QUALITY CARE CLOSE TO HOME
New organization unites regional cancer centers and raises the bar overall on patient care
He is 77 years old and has been in good health since being treated for prostate cancer almost two decades ago. That, however, is changing. Recent tests show his cancer is back.
He is not in the room and his name is not known as his physician shares radiology, pathology, medical history and exam details with colleagues. Afterwards, more than two dozen oncologists, radiologists, urologists and surgeons – a dream team of prostate cancer specialists – ask questions. How was his first cancer treated? How long did it take his prostate-specific antigen level to double? What was his Gleason score five years ago compared to today? Does he have any other health issues? In what organs and where, exactly, is his cancer now? Does a scan indicate bone cancer?
They then all share similar patient cases and outcomes, related research they have conducted or reviewed, treatment options they can offer and new medications that could help, including innovative therapies available through clinical trials.
"In many ways, this is a typical tumor board," says Ralph deVere White, UC Davis Cancer Center director, referring to standard meetings of cancer experts to devise treatment plans. "The goal is always to give patients the best chance for cure. The big difference with this tumor board is that all participants are not in the same room."
UC Davis Cancer Center recently initiated "virtual tumor boards," where state-of-the-art videoconferencing links cancer specialists throughout Northern and Central California and significantly expands perspectives on patient care. These electronic meetings of the minds are also part of the glue that links four community hospitals with the cancer center as part of the new UC Davis Cancer Care Network, which launched in October of this year.
A new organization
The new network actually began eight years ago, when alliances were first developed with Fremont-Rideout Cancer Center in Marysville and Mercy Cancer Center in Merced through business partnerships – or limited liability corporations. These agreements have since been expanded to include formal clinical connections.
These successful affiliations led to expanded interest in decentralized cancer care. To explore options, a management team was formed that included cancer center Director Ralph deVere White along with Scott Christensen, a UC Davis associate professor of hematology and oncology; Kay Harse, chief administrative officer for the UC Davis Cancer Care Network; Patricia Keast, regional affiliations officer for UC Davis Health System; and Jeanine Stiles, the cancer center's associate director for administration.
Agreements have since been initiated focusing on access to clinical trials and specialty care with Tahoe Forest Cancer Center in Truckee and Regional Cancer Center at ValleyCare in Pleasanton. Add three UC Davis Cancer Center satellite clinics in midtown Sacramento, Elk Grove and Rocklin and the UC Davis Cancer Care Network was born.
The specialty-care network is one of the first in the nation to be linked with a public health-care institution. While it may seem a little entrepreneurial for academia, Keast notes that the network supports UC Davis' distributed care model of providing clinical services along with the outreach commitments of its National Cancer Institute-designated cancer center.
"It truly is a unique approach to providing health-care services, yet it is a natural outcome and an expectation of our role as the leading cancer research center in the region and the only one with NCI designation," says Keast. "The network formalizes our commitment to collaboration with community providers and promoting first-rate patient care across the region."
Keast is responsible for structuring network agreements and, while each is unique based on a menu of services and fees, the unifying goal is to assure that quality cancer care is provided to patients as close to home as possible.
"Cancer is not a disease that travels well," says Christensen, who was recently named the network's first medical director, "and being in familiar surroundings and having a strong support network nearby are very important aspects of treatment and recovery. That's why our priority is to make sure each site has what it needs to provide the best care right in the community setting."
Access to specialists
There are specialty and subspecialty services that are unique to UC Davis, and patients at network sites can be easily referred for those services. This was especially important to Jenny Walker, a patient of Mercy Cancer Center.
In diagnosing her breast cancer, medical oncologist Lucio Nobile also found a suspicious spot in her lung. He referred Walker to Royce Calhoun, UC Davis surgical director of thoracic oncology and the only cardiothoracic surgeon in the region using video-assisted thoracoscopic surgery – or VATS.
The procedure involves making small chest incisions for inserting a tiny fiber-optic camera and specialized surgical instruments. There is no cutting or spreading of the ribs as there is with the traditional thoracotomy. Instead, the surgeon performs the entire operation through the small incisions, using images from the camera projected onto a video monitor for guidance. When compared to open chest surgery, VATS patients experience much less pain, shorter hospital stays and quicker recovery times.
Walker was thrilled to be a candidate for the less-invasive approach and did very well following surgery. While she is happy for the connection between her physician and UC Davis, she is even happier to be home.
"I do much better in the comfort of my own bed," she says.
A new model for specialty care
Now that the formal network is launched, expansion plans are, once again, in the works.
"We are seriously considering a number of other hospitals that have asked about joining the network, but those opportunities need to move forward carefully. We need to be sure to balance growth with the necessity of meeting current obligations," says deVere White.
The specialty-care model that he and the team started, though, fits well into the culture of care and community at UC Davis and could easily expand.
"The Cancer Care Network is an exciting partnership that will increase access to state-of-the-art care for patients across our region," says Claire Pomeroy, UC Davis vice chancellor of Human Health Sciences and dean of the School of Medicine. "Together with four outstanding community hospitals, we will increase early cancer detection, enhance quality of life and improve survival rates for our patients. This new model for specialty care reflects UC Davis' deep commitment to our community and is a shining example of our passion for advancing health for all."