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family history of cancer and their treatment goals," Dr. Lai says. "When appropriate, genetic testing is performed as the first step in an individualized care plan to help us understand if there is an inherited cause of the cancer." Working together in a multidisciplinary clinic, Dr. Lai and her colleagues prepare a range of treatment options for each patient. The tumor board is central to this process. During these gatherings, breast surgeons, medical oncologists, radiation oncologists, radiologists and pathologists review the patient's diagnosis and collaborate on treatment options. Each treating physician then meets with the patient to discuss his or her recommendations. It can be a long visit for the patient and their family, but it is very helpful as both the patient and the medical team leave with a specific plan in mind. "Breast cancer treatment has changed remarkably in the last few decades," Dr. Lai says. "We have highly e„ective adjuvant therapies and can o„er patients excellent aesthetic results, including breast reconstruction and nipple-sparing surgery. At Upstate Cancer Center, we also o„er a wide range of clinical trials. These trials benefit the patient who participates as well as future patients by advancing cancer treatment even further. Many patients come to us for treatment so they can participate in one of our trials. "There is quite the dichotomy when treating patients with cancer," she explains. " We love our patients dearly but hate cancer so much. We are here to get them through it. There is a bell in the Cancer Center for patients to ring when treatment is complete. There is no greater sound to be heard." LISTEN AND RESPOND Brisk responsiveness is another hallmark of Upstate Cancer Center's patient-centered approach. When a patient calls for an appointment or is referred, he or she is typically seen within a week after the initial contact, says Ajay Jain, MD, Chief of Surgical Oncology and Associate Chief of Hepatobiliary and Pancreatic Surgery at Upstate Cancer Center. Nurse navigators make scheduling especially e'cient for patients. "Our nurse navigators take the burden o„ patients," Dr. Jain says. "We provide them and the patient's referring physician with the treatment summary. The navigator knows what treatments, in what order, the patient should receive." At Upstate Cancer Center, a multidisciplinary approach helps address the many, varied nuances present in Dr. Jain's specialty, which is surgery for liver, gallbladder and pancreatic cancer. "Depending on how cancer presents, surgery may not be an option, or it may not be the right first option — we may need to shrink tumors with chemotherapy or radiation first," Dr. Jain says. "Making these distinctions can be very challenging. We approach and manage each patient's cancer as a team, working in tandem with referring physicians and always putting the patient first." COMMUNICATION IS KEY Like his colleag ues, Gennady Bratslavsky, MD, Professor and Chair of the Department of Urolog y at Upstate Medical Center, o„ers advanced procedures to remove cancer. He also performs necessary reconstruction afterward. Trained at the National Cancer Institute, Dr. Bratslavsky points out that he and most of his fellow urologic surgeons — the number has grown from two to more than 20 in the past six years — have completed specialized fellowships. " We a ll provide groundbreaking and lifesaving surgeries using the most modern techniques, including robot-assisted surgery for patients with prostate, kidney, bladder and testis ca ncer, as well as adrena l tumors," Dr. Bratslavsky says. " While robotic surgery may be available at other institutions, it is the specia lized training, including fellowships with a focus on cancer and reconstructive surgery, that ma ke the robotic surger y at Upstate Ca ncer Center ex traordina r y. Our additiona l training provides a deep understanding of the disease processes and knowledge of additional tricks that may be used intraoperatively. That, along with our multidisci- plinary collaboration and our tumor boards across numerous subspecialties, improves patient outcomes and allows us to o„er the highest level of care." As his department opens practices across central and upstate New York, Dr. Bratslavsky embraces a process for a mple, near-instantaneous communication with referring providers. EMR is central to that process. The EMR system sends notes to the entire care team, including referring physicians, after each patient visit. "Finally, we have a format known as 'rich communications,'" Dr. Bratslavsky says. " When people are connected, it allows for maximal exchange of information." He says he is proud that members of his tea m ser ve on national research consortia and committees and are among the "leading scientific minds in their field." This, he says, provides deeply persona lized expert care to patients that, along with near-instantaneous communication to colleagues and referring physicians, allows patients to reap the benefits as cancer care continues to progress. To learn more, visit upstate.edu/cancer. ■ M D N E W S .C O M /// M D N E W S C E N T R A L N Y ■ 2 017 0 9 Jason Wallen, MD, Chief of the Thoracic Surgery and Thoracic Oncology Program