Kuakini Medical Center, Ground Floor - Radiation Therapy
Kuakini Medical Center, Second Floor - Chemotherapy
Kuakini Medical Center, Fifth Floor - Makai 5
• Inpatient Services
• Outpatient Services
• Surgical Services
• Support Services
Oncology Services at Kuakini Medical Center provide comprehensive care, support and guidance for patients with cancer through a team of highly qualified multidisciplinary staff. In addition to general patient care, the staff provides patient education and prevention, pathophysiology, diagnostic and treatment methods, chemotherapy, multidisciplinary, emotional and spiritual counseling for patients and families.
Kuakini hosts several support groups, such as the Breast Cancer Education and Support Group and Us Too, a prostate cancer support group.
Oncology Services are provided on the 5th floor (Makai 5) of the Medical Center. Kuakini's Chemotherapy Service was established in 1969 and sees more than 2,000 cases annually. The Radiation Therapy Department was also established in 1969 and upgraded to a dual high/low energy accelerator in 1988. A new state-of-the art Clinac 2100 C/D linear accelerator was installed in 1999 to offer more capabilities in treating cancer patients.
Commission on Cancer Grants Kuakini Three-Year Accreditation - December 9, 2011
Inpatient Services
Oncology and Surgical Units
Oncology Services are provided on the 5th floor of the Medical Center (Makai 5) which is a 35-bed oncology, medical and surgical unit. Patients with a variety of oncology diagnoses are admitted for services that include the services listed above in addition to symptom management, pain management, supportive care and end of life care.
Surgical Oncology patients are cared for on Waikiki-Ewa 4, the designated surgical unit. This unit consists of 28 beds, including four private rooms.
Chemotherapy
The Chemotherapy Department, located on the 2nd floor of Kuakini Medical Center, supports inpatients by administering chemotherapy, therapeutic apheresis and therapeutic phlebotomy.
The professional staff on both Makai 5 and the Chemotherapy Department consist of Registered Nurses who have received special training in Oncology and have ongoing clinical and educational opportunities. The nurses are encouraged to have national certification in oncology.
Radiation Therapy
The Radiation Therapy Department is located on the ground floor on the makai end of the Medical Center, near Emergency Services. Inpatients who receive radiation therapy go to the department for treatment Monday through Friday.
Dietary Services
Kuakini's Dietary Services staff provides nutritional support through nutrition screening, assessment, and recommendations for nutrition care during hospitalization. Dietary counseling is provided to patients and families and includes a nutrition class for patients who will be having radiation therapy and chemotherapy. For more information, call the Dietary Services Department at 547-9584.
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Outpatient Services
Chemotherapy/Hematology
The Chemotherapy Department at Kuakini Medical Center is a 12 bed/recliner unit located on the 2nd floor of Kuakini Medical Center. Department hours are Monday through Friday, 7 a.m. - 5:30 p.m.
Services include the administration of chemotherapy (both inpatient and outpatient), blood transfusion support, apheresis, therapeutic phlebotomy, supportive infusions (IV hydration, antibiotics, IVIG), and diagnostic/therapeutic procedures (bone marrow biopsies, thoracentesis, paracentesis, lumbar punctures/Ommaya reservoir treatments).
The department is staffed by registered nurses. All of the nurses have National Certification in Oncology and are members of the Oncology Nursing Society (both local and national chapters). Certification for oncology nursing validates competency in oncology nursing and demonstrates commitment, professional development, and leadership in state-of-the art cancer nursing. For the patient and the patient's family, certification provides assurance the nurses have obtained the knowledge and skill which will enable him or her to competently provide the patient with specialized care.
As part of your oncology team, the nurses will provide each patient and family with education about their treatment regimen, potential side effects and interventions to help support and minimize these side effects throughout the course of their treatment. They assist the patients and families, together with the physicians and other members of the oncology team to provide comprehensive cancer care and coordination of resources.
The following Outpatient Services are available at Kuakini Medical Center.
Chemotherapy - is the treatment of cancer with drugs that can destroy cancer cells. These drugs often are called "anticancer" drugs. Anticancer drugs destroy cancer cells by stopping them from growing or multiplying.
Depending on the type of cancer and how advanced it is, chemotherapy can be used for different goals:
• Cure the cancer
• Control the cancer
• Relieve symptoms that the cancer may cause.
Your doctor will recommend the type of chemotherapy drugs you receive depending on what kind of cancer you have, what part of the body the cancer is found, the effect of the cancer on your normal body functions, and your general health.
Chemotherapy can be given in several different ways: intravenously (through a vein), by mouth, through an injection (shot), or applied on the skin.
How often and how long you will get chemotherapy depends on the kind of cancer you have, the goals of the treatment, the drugs that are used, and how your body responds to them.
Therapeutic Phlebotomy - is performed to remove increased quantities of abnormal blood cells or plasma constituents. A therapeutic phlebotomy is performed by inserting a needle into the vein and removing blood. The volume of blood removed depends on the condition being treated and the individual's health status.
Therapeutic Apheresis - is the process of separating blood into components and removing one or more of these components. Therapeutic Apheresis is the removal of a specific blood component from a patient for the purpose of depleting that offending component from the patient's circulation.
Blood Transfusions - Blood is made up of different components. Red blood cells carry oxygen from your lungs to the rest of your body. Platelets form blood clots to help stop bleeding. White blood cells help protect you from infections. Plasma is the fluid portion of the blood in which cells are suspended.
Any of these components may be given intravenously (into a vein) through a blood product transfusion. A blood product transfusion may be used to save the lives of patients who need surgery or other medical treatment, for accident victims and for patients with cancer, hemophilia and other serious diseases.
Imaging Services
The Imaging Services Department offers services to inpatients and outpatients. The staff is comprised of qualified and licensed technologists, radiologists and nuclear medicine specialists. Several services related to Oncology are performed in the Imaging Services Department.
Kuakini Medical Center’s Imaging Services Department is now offering the revolutionary CADx (Computer-Aided Detection) screening technology that uses a computer to analyze mammograms.
Stereotactic Breast Biopsy
Mammotome Breast Biopsy - is a computer-aided procedure which utilizes a special machine to precisely localize an abnormal area in the breast. The device, called the Mammotome, is a vacuum-assisted needle biopsy system designed specifically for breast biopsies. Under local anesthesia, a needle biopsy is performed on the targeted area and the biopsy samples are sent to a lab for analysis.
Endoscopic Ultrasound - provides detailed information without expensive and painful exploratory surgery. Endoscopic Ultrasonography allows the physician to bypass obstructions such as external bone structures and other organs in order to examine the targeted area close-up. The result is a more accurate image which allows physicians to determine whether abnormalities are contained or have spread to other areas. In comparison, the new system shows detail down to one-tenth of a millimeter as opposed to one centimeter when using conventional ultrasound.
FDG/PET - Kuakini Health System's Nuclear Medicine Department performs Positron Emission Tomography (PET) scans using Flourine-18 deoxyglucose (FDG), a positron-emitting glucose analog that has shown a higher uptake in malignant tumors than in normal tissue. Clinical studies have validated the utility of Molecular Coincidence Detection (MCD) and PET imaging in the diagnosis and staging of lung cancer and lymphoma and in the detection and restaging of recurrent or metastatic cancers, such as melanoma and colorectal cancer. MCD/PET scans have been extremely helpful eliminating unnecessary, expensive surgeries and determining the correct course of action between chemotherapy, radiotherapy and surgery. MCD/PET scans provide information different from Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI). MCD/PET scans examine the organ's chemistry and function rather than just body structure. Thus, they can differentiate benign from malignant lesions. Another very useful application of MCD/PET in oncology is to monitor cancer therapy.
Nuclear Medicine - provides diagnostic tests for patients in a noninvasive manner by utilizing radioactive materials with highly specialized scanners. Nuclear medicine scans give physiologic information, which complement the anatomic information provided by X-rays and other diagnostic equipment. The latest high-tech equipment, including the latest MCD (Molecular Coincidence Detection) Testing, SPECT (Single Photon Emission Computerized Tomography), thalium stress tests and a bone densitometer are available.
Nuclear Medicine is located in the Imaging Services Department, on the ground floor of the Medical Center. Department hours are 8 a.m. - 5 p.m., Monday - Friday and 8 a.m. - noon on Saturdays. The staff is comprised of qualified and licensed technologists, radiologists and nuclear medicine specialists.
Radiation Therapy
The Radiation Therapy Department is located on the ground floor on the makai end of the Medical Center, immediately across from the Outpatient Registration area, near Emergency Services. The hours of operation are Monday through Friday, 7:00 a.m. to 4:30 p.m.
Staff consists of the Radiation Oncologists, a Department Manager, a Unit Manager, a Medical Physicist, a Dosimetrist, five Radiation Therapists, two Radiation Therapy Specialists (R.N.) and two Clerical staff.
Utilizing the latest in technology, the staff provides high-quality service, professionalism and expertise. The department uses a Varian Clinac 2100 C/D Dual Energy Linear Accelerator with Multileaf Collimation capabilities, an ADAC Pinnacle Treatment Planning Computer with CT Treatment Planning capabilities, an IMPAC Radiation Oncology Management System, a Portalcast Blockcutting system, and low dose brachytherapy equipment. The staff provides conventional radiation therapy treatments as well as intensity modulated radiation therapy (IMRT).
The following are terms associated with the services provided in Radiation Therapy.
Brachytherapy - a type of radiation therapy in which radioactive material is placed permanently or temporarily in the body, within a cancerous growth or within a body cavity near the tumor.
External Beam - in external beam radiation therapy, a machine directs carefully aimed beams of high-energy X-rays to the cancer site, The machine can change positions so that the beams can enter from different angles, affecting the cancer cells and the fewest normal cells.
Implants - high doses of radiation delivered by internal radiation therapy, using radioactive materials that are implanted temporarily or permanently around a tumor, the implant positions the cancer-killing radiation as close as possible to the tumor. The type of implant and where it's placed depends on the size of the tumor.
IMRT - intensity modulated radiation therapy - a state-of-the-art cancer treatment that delivers multiple beams of high energy X-rays directly to a specific area while sparing surrounding tissues and organs.
CT Simulation - the process of locating the treatment field to be targeted in radiation therapy using a Computerized Tomography (CT) Scanner. All of the information from the CT scan will be put into a treatment planning computer system and will be used to determine the type of treatment field, energy and angle of the beam for the radiation treatment.
3-D Treatment Planning - a manner of determining the type of treatment field, energy and angle of the beam for radiation treatments done on a specialized computer software.
G.I. Services
Physicians and specially trained nurses provide diagnostic and therapeutic procedures related to the gastrointestinal system. The procedures are performed using specialized equipment called endoscopes which are used to examine the esophagus, stomach and large intestines. Other procedures such as liver biopsies, gastrostomy tube placement, endoscopic retrograde cholangio-pancreatography (ERCPs), dilations and stent placements may also be done through this service. These procedures are performed on inpatients and outpatients. Kuakini's G.I. Lab was also the first in the state to use a state-of-the-art ultrasound machine to detect abnormalities and cancers in the gastrointestinal tract. This new outpatient procedure provides detailed information without expensive and painful exploratory surgery.
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Surgical Services
Surgery/Operating Room
Kuakini Medical Center's Surgery department, which consists of eight suites, performs an average of 360 inpatient and outpatient surgeries per month. The general case work consists of Ophthalmology, Orthopedic, Cardiovascular, General including Laparoscopic procedures, Urology, and Neurosurgery procedures. Kuakini Medical Center is involved in a national study with the National Surgical Adjuvant Breast and Bowel Project (NSABP) in which three of our surgeons are detecting the sentinel node(s) in breast cancer. We also participate in the Orthopedic and Cardiac Design Teams utilizing clinical pathways.
Kuakini's Surgery department is a fully computerized unit with scheduling, peri-operative charting, surgeons' preference cards, inventory, and charging capabilities. It is staffed 24 hours a day, seven days a week (including holidays).
Ambulatory Care Services
Ambulatory Care Services (ACS) provides quality medical care at a lower cost and in a minimum amount of time. Patients can be admitted, treated and released all in one day. The staff provides care to patients in comfortable surroundings and with individualized attention. ACS has four private rooms, can accommodate up to 43 patients daily and provides more privacy for recovering patients. Ambulatory Care Services is for patients who need minor surgery or other procedures that do not require an overnight stay, such as cataract surgery, arthroscopy and biopsies.
Procedures
There are many types of Oncology-related procedures that are processed through Surgical Services such as:
Sentinel Lymph Node Biopsy involves injection of the technetium sulfur colloid around the tumor. A gamma detection probe is used to locate involved tissue. Patients are transported to the operative suite two hours after the injection of the radiocolloid in nuclear medicine.
Mammotome Breast Biopsy is a new technology involving a biopsy suction apparatus that will remove progressively larger core tissue in and around a lesion identified on mammograms. The advantage of this technique over a stereotactic biopsy is a larger tissue sample for the pathologist to examine.
Radiofrequency Thermal Ablation
Radiofrequency Thermal Ablation (RiTA) is a procedure in the treatment of liver tumors and was first used in Hawaii at Kuakini Medical Center. Approved by the FDA in 1997, RiTA is non-resectional, meaning removal of the organ or cutting out the tumor is not necessary. RiTA can be accomplished under local anesthesia and on an outpatient basis under percutaneous (external ultrasound for guidance and no incision) methods. This procedure takes less than 15 minutes for each session. For laparascopic cases (using an internal scope and requiring a one-centimeter incision) or a laparatomy (involving open surgery), RiTA requires a recovery time of one to five days.
RiTA requires a single insertion of a cannula (insertion tube), an instrument a little smaller than a ball-point pen. There is almost no bleeding. Using image guiding techniques, usually ultrasound, the RiTA cannula is inserted into the tumor. From the tip of the cannula, four prongs or electrode arrays are deployed to encompass and heat a sphere of tissue three to four centimeters in diameter. Sensors are present for monitoring temperature and monitor the tissue as it is heated for five minutes at 60 - 70ûC. RiTA is now being used to treat liver tumors and may someday become available for the treatment of tumors in other organs such as the prostate and the brain.
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Support Services
Patient Support Groups
Breast Cancer Education and Support Group - For those diagnosed with breast cancer, Kuakini sponsors a support group which meets in Kuakini's HPM-1 conference room from 10:30 a.m. until noon on the last Thursday of every month. There is no cost and validated parking and beverages are provided. These private, confidential meetings allow participants to ask questions, share experiences and give encouragement. For more information and registration, call the Education Services Department at (808) 547-9595 or (808) 547-9788.
Prostate Cancer Support Group - "Us Too", a support group for those diagnosed with prostate cancer and their significant others, meets every second Wednesday in Kuakini's PB-5 classroom. The meetings are free and are co-sponsored by Kuakini and the American Cancer Society. Meetings begin at 7 p.m. and last two hours. Call Jeanne Foster, Patient Care Coordinator/Support Group Facilitator, at (808) 547-9749 for more information.
Medical Social Workers
Medical Social Work Department provides support for the psychological, social and emotional needs of patients and their families. Social Workers are masters-level prepared and licensed to practice in Hawaii. They focus on aiding the patient through the various stages of cancer - from diagnosis, through treatment, discharge and possibly end of life issues. For more information about Medical Social Work's services and programs, call (808) 547-9189.
Pastoral Services
Kuakini Medical Center contracts with Pacific Health Ministry for a clinically trained minister to serve as the Hospital Chaplain. Pastoral services are consistent with the guidelines set forth in the Standards for Accrediting Pastoral Services published by the Congress on Ministry in Specialized Settings. The Hospital Chaplain is available to provide or arrange for spiritual support to patients and families. Services include spiritual counseling, crisis intervention, performance of ritual rites and referral to private clergy in the community. The Chaplain can be reached by calling (808) 547-9327 or the Medical Social Work department at (808) 547-9189.
Research
For more information, contact the Office of Research at (808) 547-9816.
A major component in Kuakini Health System's mission is to encourage and promote clinical research for the community. Kuakini's commitment is evident in the large number of patients Kuakini registers onto clinical trials in Hawaii. Kuakini's Oncology Services participates in the following cooperative study groups:
• National Surgical Adjuvant Breast and Bowel Project (NSABP)
• Radiation Therapy Oncology group (RTOG)
• Southwest Oncology Group (SWOG)
• Gynecological Oncology Group (GOG)
• Cancer Research Center of Hawaii - pharmaceutical sponsored studies (CRCH)
A clinical trial is the first stage in a careful cancer research process. The goal of this research is to find better ways to treat cancer. Many of today's current treatments are based on previous clinical trial results.
Cancer trials include research at three different phases:
• Phase I trials is the first step in testing a new treatment in humans
• Phase II trials focus on learning the new treatment's anticancer effect
• Phase III trials compare the new treatment against current standard treatments
Clinical trials offer high-quality cancer care. if you have questions about how a clinical trial works or if a clinical trial is available for you, talk to your doctor or another health care professional.
For more information on clinical trials contact:
Kuakini Medical Center Education Services at (808) 547-9252
Kuakini Medical Center Chemotherapy at (808) 547-9735
Kuakini Medical Center Office of Research at (808) 547-9816.
or log on to NCI's website at http://cancerTrials.nci.nih.gov
Oncology Data Registry
The Oncology Data Registry is one of four major components of the Commission on Cancer approved Oncology program at Kuakini. The primary purpose of the Registry is to collect and analyze data on all newly diagnosed cancer patients who are seen at Kuakini. The Registry collects demographic, diagnostic, treatment and follow-up data which contributes to overall treatment planning, staging and continuity of care. The information gathered can ultimately be used to improve the quality and effectiveness of treatment for future oncology patients.
Hospice Care
Support for the terminal patient and family is done here at Kuakini Medical Center with dignity. A comprehensive hospice program is established along with Hospice Hawaii. Inpatient hospice admission is evaluated by the medical team and is dependent on bed availability. Hospice care can also be arranged with the patient and family at home. Interest in Hospice Care should be directed to your physician or by calling the Medical Social Work department at (808) 547-9189.
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