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SE.NL -ANTNUAL REPORT TO THE rMW YORK CITY CANCER COMITTEE January 1, 1951 - June 30, 1951 NEMORIAL CENTER FOR CANCER AND ALLIED DISEASES

1• I. WMICAL EDUCATION FUND $169,620.00 The New York City Cancer Committee, through its support of members of the Faculty of Medical Education, has continued to play a major role in~Memorial Center's education program. The Underlying Philosophy Care of the cancer patient as a whole is a guiding principle of Memorial Center. It involves first treatment through the cooperative effort of the various special skills assembled. Secondly, it embodies the realization that cure or control of the disease is meaningless if the patient is not returned to a useful and happy existence. Thirdly, it is based upon growing scientific data which reveal that cancer is accompanic:d by a general disturbance of bodily function greater than can be understood in terms of the mere physical presence of a neoplastic grosrth. From this principle has evolved, at the Memorial Center, a new program of professional education. The curriculum has been revised to cut across the old boundaries of didactic training. Men specialtzing in internal medicine are instructed'in the fundamentals of surgical procedures. Surgeons and radiation therapists become familiar wi~h the supportive medical techniques for the cancer patient and the new tools of chemotherapy. Thus each learns what the others' specialities have to offer and each is stimulated and encouraged to call upon the others' skills for the greater benefit of the patient committed to his care. Under this new program, rehabilitation is coneidered of major importance. Dr. Arthur Sutherland, a psychiatrist trained in general med_c-1ne, has been adaPd to the full-time staff to study the psycho- locical effects of cancer and. of the radical surgery its treatment may req:aire. Dr. Suthe-rla:n.d, as part of this long-term study, has ,jiist completed an i.ntensive investigation on the adjustments to a colcstomy (an artificial bowel opening, inithe abdominal wa.il) of 62 clinic patients. Frcrait.zis studY, he has been able to determine the basic factors, both physical and. psychol.,)gical, essential for a good ad~ustr~ent to this al~~tered physic4l state. His preliminary re- port stresses the neceGsi_t*y of inst:~tuting a program of rehabilitation ~ in these patients before neurotic behavior patterns centering around the colostomy have a chance to crystallize. There are preliminary indications that by the Rorschacil test it may be possible to deter- mine, preoperatively, the patients who will respond badly to a G 0

2 colostomy and so institute preventive psychiatric treatment in these cases. In addition to this program of research, Dr. Sutherland and his co-workers, a clinical psychologist and a psychiatric social worker, stand by to help the individual patient in need of psychiatric guidance. Dr. Sutherland's participation in Memorial's teaching program is made possible through the New York City Cancer Committee. Social Service, physical retrainizig, vocational guidance and recreational therapy are also receiving increased emphasis in both the teaching and treatment programs. These activities in the field of rehabilitation reflect the new concept of professional responsibility - not merely to eradicate the disease but to re- store the patient to a useful and satisfactory place in 1ii.s home and community. Palliation, long accepted in other chronic diseases such as cardiac and vascular disorders, is becoming increasingly important in total cancer care. Those patients whose disease is too general- ized for cure by mechanical eradication have now been brought into the area of intensive study. Previously deemed of little interest because capable of little benefit, they now are treated by new procedures of radiation therapy, radical surgery and chemotherapy. From this new trend in cancer treatment has come not only relief of suffering, increased pat!.ent morale, and prolonged useful life for the individual, but also a more complete understanding on the part of the staff and the student of the natural history of the disease and of the problems, psychological and physical, faced by those of its victims who were formerly classified as hopeless and sent home to die. A major factor in the Memorial Center's programof care and education is the Sloan-Kettering Institute, the research unit. The close physical proximity of laboratory bench and hospital bedside has led, as it was intended, to a steadily growing mutual under- standing between those who strive to employ and perfect the conven- tional methods of attack and those who seek new weapons against the diaease. one such successful cooperative venture was the study undertaken by the Chemotherapy Service of the Sloan-Kettering In- st-11,-ute with the cooperation of the Breast Service of the Hospital to investigate the use of male and female sex hormones in the treatment of inoperable breast cancer. Under this program the criteria have been estwblished by which these agents can be used most effectively. Now the study is being extended to investigate the comparative effects of newly available hormonal compounds and of comained radiation therapy in these cases. During the last year a similar concerted attack against cancer of the rectum and large

3 bowel was initiated which w:lk.ll join the resources of the Gastric and Rectal Services of the Hospital with those of the Institute. Last June, the Sloan-Kettering Institute was incorporated as the Sloan-Kettering Division of Cornell University Medical College. By this agxec*ment, the s-Faff of the Institute will acquire full academ:*,c s tand.t.Lg. T:zu3 t:le skills, experience and facilities developed under our canc-nr re3earch program can be more effectively used for the tEacLiug of can~lj.datPs for advanced degrees in the physical and bioiog?.cai sciences. The Program~ Against this background the program of training for medical students and graduate students has taken shape. Since a detailed re- port of our graduate training program was included in Memorial's annual report to the New York City Cancer Comm:.ttee and since there have been few changes in its operation, the present report is centered around our undergraduate training course. Medical students from New York University, New York Medical College and Cornell Medical College are offered a special course on cancer at Memorial Center as a fourth-year elective. These students come to us in groups numbering not more than fifteen for periods of one month each. During the past year, eighty-two medical students have participated in the program. During the one-mor_.th period, we attempt to give the students a picture of the natural life history of cancer. Special emphasis is placed upon the procedures of early detection and diagnosis since those of the students who become general practi- tioners will have particular responsibility in this area. A survey of what surgery, radiation therapy, and chemotherapy can offer in the various forms and stages of the disease is presented. Fiaally, the students are grounded in the roles that nuzsing, social service and psychiatry can play in restoring the patient to maxim,= useful- ness, prodtrctivity and individual happiness. Two years ago it was decided that our broad goals for undergraduate education could best be met throughthe tutorial system of training. It was felt that only th_rough such a system could we focus on the patient rather than on the individual disci- plines which may play a part in his care. In terms of medical edu- cation,thas was a revolutionary concept. Our results so far under this system and our response from the individual students have, we believe, not only ,jsstii'ied our effort but indicated that the system could be used to advantage in other teaching hospitals.

4 Under our present program, the students are subdivided into small groups of two or three each. In these groups, they meet with members of the resident staff for teaching rounds through the wards every morning and also attend the regular outpatient clinic sessions of the various services on a rotation schedule. The rounds with tutors enable the s~udents to see patients before, during and after treatmenic and to comprehend the problems involved inithe total management of the individual with cancer. A member of the Department of Pathology meets with the students three afternoons a week. At this time, the pathologist demonstrates and discusses the day's most interesting surgical or autopsy specimen and so leads the students to an understanding of the role of pathology in the diagnosis, prognosis, and treatment of the cancer patient. The participation of several of our patholo- gists in these meetings is made possible by the New York City Cancer Committee. The entire group meets together for orientation lectures, service conferences, grand~rounds, clinical pathology conferences and end result conferences. The students receive special lectures on~rehabilitation, nursing problems, radiation physics, x-ray diagno- sis, radiation therapy, chemotherapy, and pain control. These formal discussions are constantly followed up by regular informal consulta- tions between the tutor and the smaller student groups. Special stress is laid in this program upon the Admitting Clinic where patients with cancer first present themselves for diagnosis and treatment. Furthermore, the students visit the Strang Prevention Clinic where they are shown the procedures of examining apparently well men and women for possible latent cancer and are instructed in the use of special diagnostic equipment which can be employed in private practice. Here they are under the direct super- vision of Dr. Emerson Day, Associate Professor of Preventive Medicine at Cornell andDirector of the Strang Clinic. Dr. Day's participation in this phase of the education program also depends upon the support of the New York City Cancer Committee. The activities culminate at the end of each week in a special conference held every Saturday morning in which one case seen in~the hosnital is presented for general discussion~. In addition to the comU.ned groups of students and their tutors, representatives from the suroical, medical, pathology, pharmacology, radiology and re- habilitation services atten&. These conferences:are planned to last two hours, but as a rule the problems raised are sufficiently stimulating to make the discussions last thirty to sixty minutes longer than scheduled. In addition to these meetings with the students, all tutors

meet with representatives of the resident staff and the chairman of the education committee at monthly dinners. These meetings are held to discuss problems encountered in the undergrad.uate teaching program and, through these discussions, to indoctrinate younger men of our own staff into the philosophy of teaching at Memorial Center . Under a new program, planned and instituted this year and offered during the summer months, a group of medical students, cor.s9:.st.ing mostly of second-year men from Cornell Medical College, will serve in the Memcrial Center as members of the cancer nursing staff. These young men, after a preliminary course of indoctrina+.ion, either will be giveathe opportunity to work as technical assistants in the operating room or will be charged with the supervised prepara- tion of patients for operations and the observation of patients in the immediate postoperative period. This program is felt to offer a unique opportunity for young men iatraining to gain first= :a.nd knowledge of the new tools and procedures involved in supportive therapy for radical surgery. In the next academic year, the program for medical students will be further expanded. At the request of the depart- ment of Medicine of Cornell University, a series of lectures cle- siened'to indoctrinate medical students into the clinical as-pects of c:ncer treatment have been planned. These lectures, to be gjvc.none hour each week for eleven weeks, will place special emphaq±s on rehabilitation and palliative therapy of cancer patients. The siza jects to be covered include: treatment of lymphoma and of lzu!c=ma.a; managemeut of inoperable cancer of the breast; palliation of i zopera.b_'_e pel•ric cancer; construction and care of a colostomy; ana gonAra'_ rehabilitaticn problems of the cancer patient. PaviPnts at vai•i:oiis 9ts.gAa in thpir treatment will be presented to the class and the d_scuszlon will focus on these individual cases. This series of eleven lectures will be offered three times a year in o:r7er to limit the s_ze of the classes to about thirty each. The course will be compulsory. The mPac~?.ers Nf^re than any other educational method, the tutorial system dereaas on the of the men c'^os::n to ,Taid;, and in- si,ru::t. We foel we are pa-,. ;icv.iar.ly fortiuiwce in the caliber of the younger men ot:' or staff wno lend the_r s~_-i-.ices to the teaching pt n,-,.~ram. 'Mos a of tlr^m •^c:ne to A4 ,ICcr;al Center early in t;~eir car. ec,rs and s iiir:ii^d ~n ch u:; di..z i.ug t'.:e:.r perio6s of reside-acy training. They are not only prot~:cie.a-` inl taei_• in~livi3.u?.1 skills but thoL"^L2,"riil<J a:vlc3,re of all the ac:ti'.'J.'Gi es of the Center and the broa,t p.roblez,3 of cancer care, Most of them already have made major contributions to:the work here.

6 Dr. Guy F. Robbins, for example, came to Memorial first in 1940 as an assistant resident. He was called into the army in 1942 and served overseas until 1945 when he returned, under a National Cancer Institute Fellowship, to complete his surgical trainirg. Now he holds an appointment as surgeon on the Breast Service, but'his scope of influence spreads far beyond this activi- ty. Dr. icbbins' genuine friendliness and interest in others have been instrumental in breaking down the barriers separating the var:.ous medical disciplines as well as in boosting the morale of b:is patie-: tc . As a doctor, he feels a personal responsibility for the overall welfa.re of the patients that extends far beyond the surgical removal of their disease. This concern, evident in his day-to-day practice, is further reflected in his studies on the causes for delay in cancer diagnosis. These seek to define and so to overcome this grave hazard to the cancer patient. Dr. Robbins' natural qualities of leadership, which came to light early in his career hare, made him one of the first to be called upon to serve as a tutor when the system was initiated. He is now also Secretary to the Committee on Medical Education. In this capacity he lends his abundant energy to the overall planning of the program as well as its execution. Another of the leaders in Memorial's educational program is Dr. Henry J. Tagnon. His function in this capacity also is made FoLs.iblie by the New York City Cancer Committee. Dr. Tagnon appears com?lt-czly opposite Upersonality to the brisk, genial Dr. Robbins but rf.hira his quiet, almost reticent, manner lies an equally quick s.nr: hignlJ eT'ficient intellect. Dr. Tagnon was born in Belgium and receised his early medical training abroad. After study at Harvard, he car.ie to Worial in 191+6 as an American Cancer Society Fellow. Early in his stay here Dr. Tagnon made a survey of the hospital: wh.fc,•h."ravealyd that 65 per cent of all patients admitted to the wards for w.z.rgPrf suffer°d from some medical illness of such an ex',Pnt and severit3r that, even in the absence of cancer, their a&ni ssion to the medical service of a general hospital would have been just'_-fied, As a result of this survey, a separate department of generwl med,:c].nE was esyablishcd in the hospital i.n 1947, at which time he .a.ss^u:ed the hig'rliy impe,rtaat function of supervising the general mzlical care of cancer patients and. of instructing others in the mc,ra;;ement of individuals with medical problems who are about to u•:.de.?gc. ;mvjor 4tLgery or other trna•:,nce:ats. Dr. '"agnon also holds an apOVLtnOnt in the S7_oaz-.{n;':tering Institute and has found time to co-sdur.;; imaortant or;.oinal research. He has made valuable con- tr:::botions to l~c?r] rc:g2 concerning the clotting of blood and is no-T emps.SQd in invcst:.ga,tina, the possibility that failure of the liver to neutralize the female sex horraone may cause the development of certain forms of cancer in women. These two men, whose leadership in the fields of both treat- ment and education has already made itself felt, are representative

7 of the entire group of staff ine!~oers selected as teachers under the Memorial system. It is through such men that the Memorial philosophy has d'eveloped and by them~tY:at we feel it can be best interpreted to young men just beginning their careers. The Memorial Center now comprises a research unit, a detection center, two hospitals and a newly completed outpatient building. As Memorial garorrs, not only in physical size but in experience, we feel with increasing keenness our responsibility to draw upon these facilities for the education of those who will serve the cancer patient here and in other communities.

8 II. NI3RSING EDUCATION FUND $18,420.00 Through the support of the New York City Cancer Committee, Memorial Center has been able to provide stipends for the members of the : ac:al:,y of Nu..TMsing Education. The well qualified individuals t:w.s: suppnrt°d ha.-ve offered to both graduate and undergraduate young women special train;ng in the skills, techniques, and philosophy necessary for the cancer nurse. A. University program in cancer nursing Offered jointly by Memorial Center and New York Un;.versity, this course has been completed in 1951 by 24 students, all of whom are graduate nurses holding positions elsewhere. Three of these are public health nurses who have come from various visit- ing nurses associations throughout the country and 21 are institu- tional nurses from a number of hospitals in Maine, New York, Okla- homr., and other states. The program is given~in a concentrated block of 4 to 6 weeks on a full-time, 40-hour-a-week basis with individual counseling and close supervision. B. Und.ergrad:aate program in cancer nursing llur.i_ng the first six months of 1951, a total of 18 studPnts have been ayc:epterl and have successfully completed their st,z,-;* i-s at riicmorial. T:zf s course is planned to operate over a lon`er perior: th,:.7 the graduate course, hence it gives the students an oppor±unity to practice the specialized hechnioues wliich they learn. The following schools of nursing are represented: 4 weeks - Yale University, New Haven, Conn. 1 8 wezks - FrFsbyterian Hospital, New Yo_k,N.Y. 4 8 wes:I.ts - Utice. Nemor_.al Hosni tal, Utica, N.Y. 7 12 weeks - Faxt•on Hospital, Utica, N.Y. 6 Total number of students: 18 Scholarship proQ.ram-s in cancer nursi ng TY`rQP, r;c:-.ciJ.arship progra*os are ciL^ren+ly una.erway in thP Department of Pi~.:'s i:ih • T'iN-e cc::ip_ ize the inEtruction of 18 scaol«:sh+:~~ r.~urses by tne (;nr•.ter,s n xs;:i.g starf . These are all C" t'~e Tu;,sea wrichci~z pos =tions in vuz~in~a ina:ituti~unselsekher.e. A taouiat_on reveals wiie geog:.,aphical coverage: 1) Sloan ScholarGbi:p Progrram: Throigh the generosity of the Alfred P. S oan Fourclaion, u number of scholarships

9 have been made available to European and Canadian nurses. The following began studying at Memorial in January; some, as indicated, have completed the course: 1 scholarship nurse for 7 months - Canada 1 scholarship nurse for 6 months - Denmark 2 scholarship nurses for 6 months - England 1 scholarship nurse for 7 months - England 2 scholarship narses for 6 months - Norway 3 scholarship nurses for 12 months - Norway 2 scholarship nurses for 6 months - Sweden 12 scholarship nurses 2) Akron Scholarship Program: Three scholarship nurses from Akron, Ohio, have been studying and obtaining specialized experience at Memorial since January, 1951. These young women completed their work here at the end of July. 3) Argentine Scholarship Program: Thirteen scholar- ship nurses from Argentina have come for a two-year period of training at the Center. An additional instructor has been attached to our nursing staff to supervise this phase of our scholarship program. D. Participation i~nspecial education programs: Members of the faculty of Nursing Education have participated in the following special education programs: Planning and Public Demonstration of the Memorial Center Civil Defense First A:d Station:at Kips Bay Health Center - Miss Pitou, Miss Johnson Development of Memorial's Casualty Committee and Civil Defense Program - Miss Pitou, Miss Kopsch Program for the ScholarShip Nurses at the Plaza Hotel - Mrs. Patterson, Miss johnson Week's tour of Vermont hospitals under the auspices of the American Cancer Society - Mrs. Coleman National League of Nursing Education~monthly meeting - Mrs. Colemany Mrs. Patterson