NCCN_Guidelines_Head-and-Neck Cancer Version 2.2013 (1).pdf
DocPiece_Final-Print
1. Makingcoordinatedcare
easierforphysiciansandtheir
patients,allacrossErieSt.Clair
2220 Kildare Road
Windsor, ON N8W 2X3
519-253-5253
1-844-904-2273 Ext. 58558
www.wrh.on.ca/wrcp
TheCancerCentreoffersadedicatedphonelineforphysicians
andcommunitypartners.ItprovideseasieraccesstoCancer
Programphysicians,nursenavigatorsandotherswhoare
involvedinpatientcare. ThelineisansweredbyCallCentre
staffduringdaytimehours.Duringevenings,weekendsand
holidays,callsareforwardedtoaswitchboardatWindsor
RegionalHospitalwhowillcontactthephysicianoncall.
Pleasenote:Thelineisintendedforuseonlyby
physiciansandcommunitypartners;itshouldnottobe
giventopatients.
519-255-6757
Forallfaxreferrals,pleaseusethisnumber:
519-253-5364
Reminder:properlycompletedreferralformshelpreducewaittimes!
AwordfromDr.TimO’Callahan,
President,EssexCountyMedicalSociety
Ourservicearea
LA K E
S T . C LA I R
C H AT H A M
S A R N I A
W I N D S O R
LA K E E R I E
LA K E H U R O N
LA M B T O N C O U N T Y
K E N T C O U N T Y
E S S E X C O U N T Y
H
H
H
H
H
L E A M I N G T O N
TheCancerCentreserves
patientsallacrossthecounties
ofLambton,KentandEssex.
Ourcoverageareamatches
thatoftheErieSt.ClairLHIN.
Adirect,dedicated
telephonelinefor
physiciansand
communitypartners.
“TheCancerProgramatWindsorRegional
Hospitalisalocalresourceofwhichthelocalmedical
communitycanbeveryproud.Ialwaysfeelentirely
comfortablereferringmy patientsthere,confident
thattheywillreceivethehighestlevelofcare.That
confidenceisreinforcedbythepatientswho,when
theyreturntousaftertreatment,havenothingbut
positivethingstosayabouttheircareexperiences.
“Fromtheperspectiveofmyfamilypractice,Igreatly
appreciatetheleveloftimelyfeedbackwereceivefrom
theCentre’sstaff,andhowtheykeepusuptodateon
developmentsaffectingourpatients.
“Finally,Ican’toverstatethevalueofhavingan
excellentcarefacilitysocloseathand.Eliminatingthe
addedcostsandstressesofaccessingout-of-towncare
contributesinabigwaytobetterpatientoutcomes.
“TheCentre’s“benchtobedside”
research,whichexploresnew
approachestoeverystageofcancer
care,involvesover500patients
andtheirfamiliesandincludes
researchpartnersnationally
andinternationally. Thislevelof
leadershipandcollaborationcertainly
gainsmyattentionandrespect.”
–Dr.GlennBauman,MD,F.R.C.P.C.
Chair/Chief,DepartmentofOncology;
Director,WesternCentreforTranslational
CancerResearch,WesternUniversity
“Idon’tthinkpeoplerealize
whatatrulyworld-classhealthcare
resourcetheCancerCentreis.And
whileIrespecttheirclinicalexpertise,
it’snotjustabouthowtheyhelped
megetbetter;it’salsoabouthowthey
mademefeelbetter.”
–Dr.MichellePrinceBHk,DC
Owner,LifetimeWellnessCentreand
cancersurvivor
“Minimallyinvasiveadvanced
laparoscopicandroboticsurgeries
allowforbettersurgicaloutcomes
andfasterpatientrecovery.For
manysurgeries,andespeciallyfor
prostatesurgeries,waittimesare
shorterthanatothernearbycentres.
Theresultistremendouspatient
satisfaction.”
–Dr.ShaelLiebmanBPHE,MD,F.R.C.S.(C)
ChiefofSurgery,
WindsorRegionalHospital
“Isincerelyhopeyou’lljoinmeincelebrating
thefacilityandthededicatedpeoplewhomake
itsuchavitalandvibrantpartofourhealthcare
community.”
Whatmakesthissuch
agreatCancerCentre?
Allofusaredeeplyandpersonallycommittedtoprovidingacare
experiencethatcombinescompassionandadvancedmedicalexpertise.
Weunderstandhowvitallyimportantitistoyourpatientsandtheir
familiestoreceivetheverybestcareinatimelymanner.
Wedeliverthatcarethroughdedicatedteamsthatincludeexpertsin
dozensofspecializedclinicalfields,somedirectlyinvolvedwithpatients
andmanymoreworkingbehindthescenes.We’realsocommittedto
reducingtheregion’scancerratesthroughpreventionandscreening,and
toreducingcancer’simpactbyprovidingtimelyaccesstoeffectivecare.
Ourevidence-basedtreatmentsareonalevelwithmajornationaland
internationalinstitutionsandwearehighlyregardedforourclinicaltrials
andotherresearchinitiatives.
Ourcommitmenttoyourpatientsandtheirfamiliescontinuesacross
everyaspectofthecancerjourney,throughdiagnosis,treatmentandend-
of-lifecareand,inmanymorecasesthaneverbefore, survivorship.
Compassionatepeople,world-classtechnologyandan
unrelentingdrivetoexcelwitheverypatient,everyday.
Q U I C K Q U O T E S
Dr. Ken Schneider,
Chief of Oncology
Dr. Tim O’Callahan,
President, Essex County Medical Society
02/15
TheWindsorRegionalHospitalCancer
Program:aphysician’sguidetoadvanced
cancercareinSouthwesternOntario
A topOntarioperformer
formeetingwait-time
targets!
www.wrh.on.ca/wrcp
Bigenoughtoknowhow.
Smallenoughtoreallygettoknowyourpatients.
2. RADIATION TREATMENT
SYSTEMIC TREATMENT
SURGICAL TREATMENT
•Alltreatmentsdeliveredbasedonprovincialstandards
•TwoofOntario’sfinestDrugAccessCoordinatorsonstaff,ensuringour
abilitytoaccessthenewestavailabledrugs
•Activeprogramofclinicaltrialsthatallowustoaccessemergingtreatments
righthereinWindsor
•MostMedicalOncologistsaremembersof,andcontributeto,Ontario
ProvincialGuidelinesGroupsforthesystemic(chemotherapyand
endocrine)treatment
•OurcollaborativerelationshipswithlargecancercentresinthenearbyUSA
allowustooffercutting-edgetreatmentsnormallylimitedtolargercentres
(i.e.Toronto).Ourpatientscanalsoaccessabroaderrangeofclinicaltrials
hereandclosetohomeinaffiliatedDetroitcentres,sometimesatnocost
•Fullspectrumofradiationoncologyexpertiseinadultoncologyacrossall
diseasesites
•State-of-the-artLinearAcceleratorsdeliveringIMRT(IntensityModulated
RadiationTherapy)withRapid-Arc®technology
•BrachytherapyincludingbothLowDoseRatepermanentimplantsfor
prostatecancer(I-125seeds)andHighDoseRatefor prostateandsome
gynecologiccancers(cervixandendometrium)
•ClosecollaborationwithandreferralstootherOntario-basedRadiation
TreatmentProgramsforhighlyspecializedtreatment(GammaKnife®and
CyberKnife®treatment)intheTorontoandHamiltonregions
•CancersurgeryofferedatbothcampusesofWindsorRegionalHospital
withdedicatedexpertiseinthemanagementofmalignantdisease
•Breast,prostate,colorectalandlungarehigher-volumediseasesites
•Uppergastro-intestinal,gynecological,headandneck,musculoskeletal
andneurosurgery(smallervolumediseasesites)arealsoofferedaswellas
melanomaandnon-melanomaskincancersurgeries
•Morespecializedcancersurgeryintheareasofgynecological,
hepatobiliary,musculoskeletalareofferedatpartnersitesinLondon
andHamilton
•Regularcollaborationbetweensurgeonsandoncologistswith
MultidisciplinaryCaseConferencingtoguideevidence-basedpractice
EXCEPTIONAL PROGRAMS
Diagnostic Assessment
Programs (DAP s )
OurDAPsareexcellentprogramsforpatientswhosesymptoms
suggestapossiblediagnosisofbreast,lung, colorectal orprostate
cancer.TheDAPs’purposeistostreamlineandsimplifytheentire
careprocessfromsuspicionthroughdiagnosis.Uponreferral
fromthephysician,anursenavigatorisassignedwhogivesthe
patientone-on-onesupport,explainsthediagnosticprocessand
streamlinestheschedulingofeverythingfromconsultationstotest
appointments.
DAPsarelinkedtoourEPS(ElectronicPathwaySolution)
programthatprovidesonlineaccesstoschedulingfor
appointmentsandreferrals,availabilityoftestresults,diagnostic
progressandnextsteps–fromthebeginningthroughtodefinitive
diagnosis–forlung,colorectalandprostatecancerpatients. RADIATION ONCOLOGISTSMEDICAL ONCOLOGISTS (C ONT ’ D)
MEDICAL ONCOLOGISTS
Khalid Hirmiz
M.B Ch. B,
F.R.C.P. (C)
Dr. Hirmiz completed
his residency
program in Radiation
Oncology at Dalhousie
University in Nova Scotia. He is currently
Adjunct Professor, University of Western
Ontario Schulich School of Medicine.
Site expertise: breast,
gastrointestinal, genitourinary, skin
and lung malignancies, lymphomas
and CNS tumours.
Ming Pan
M.D., F.R.C.P.(C)
After graduating from the
Tianjin Medical University,
Dr. Pan worked as a
Radiation Oncologist
in China until 1999. He
completed a two-year fellowship in Radiation
Oncology in Paris, France in 2001 and then a
residency in Radiation Oncology at McMaster
University in 2009. Site expertise: lung,
genitourinary, gastrointestinal, skin, and
head and neck malignancies.
Kenneth Schneider
M.D., F.R.C.P. (C)
Dr. Schneider graduated
from McMaster University
where he also completed
his residency in Radiation
Oncology. He is the
Program Head for Radiation Oncology and Chief,
Department of Oncology at Windsor Regional
Hospital and Radiation Lead for the Erie St.
Clair Regional Cancer Program. He also has an
Adjunct Professorship in the Department of
Physics, University of Windsor. Site expertise:
CNS tumours, head and neck, breast,
gynecologic malignancies and sarcoma.
clinical care sta f fcanc E r progr A ms ser v ices
Men’s health
A2011assessmentoftheregion’sservicesshowedthatcoordination
betweenprimarycarephysiciansandspecialistswascausingextended
waittimesandneededimprovement.Twomajorinitiativesresulted.
ThefirstwasthecreationoftheProstate
DiagnosticAssessmentProgram
(DAP).Theotherwasamajorcapital
campaigntopurchasenew,state-of-the-
artsurgicalequipment.Bothprograms
weresuccessful;betweenJuly1,2012
andDecember31,2013,228menhad
beenreferredtotheprogram,71%of
whomhadapositiveprostatecancerdiagnosis.InAprilof2014,the
WindsorEssexCountyCancerCentreFoundationconcludeditscapital
campaignhavingraised$5.4million.Thecentrepieceofthecampaign,
therenowneddaVinci®SurgicalAssistingRobot,offersless-invasiveand
less-painfulsurgerywithquickerrecoveryandlowerriskofpost-operative
complicationsthanfromconventionalsurgery.
I nternational Research
In2012,theWindsorCancerResearchGrouplaunchedasapartnership
betweentheUniversityofWindsorandWindsorRegionalHospital.
TheGrouphasalreadyassembledcollaborativeresearchprojectswith
theUniversity,pharmaceuticalcompanies,otherresearchgroupsand
partnerssuchasDetroit’sBarbaraAnnKarmanos
CancerInstituteandHenryFordHospital.
WCRGisbuildingworld-renownedcancer
researchprograms,developingnovelclinical
trialsandgrowingcancerresearchnetworks
withnationalandinternationalpartners.
AF TER-CANCER SURV IVORSHIP
OurRENEWLife-After-CancerEducationandFitnessPrograms
providecancersurvivorsaccesstoexpertinformation,educationand
fitnessprograms.Theeducationalseriesincludesinformationon
screeningandpreventionforaftertreatment,
potentiallong-termsideeffects,healthyeating
andnutrition,exercise,relationships,and
back-to-workplanning.RENEWexerciseand
yogaclassesaredesignedforcancersurvivors
andaredeliveredbycertifiedprofessionals.
MULTI DI S CI PLI NARY CASE
C ONF ERENCES
MCCsareregularly-scheduledmeetingsinwhichrepresentatives
fromsurgery,medicaloncology,radiationoncology,pathology,
anddiagnosticimagingpresentpatientcasesanddiscusstreatment
options.Researchshowsthatpatientoutcomescanimprove
throughmultidisciplinarycaseconferencing,especiallyincomplex
cases.Theyofferpatientsthebenefitofcombinedexpertiseacross
manyspecialtiesrelatedtotheirconditionand,ultimately,thebest
treatment.
Thesesessions,which
oftenincludephysicians
linked-inbyvideo
conferencing, give
doctorsfromacross
ourservicearea
anopportunityto
collaboratewiththeir
peersoncomplexorcross-disciplinarycases.Assuch,theyarea
valuedassetforplanningsurgicalpathwaysbecausesurgeonshave
theopportunitytoseekinputfromavarietyofrelevantspecialties.
Theygivesurgeonstheopportunitytochallengetheirdecision-
makingwithcolleaguesandtheyoftenincludeteachingsessions
thatinvolvereviewingnewmedicalliterature.Theendresultis
improvedoutcomesforallourpatients.
Rasna Gupta M.D.
Dr. Gupta graduated from
Government Medical
College in Amritsar, India
2003, completed her
residency in Internal
Medicine at Wayne State
/ Detroit Medical Centre and her Fellowship at
Barbara Ann Karmanos Cancer Institute. She is
a member of the American Society of Oncology
and Hematology (ASCO), American Society of
Hematology (ASH), and the American Medical
Association (AMA). She is also Adjunct Professor
at the University of Windsor’s Schulich School
of Medicine and Dentistry. Site expertise:
breast, lung, hematology and sarcoma.
Tarek Elfiki
M.B.Ch.B., M.R.C.P.I.,
Medical Oncologist
Dr. Elfiki graduated from
Garyounus University in
Libya. He trained and
was certified in Internal
Medicine and Medical Oncology in Ireland,
followed by a fellowship in clinical trials, and
a second clinical and research fellowship in
breast and colorectal cancers at the London
Regional Cancer Program, UWO. Site expertise:
metastatic breast cancers and connective
tissue tumors “sarcoma.”
Akmal Ghafoor
M.D., F.A.C.P.
Dr. Ghafoor, originally
from Pakistan, completed
residency training in
Medicine at Brookdale
University Hospital, NY,
N.Y. in 1998 and fellowship training in Medical
Oncology and Hematology at Albany Medical
College, N.Y. in 2001. After finishing his fellowship
he worked as a Medical Oncologist at Dr. Everett
Chalmers Hospital in Fredericton NB since
2001. Site expertise: gastrointestinal and
gynecological malignancies.
Junaid Yousuf
BSc, MD, FRCPC
Dr. Yousuf graduated
from the University of
Ottawa with his M.D. in
2005, and completed his
residency in Radiation
Oncology at Queen’s University in 2011. His
primary area of clinical research interest lies
within genitourinary malignancies and focuses
on the clinical aspects surrounding prostate HDR
and LDR brachytherapy. Dr. Yousuf is also Adjunct
Professor with the Department of Oncology and
Faculty of Medicine, Western University.
Site expertise: genitourinary,
haematological, breast, lung, and skin
cancers.
Colvin Springer
M.B., BS., F.R.C.P. (C),
BSc., MSc.
After graduating from the
University of West Indies,
Dr. Springer completed his
residency and fellowship in
Radiation Oncology at the Ottawa Civic Hospital.
He is currently Adjunct Professor, University of
Western Ontario. Site expertise: prostate
malignancies and treatment.
Sindu Kanjeekal
M.D., F.R.C.P. (C)
After graduating from
the University of
Western Ontario, Dr.
Kanjeekal completed
her post-graduate training in Internal Medicine
and Hematology at McMaster University followed
by Medical Oncology at the University of Ottawa.
She is Adjunct Professor with the Schulich School
of Medicine and teaches both undergraduate and
post-graduate students. She is a member of the
provincial hematology and survivorship disease
site groups and has been the local PI of multiple
clinical trials offered at the Cancer Centre.
Site expertise: hematologic, genitourinary
and gastrointestinal malignancies.
John Mathews
M. D., F.R.C.P (C)
Dr. Mathews graduated
with his MD in 1983 and
trained in Internal Medicine
at Dalhousie University
in Halifax and Medical
Oncology at the University of Ottawa. He joined the
Cancer Program in 2000. He is certified in Internal
Medicine and Medical Oncology by the American
Board of Internal Medicine. He is currently Adjunct
Professor, University of Western Ontario Schulich
School of Medicine.
Site expertise: gastrointestinal,
genitourinary cancers, breast cancer and
melanoma and hematological malignancies.
Caroline Hamm
M.D., F.R.C.P. (C)
Dr. Hamm graduated from
Dalhousie Medical School
in Nova Scotia, completed
Internal Medicine and
Medical Oncology
fellowships in Ottawa and completed a fellowship
in hematology with specialized training in the area
of bone marrow transplantation at Karmanos.
She stayed on staff at Karmanos/ Wayne State
University until she joined the Cancer Program
in 2002. She is the Clinical Trials Department
Physician Lead and Clinical Research Director for
the Windsor Cancer Research Group. She is also an
Assistant Professor Schulich School of Medicine,
Department of Oncology. Site expertise:
breast cancer, leukemia, lymphomas, and
melanoma.
Amin Kay, M.D.,
F.R.C.P. (C),
Medical Oncologist
Dr. Kay graduated
from Boston University
School of Medicine. He
completed residency
training in Internal Medicine at Queen’s
University, followed by fellowship training in
Medical Oncology at University of Toronto/
Princess Margaret Hospital. He is a fellow of
Royal College of Physicians of Canada, and
certified by the American Board of Internal
Medicine. Site expertise: breast, lung,
brain, and hematological malignancies.
Mohammed Jarrar M.D.,
F.R.C.P.,
Dr. Jarrar graduated from
the University of Jordan
Medical School in Amman
Jordan in 1993 where
he also completed his
Internship. His post graduate training included
Pediatric Residencies at the Islamic Hospital in
Amman Jordan and the Children’s Hospital of Austin
Texas, and as an Oncology Fellow in Pediatric
Hematology at the Children’s Hospital of Los
Angeles California. Dr. Jarrar’s expertise is with
young hematology patients through his position
as Staff Pediatrician Pediatric Hematologist-
Oncologist at Windsor Regional Hospital.
Site expertise: young adults, age 17-24
with malignant hematology diagnosis.
Swati Kulkarni
B.Sc., M.B.B.S., F.R.C.P. (C)
After graduating from Bhopal
university in India, Dr. Kulkarni
completed the Internal
Medicine Residency and
Medical Oncology fellowship
at Queen’s University, Canada. She is a fellow of Royal
College of Physicians and Surgeons of Canada and is
also certified by American Board of Internal Medicine
in Internal Medicine and Medical Oncology. She is also
Adjunct Professor at the Department of Oncology,
University of Western Ontario, Schulich School of
Medicine and is involved in teaching and research.
Site expertise: breast, lung, brain and head
and neck malignancies.
PALLIATIVE CARE
Rita DiBiase
MSN, RN (EC),
NP-Adult, AOCNS
Rita earned her MSN
from Wayne State
University, is board
certified as a Nurse
Practitioner in both Canada and the US and as
an Advanced Oncology Clinical Nurse Specialist.
She is the Nurse Practitioner for the Palliative
Care Medicine Consultative Team.
Muna Al Haddad
BsCN, MN, RN (EC)
Muna Al Haddad
graduated with
Bachelors of Nursing
from the University
of Windsor in 2009
and earned a Masters and Nurse Practitioner
Certificate in 2013.
Jane Simanovski
RN (EC), MScN, NP-PHC
Jane completed her
BScN, MScN and Nurse
Practitioner training at
the University of Windsor.
She started her career
as a Registered Nurse at Henry Ford Hospital in
Detroit, MI where she worked for 11 years and
joined the Windsor Regional Cancer Program as a
Nurse Practitioner in 2010. She holds Primary Care
Nurse Practitioner Certification in Ontario as well
as national board certification with the American
Academy of Nurse Practitioners in Michigan.
Kimberly Simard Grubb
RN (EC)
ACNP-MN-Adult
Kim Simard graduated
with a Bachelor of
Kinesiology with honours
from McMaster university
in 2005, and completed her BScN at the University
of Toronto in 2007. She began in the surgical
program at Windsor Regional Hospital in
2007- 2013 while completing
her ACNP-adult with Masters
at the University of Toronto
in 2012. Kim works on
the inpatient unit.
Hakam Abu-Zahra
M.D., F.R.C.P. (C),
Medical Oncologist
Dr. Abu-Zahra graduated
from Cairo University,
Egypt in 1961 and
completed postgraduate
training in Haematology at Dundee and Edinburgh
Universities in Scotland. He was a Research Fellow in
Haematology at Queen’s University in Kingston, and
a Research Associate at Princess Margaret Hospital
in Toronto. He was Head of Systemic Therapy and
Chief Executive Officer, as well as Vice President of
Cancer Care Ontario’s Erie St. Clair Regional Cancer
Program, and Chief of Oncology, Windsor Regional
Hospital. Now semi-retired, he provides well follow-
up services and End-Of-Life Care at the Hospice
Residential Home.
nurse practitioners
Nicole Freeman
M.D.
Dr. Freeman received
her Honours Bachelor
of Human Kinetics
from the University
of Windsor and her
Doctorate of Medicine from the University of
Ottawa. Dr. Freeman completed her Family
Medicine Residency at Western University, and
her postgraduate and specialized training
included a conjoint program in Palliative
Medicine Fellowship at the University of Toronto
Department of Family and Community Medicine.
Lawrence Aoun M.D.
Dr. Aoun has post
graduate training in both
Internal Medicine and
in Family Medicine. His
areas of clinical interest
include Hospitalist
Medicine and Palliative Medicine. Dr. Aoun is
active in teaching at both the undergraduate
and post-graduate levels. Dr. Aoun is Physician
Lead for the Palliative Care Program
for Windsor Regional Hospital.
well follow-up CARE