Special Expertise

Specialty Centers include:

• Risk Assessment Programs for people with a family history of specific cancers (breast and/or ovarian cancer, prostate cancer, gastrointestinal cancers, and melanoma)
• Multidisciplinary Treatment Centers for adult solid tumors and hematologic malignancies
• Pain Management Center
• Naomi and Phil Lippincott Hospice Program

Other areas of expertise include:

• Immunotherapy with specially developed antibodies or therapeutic vaccines
• Minimally invasive, computer-enhanced robotic-assisted da Vinci S Surgical System
• Video-assisted thoracic surgery
• Radiofrequency ablation
• Interventional bronchoscopy and radiology
• Photodynamic therapy
• Endoscopic ultrasound and various interventional endoscopy procedures for gastrointestinal cancers
• Maxillofacial prosthetics, microsurgery, and reconstruction for head and neck cancers
• Advanced breast reconstruction using tissue-transfer procedures

State-of-the-art radiation therapy and radiology technology includes intensity-modulated radiation therapy (IMRT); the Trilogy Stereotactic System for image-guided radiation therapy and stereotactic radiosurgery; the Calypso 4-D Localization System; CT on Rails; BAT (B-mode Acquisition and Targeting) positioning system; high-dose–rate brachytherapy (temporary radiation implants) and permanent low-dose brachytherapy; MRI treatment simulation for radiation therapy; combined PET/CT scanning; 4-D CT; magnetic resonance spectroscopy (MRS, or functional MRI); and stereotactic breast biopsy, among others.

Referring Physician Line

888.FOX.CHASE (888.369.2427)

Facility

Campus is in northeast Philadelphia

Lodging

Available through furnished apartments and local hotels that offer a special rate for patients and their families. To arrange, call Ellen Herrmann at 215.728.3628.

Breast Evaluation Center Gastrointestinal Cancers
Genitourinary Cancers
Gynecologic Cancer Center
Head and Neck Cancer Center
Hematologic Cancer Center
Lung Cancer
Neuroendocrine Cancers
Neurological Cancers
Pigmented Skin Lesions
Sarcomas

215.728.2570

Familial Melanoma Risk Assessment Program

215.728.2191

Prostate Cancer Risk Assessment Program

215.728.2406

Social Work

A social worker with expertise in the medical aspects of terminal illness assesses the needs of patients and caretakers and provides counseling. This facilitates adjustment to the illness and secures resources that allow patients to remain in the company of family and friends.

Home Health Aides

Trained and supervised aides can provide personal-care services, such as bathing, feeding, toileting and skin care.

Insurance

The following insurance companies cover hospice and palliative care services in the home:

• Medicare
• Major Medical
• Commercial Insurance
• Blue Cross

Patients without insurance coverage may arrange for hospice and palliative care services. Fox Chase Cancer Center will make every effort to accommodate individual patient needs.

Referrals

Physicians, other health-care professionals, patients or families may initiate inquiries and requests for the Lippincott Hospice Program.

Activities in Cooperative Group

Committee chairs and membership

100

4,104

5.3

71,508

69

Director, Margaret Dyson Family Risk Assessment Program

Angela Bradbury, MD

Director, Gastrointestinal Risk Assessment Program

Neal Meropol, MD

Director, Familial Melanoma Risk Assessment Program

Stuart Lessin, MD

Director, Prostate Risk Assessment Program

Veda Giri, MD

Pedigree Review Conference

The Risk Assessment Programs hold Pedigree Review conferences to assign a cancer pattern and genetic risk status following a counseling session. The Pedigree Review team consists of a multidisciplinary group of health care professionals including medical oncologists, genetic counselors, nurses, health educators, and research coordinators. This system helps determine eligibility for genetic testing and/or other research opportunities based on the participant's family history via pedigree expansion and evaluation.

Eligibility for participation in genetic testing and related research projects is determined by careful analysis of the family pedigree and other personal risk factors.

Informed Consent Procedures

Fox Chase uses a multi-staged process to obtain informed consent. Consent forms relate to specific research studies and cover any of the following: the collection of baseline data, family history data, or research-specific surveys (such as psychological surveys) and entering family history and other medical data into a research database. Consent forms may be sent by mail or obtained at the point of contact with participants.

At individualized counseling sessions, the goals and procedures of cancer risk counseling and/or research are fully discussed with a trained health professional in Cancer Risk Assessment. Primary and secondary prevention is tailored to the individual level of risk. For individuals who proceed to genetic testing, the benefits, risks, and limitations of obtaining genetic information are discussed and consent is obtained prior to having their blood drawn. A pre-test consent form is also obtained, allowing the counselor to disclose the patient’s test results to a family member or friend in the event that the patient is not able to receive them due to death or severe trauma. The blood sample can either be sent to a commercial laboratory or to the genetic testing facility at Fox Chase Cancer Center for BRCA1/2 testing, depending on the needs of the patient. If the participant is tested at Fox Chase, a second blood sample accompanied by a separate consent form is required for quality assurance.

During the disclosure session, the genetic test results, the implications of the results, and medical management recommendations are discussed with a genetic counselor and either a nurse practitioner or a physician. Another consent form allowing the Risk Assessment Program to enter the patient’s test results into their database is also offered at that time.

Participants eligible to take part in one of our cancer family registries or the Biosample Repository are given detailed information about the content of the data to be collected, potential uses of the data, safeguards to prevent unauthorized disclosure, and the kinds of information they will receive in feedback.

Testing

The risk-assessment programs at Fox Chase offer genetic counseling and testing for the following cancer sites and by gene testing research. Genetic testing for other cancers or cancer family syndromes is available through Fox Chase.

Laboratory Quality Assurance

The Clinical Molecular Genetics Laboratory is a CAP/CLIA certified molecular testing laboratory in the Department of Pathology at the Fox Chase Cancer Center. Quality control and quality improvement programs are appropriate in design and practice for the rigors of federally overseen clinical sample testing and ensure the integrity, specificity, and sensitivity of testing data. Proper sample identification is maintained throughout pre-analytical, analytical, and post-analytical monitoring. Results are always correlated in the context of all the data available, i.e., personal and family history, any former testing data and current scientific literature review. Molecular genetic test reports are released/transmitted in a manner adequate to maintain patient confidentiality at a level appropriate for the particular test. Computerized records are backed-up daily by the institution.

Risk Management

During the individual counseling session and/or follow-up clinic visits, screening, medical management and risk-reduction issues are reviewed and resources and referrals provided as needed.

Medical and Surgical Management

Participants receive an explanation of findings and consideration of options for chemoprevention, screening, and surveillance and risk-reducing surgery if appropriate.

Clinical Follow-Up

Participants have the option of receiving medical evaluation and follow-up for breast and/or ovarian cancer risk in the new state-of-the-art Prevention Pavilion at Fox Chase Cancer Center. The clinical component includes a comprehensive cancer risk evaluation of personal and medical history along with a physical evaluation. Both the patient and her referring physician will receive information about medical management, screening recommendations, and eligibility for enrolling in current prevention trials. The medical evaluation is a service that is billed to the client’s health insurance provider.

Some women with histologically identifiable breast biopsies, such as lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH), are at a higher relative risk of breast cancer. The risk may be further increased when there is a positive family history. The clinical component of the Dyson Family Risk Assessment Program provides patients the opportunity to meet clinicians with special training in breast diseases (consultant surgeon, breast physician). Preventive measures such as chemoprevention with tamoxifen, other drugs when their role in prevention has been established, or surgery are highlighted during these discussions.

The Prostate Risk Assessment Program (PRAP) provides comprehensive evaluation of prostate cancer risk based on personal medical history along with a physical examination and prostate specific antigen (PSA) blood test. PRAP utilizes the percent-free PSA blood test for men with a total PSA of 1.5 ng/ml as part of its criteria for prostate biopsy. Current literature and PRAP data show that use of the percent-free PSA blood test to determine appropriateness of biopsy increases cancer detection and decreases unnecessary biopsies. Men with normal findings on examination and PSA blood test are screened on an annual basis; men with abnormal findings undergo further diagnostic studies (e.g. biopsy, endorectal MRI). The medical examination and the PSA blood test are services billed to the participant’s health insurance provider.

The Melanoma Risk Assessment Program provides cancer risk assessment, cancer prevention, and early detection of melanoma and complements our state-of-the-art services of staging and treatment. Our staff is dedicated to helping prevent melanoma and other forms of skin cancer.

Improving Counseling Methods

The purpose of the counseling research is to test communication strategies for providing genetic risk information, to prepare individuals for participation in genetic testing research, and to evaluate the psychosocial and clinical impact of genetic risk information.

Internet Risk Assessment Program:  Cancer-risk counseling would ideally include multiple family members. Frequently these family members live in many different areas across the country. To address this issue, the Fox Chase Cancer Center created IRAP (Internet Risk Assessment Program). IRAP is an internet/computer program to help families that are geographically separated receive cancer risk counseling and genetic testing information. This is done through use of a computer and internet program that allows for video and audio on personal computers.

An interactive multimedia program using compact disc interactive (CD-i) technology has been developed for use with individuals in the FRAP. The program is designed to improve patient satisfaction with decision-making regarding genetic testing by improving comprehension of their personal cancer risk and improving knowledge regarding cancer genetic testing options.

Quality of Life After Prophylactic Oopherectomy

Final analysis is under way for this prospective study that compares a group of women who chose prophylactic oophorectomy to reduce risk of ovarian cancer with a control group. The groups were matched in age, race, education, marital status, and BRCAgene mutation testing status. Findings show statistically significant short-term differences between groups, with the surgery group experiencing more hot flashes, night sweats, and cold sweats; decreased physical and social functioning; and decreased sexual activity, frequency, and pleasure. Given that the majority of women were premenopausal at the time of surgery, the abrupt drop in hormone levels after ovary removal accounts for the symptoms reported. This is a key area for clinical intervention that we are addressing.

Studying Impact of Receiving Genetic Information on Health-Related Outcomes

Communicating Genetic Test Results to the Family: This study, funded by the National Cancer Institute, is targeted to families in which a genetic alteration has been identified. First-degree relatives of individuals who have tested positive are provided with educational materials to help them better understand their genetic risk and make an informed decision about pursuing genetic counseling and/or testing.

Preference Shift & Spousal Utility for Cancer Treatments: This PRAP study is designed to evaluate differences in preferences between men participating in a prostate cancer-screening program and their spouses/partners, and to evaluate shifts in men's preference when responses are elicited with input from the female spouse/partner. Using the Time Trade-off technique, partners are interviewed separately, then jointly, to determine their preferences and potential shifts in preferences for prostate cancer screening and treatment options. The findings of the proposed study will have relevance to outcomes research and will also have application to clinical decision-making.