From breast cancer treatment to maternal-fetal medicine to cardiac care, the Garden State’s healthcare networks have been drastically transforming the way they approach women’s healthcare services. While cutting-edge technologies in diagnostics and treatment are allowing women to identify and address health issues like breast cancer faster and more effectively than ever before, new approaches in the way hospitals are reaching female members of their communities are helping to ensure that conditions like heart disease are prevented whenever possible.
Breast cancer, in particular, is one disease that the state’s hospitals continue to tackle head on. According to Dr. Eleonora Teplinsky, head of breast medical oncology for Valley Medical Group and Valley-Mount Sinai Comprehensive Cancer Care and clinical assistant professor of medicine at the Icahn School of Medicine at Mount Sinai, significant progress has been made in treating breast cancer over the last few years, from cutting-edge breakthroughs in new drug approvals, such as immunotherapy for triple negative breast cancer, to the use of 3D mammography for improved cancer detection.
On the treatment side, healthcare networks like Valley are improving the patient experience and outcomes for women with technologies such as Intraoperative Radiation Therapy (IORT), which allows radiation to be delivered at the time of surgery, and Deep Inspiration Breath Hold (DIBH) to minimize the exposure of radiation to the heart. Additionally, Teplinsky notes that improvements in surgical techniques like oncoplastic breast surgery, which involves integrating plastic surgery techniques into breast surgery, as well as nipple-sparing mastectomies, are improving not only cosmetic outcomes but patient satisfaction. “Cancer care is about treating the individual and their family, not just the disease. We do that at Valley through a patient- and family-centered approach where we come up with a personalized and individualized treatment plan for each patient,” she adds.
But it’s not just the technology that’s constantly evolving; New Jersey hospitals are undergoing a shift in the way they approach women’s health issues like breast cancer in the first place. “We continue to understand more and more that not all cancers are the same, and a personalized and precision medicine approach is critical,” Teplinsky says. Thanks to the latest research, more and more women are avoiding chemotherapy for the treatment of an early stage breast cancer. Valley has also furthered its commitment to improving patient care and outcomes for this disease through a robust clinical trials program. “Clinical trials are important because they test new ways to treat cancer, prevent cancer, diagnose cancer, and manage symptoms of cancer and side effects from treatment,” she says.
Dr. Susan McManus, a breast surgeon at Saint Peter’s Breast Center, agrees that clinical trials are an important piece of the puzzle when it comes to improving women’s healthcare – and the good news is that women have become more amenable to participating in recent years. Among the hospital’s recent trials include a Tomosynthesis Mammographic Imaging Screening Trial (TMIST) that compares 2D and 3D digital mammography for breast cancer screening, as well as a trial that examines how weight loss could impact the recurrence of breast cancer. “Throughout my career, I’ve heard many women say that they don’t want to be ‘guinea pigs,’ but we’re no longer finding that to be the case,” she explains. “Women are motivated to help decide whether one treatment modality is better than another.”
The state’s hospitals are also responding to the fact that patients are better informed than ever before by partnering with women and their families to determine the best course of action for each individual patient. “Women are understanding that healthcare is a team effort, so lots of patients are doing their homework … and providers better have a good reason for what kind of treatment they’re recommending,” McManus adds.
In addition to cancer, tremendous strides are being made when it comes to maternal-fetal medicine in New Jersey. At Hackensack Meridian Health, the Center for Abnormal Placentation (CAP) performs the most placenta accreta surgeries in the country, and has become an active referral center for mothers dealing with these types of conditions; placenta accreta occurs when blood vessels and other parts of the placenta grow too deeply into the uterine wall, which can lead to life-threatening complications. There have been 250 surgeries since the CAP program was established 12 years ago.
“The way these types of conditions used to be treated was traumatic for both the patient and their family as well as for the healthcare provider, so we developed a program to focus on the early diagnosis and better treatment of abnormally-invasive placentas,” explains Dr. Abdulla Al-Khan, director of the Center for Abnormal Placentation (CAP) and vice chair of the department of obstetrics and gynecology at the Donna A. Sanzari Women’s Hospital at Hackensack Meridian Health’s Hackensack University Medical Center. The institution utilizes the latest technological advancements in ultrasonography as well as 3D placental mapping. Once a diagnosis is made, surgical intervention occurs between 32 to 34 weeks – and in all of the center’s 250 operations, both the mothers and their babies have experienced successful outcomes.
“Ultrasounds have been around for almost 80 years, but the quality and technology of ultrasound medicine has drastically improved,” Al-Khan explains. “The latest machines available allow us to make diagnoses of various pathologies of the fetus in the womb. In the past, we could only focus on the mother, and if the baby had a cardiac or lung disorder, we weren’t prepared to immediately intervene,” he explains. “These advances have revolutionized the field because now not only is the mother a patient, but the fetus in the womb is a patient … and the more we utilize this ‘womb with a view’ technology, the better it is for both the mother and her baby.”
Maternal-fetal medicine specialists at Englewood Health have also remained at the forefront of innovation in high-risk pregnancy care, including cases where the mother has a chronic health condition, there’s an abnormality of the fetus, or unexpected complications arise during pregnancy or childbirth. “The field of pregnancy care has exploded in the best possible way, beginning with physicians’ increased ability to detect fetal issues through imaging and blood testing. If an issue with the fetus is detected, we’re able to monitor the fetus before birth, perform certain procedures if necessary, and craft the best possible birth plan for that individual pregnancy,” explains Dr. Nathan Fox, a physician in obstetrics and gynecology, maternal-fetal medicine at Englewood Health.
According to Andrei Rebarber, physician in obstetrics and gynecology, maternal-fetal medicine at Englewood Health, other advancements include prenatal testing that can be done earlier in gestation than ever before – blood tests can measure hormone levels in the placenta during the first trimester to identify conditions such as Down syndrome. “At 10 to 12 weeks, we can do a procedure called chorionic villus sampling to detect birth defects and a wide array of genetic diseases that are age dependent. We also have enhanced genetic analysis that detects genetic syndromes that are not age-dependent,” he adds.
The Garden State’s healthcare networks are also realizing that specialized women’s healthcare needs to extend beyond breast cancer and OBGYN services; Virtua Health System has a cardiology program targeted specifically towards improving women’s cardiac health, and includes WomenHeart at Virtua, a cardiac support group for women, by women. “Women tend to not report symptoms the same way or experience the same cardiac symptoms men do, so these types of issues often go unrecognized,” explains Nicole Lamborne, program director of women’s health at Virtua Health System.
Virtua has also experienced growth in its OBGYN department, which sees close to 8,000 deliveries a year and encourages personalized birth plans by offering labor tubs, alternate pain-relief options such as nitrous oxide, and enhanced midwifery services. From a surgical perspective, Lamborne notes, Virtua has continued to advance its minimally-invasive techniques, from robotic therapies that allow surgeons to perform a hysterectomy with a single incision to less-invasive nipple sparing and hidden scar surgeries that allow surgeons to perform mastectomies and lumpectomies without leaving visible scars or deformities. “These new technologies are helping to improve patients’ overall body images while getting them back to their previous state of wellness. It’s all designed to help women realize they can still live a full and abundant life after surviving an illness like heart disease or breast cancer,” she says.
But, along with all of the state-of-the-art technology that the state’s healthcare networks are offering to women, they’re also making new efforts to hone in on some of the challenges that their female patients continue to face. Along with difficulties in getting the insurance coverage they need, particularly for preventive care, Dr. Nadra Moulayes, director of breast surgery at St. Joseph’s Health, notes that the state’s hospitals are making greater efforts to reach out to patients in their communities and improve their access to education on the health issues that impact women the most.
“I think the biggest challenge women face across the board is a lack of education. One of the biggest myths is that if breast cancer doesn’t run in their family then they don’t need to worry about it, but in reality, around 80% of breast cancer cases occur in women with no family history,” she asserts. “I find a lack of education to be an even bigger challenge than a lack of insurance coverage, because even women who can afford to go to the doctor still aren’t going.” To that end, St. Joseph’s is participating in an increasing number of community outreach and awareness programs, such as those that provide screenings for breast and reproductive health.
RWJBarnabas Health (RWJBH) has also shifted its approach to women’s health by tailoring programming and services to each of the communities it serves, such as through the use of Patient and Family Advisory Councils. “We’ve found that two women living in the same community can have vastly different needs, so how do we as a healthcare system meet those needs? Through the incredible partnerships we have with providers and programs that we’re able to adapt from one area to another,” asserts Suzanne Spernal, vice president of women’s services for RWJBH, which has also placed a greater emphasis on cardiac health for women in recent years.
The healthcare network has developed new systems to alert providers through its electronic medical records (EMR) when a woman who recently gave birth is entering the emergency room so that she can be fast-tracked into the triage area. “We’re looking beyond maternity care as a single event in a woman’s life – pregnancy can be almost be like a looking glass into the future because women who experience complications in pregnancy like diabetes or preeclampsia tend to develop these types of issues later in life,” she adds. “We’re trying to guide female patients into taking a more preventive approach to their healthcare moving forward, because when it comes to women’s heath, prevention is the key.”
RWJBH is also taking advantage of advancements like telehealth and online appointment scheduling, expanding evening and weekend hours, and offering as many services as possible in one location in its efforts to make healthcare more accessible to busy women who may be juggling careers and families. “The more convenient we make healthcare for women, the more likely they are to make appointments and take these preventive measures so we don’t end up having to treat something that could have been either prevented or diagnosed much earlier and more efficiently,” she adds.
“We know that there are a lot of barriers to accessing healthcare for women – from the fear of how they’re going to find the time to get to the doctor to the fact that women still continue to put themselves last, behind their children and their families,” Lamborne concludes. “That’s why we’re trying to design our healthcare services around women’s unique needs and schedules and making sure that female patients aren’t passing off a symptom as anxiety or stress when it’s really an early indicator of heart disease.”
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