Kristina Kim

The Smilow Cancer Hospital at Yale New Haven has created a new program that provides a comprehensive, multidisciplinary approach to treating patients.

The new Liver Cancer Program, launched in mid-December, marks the first time that experts from a wide range of specialties have formally been brought together to see patients in one location, said Renee Gaudette, the Yale Cancer Center’s director of public affairs and marketing. With a renewed emphasis on providing personalized patient care, this freestanding program integrates expertise from physicians in the departments of medical oncology, interventional radiology, surgical oncology, hepatology and transplantation surgery, said Rogerio Lilenbaum, the chief medical officer at Smilow.

“The five disciplines that constitute the Liver Cancer Program at Smilow all have enormous expertise and national recognition,” Lilenbaum said. “We felt it was important to create a structure that allows these experts to come together and provide — in a collaborative manner — a treatment plan that best suits a particular patient.”

The program originated when physicians recognized that some complications could not be adequately treated by a single specialist, requiring a multidisciplinary approach, according to medical school professor Mario Strazzabosco, director and clinical program leader of the Smilow Liver Cancer Program. The physicians began convening weekly to discuss patient cases, a procedure that later evolved into a formalized tumor board — a forum providing a standardized process to share findings and recommendations.

The tumor board meetings eventually developed into an official clinical program that began operating last December, according to Strazzabosco. He noted that the creation of a freestanding program was motivated by multiple factors, including the rising incidence and mortality of liver cancer. Connecticut experiences a relatively high prevalence of the disease, Strazzabosco said. According to the American Cancer Society, the incidence of liver cancer has more than tripled since 1980.

“[Liver cancer] is very complex because not only is it an oncologic disease, but it’s also combined with a failing organ,” Strazzabosco said. “The treatments need to be personalized to your specific features of the disease, so patients should not be offered a limited range of possibilities. Our aim is to build a world-class program because we really have all the ingredients here — every provider across the different specialties is a star, professionally and scientifically.”

Radiology and Biomedical Imaging Department Chair Jeff Geschwind further highlighted the difficulties of treating liver cancer, pointing out that the disease is insidious and often diagnosed late. A member of the Liver Cancer Program’s interventional radiology team, Geschwind said he uses minimally invasive image-guided therapy to treat the cancer at its precise location, a technique that maximizes the potency of treatment while leaving the fragile underlying liver untouched. Such therapies have successfully prolonged patient survival.

These techniques, combined with procedures performed by other specialists, are crucial for maximizing protection of the liver and controlling disease progression, Geschwind said. The Liver Cancer Program’s ability to unify previously fragmented expertise can ultimately help meet the growing unmet needs for treatment, he added.

“Due to our collective expertise, we are able to design clinical trials that are highly innovative and unique to our center,” Geschwind said. “We can provide cutting-edge therapies that our patients will have access to here but nowhere else in the country.”

Strazzabosco, who previously served as the founding chief of the Yale School of Medicine’s section of digestive diseases, was appointed director of the Liver Cancer Program on Jan. 1. Digestive Diseases Section Chief Michael Nathanson, who spearheaded the search for the Liver Cancer Program’s leadership, described Strazzabosco as internationally recognized for both his research and clinical expertise.

Nathanson also pointed out that liver cancer is the second most common cause of cancer death worldwide and one of the few cancers on the rise nationally.

He attributed the rising incidence to the growing number of people affected by hepatitis B, hepatitis C and fatty liver disease, all of which make patients more susceptible to developing liver cancer. Given these statistics and Yale’s record of attracting most of the state’s liver cancer patients, the establishment of a freestanding program is “not only timely but perhaps also overdue,” he said.

The establishment of a freestanding program has many benefits, such as more cohesion in treatment protocols, more effective sharing of knowledge between treatment providers and a standardized system of evaluating patient outcomes, Strazzabosco said. Going forward, the program plans to continue collecting data that will be used for ongoing quality improvement projects, he added.

The Liver Cancer Program is one of 12 cancer programs offered at the Smilow Cancer Hospital.