldano, a Nurse Practitioner who works with Dr. Lowy, says, "our goal is to take care of the patients. Patients are scared. We're here to educate them about cancer and help to relieve some of their anxiety, to reassure them, to help them through each decision point. I think of my job as a humanitarian job."

Meanwhile, administrative assistants (AAs) triage incoming patients, obtain their medical records, order tests, provide clinical support to surgeons. They are the first point of contact for patients, helping them connect with a doctor and navigate the system.

Kate Trulock, administrative assistant to Dr. Lowy, says that she enjoys a high degree of autonomy in her position: "We aren't micromanaged. Dr. Lowy gives us a lot of latitude, which is possible because we work in such close proximity and we've together for so long. There are high degrees of trust."

Lowy thinks the nurse and AA relationship with patients is vital: "Just like the patient has a relationship with the doctor, it's ideal for them to have a relationship with a care team. They speak with the assistant and the NP more than they speak with me. What's more personal than being cared for, for cancer? To have people who really know you is a really comforting thing for people, and the care is better."

Michelle Benton, who has worked as the administrative assistant to Dr. Anne Wallace for 4 years, describes her job as rigorous but rewarding: "It's stressful but I love it. We really care about our patients, and Dr. Wallace does too—and she cares about us. She's all about the team."

Looking ahead, Dr. Lowy says his goal is to create a work environment where all members of the team can thrive. "One thing that is always on my mind is staff and faculty advancement opportunities. It's really important to be mindful of how we can promote the careers of people we have in our employ. We have these great people, we invest in training them…shame to lose them. Everything is about people. That's what makes us great or not great. There's nothing more important than investing in them."