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T W ENT Y Y E A R S AGO, when Joseph E spat , M D, wa s complet i n g h i s fel- lowship tra ining at Memor ia l Sloa n Kettering Ca ncer Center in New York, he cou ld not have know n that he wa s sta nding at the forefront of two revolu- tions in medicine that would ultimately shape his career. One was the emergence of minima lly invasive surger y, a nd the other was a revolution in the treatment of ca ncer. " W hen I ca me out of tra ining in the late 1990s, the expected sur viva l time of a patient w it h colon ca ncer meta- static to the liver wa s on the order of 14 months," Dr. Espat reca lls. " Today, a f ter resection, the f ive-yea r sur viva l rate is 58 percent in ma ny sectors, a nd we have a n ex pected sur v iva l that is measured in yea rs, not months." In large part, the improved life expec- t a nc y comes dow n t o t he i ncrea sed adoption of exactly the kind of multi- disciplina r y, tea m approach Dr. Espat and his colleag ues practice at the Roger Wi l lia ms Ca ncer Center. In fact , the center is a pioneer in its f ield, using severa l lea d i n g- ed ge approa ches t o ca ncer treatment, including ma ny that refer ring physicia ns may not ex pect from a 130-bed hospita l in Providence, R hode Isla nd. " The Ca ncer Center we have bui lt her e i s r e l a t ive ly u n ique i n t h a t it h a s repre sent at ion of a l l onc olog ic disciplines under one roof: radiation oncolog y, medica l oncolog y and surgica l oncolog y," says Dr. Espat, who is Chair of Surger y and Chief of Surgica l Oncolog y. " This enables a patient to potentia lly get a ll three of those disciplines' input on their condition during a single visit. That 's in sha rp contrast to the Boston prog ra ms or the New York prog ra ms where you ty pica lly have to wait a week or two between appointments, assuming you could coordinate them." I n fa c t , w it h so m a ny speci a l i s t s operating under one roof, the Ca ncer C ent er h a s b e en a ble t o i n s t it ut e a mecha nism by which a referra l that is deemed urgent ca n be seen by at least one of the ava ilable physicia ns within a 24-hour period. " We recognize that when patients get a devastating diag nosis of ca ncer, they want to be seen as soon as possible," says Vincent A rmenio, MD, a hematologist- oncolog ist who is Cha ir of Medicine at Roger Willia ms Ca ncer Center. "Since a lot of the internists in the a rea have our cell phone numbers, they ca n ca ll us directly." W hether on 24 -hour notice or not , once the patient is referred, Dr. Armenio likes to assure referring physicians that a ny treatment moda lit y their patient may need ca n a l l be prov ided u nder one roof. A TE AM APPROACH ALLOWS THE NATIONALLY RENOWNED CENTER TO PROVIDE COMPLETE AND COORDINATED CARE FOR PATIENTS. Joseph Espat, MD, Chair of Surgery and Chief of Surgical Oncology at Roger Williams, believes in a multidisciplinary, team approach to cancer care. The Integrated Cancer Program at the Roger Williams Cancer Center BY K AREN ELLERYJONES 1 8C O V E R F E A T U R E 1 8