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Oncology Service Line: A Change in Focus

Marianne Aiello, for HealthLeaders Media, March 21, 2014

From genetic testing to advanced chemotherapy procedures, hospitals and health systems are changing the focus of oncology from merely ensuring survival to, in many cases, providing comprehensive long-term care and even cures.

This article appears in the March 2014 issue of HealthLeaders magazine.

The prognoses delivered in hospital oncology departments around the country are decidedly less grim than they were a decade or even five years ago. The rate of technological innovations in cancer care is speeding forward like never before, leading to better results, fewer treatment side effects, and an improved quality of life for patients.

From genetic testing to advanced chemotherapy procedures, hospitals and health systems are changing the focus of oncology from merely ensuring survival to, in many cases, providing comprehensive long-term care and even cures.

Success key No. 1: personalized medicine

At Inova Health System, a seven-hospital system based in Falls Church, Va., researchers are trailblazing ways to treat cancer more efficiently and detect it sooner via enhanced personalized medicine.

The Inova Translational Medicine Institute aims to move the healthcare industry from a reactive to a predictive model using technological innovation, research, and information management. Its goal is an ambitious one: to provide the right treatment for the right patient at the right time, and ultimately prevent disease in the first place.

"We are working on a comprehensive plan to personalize the care for cancer patients in a number of ways," says John Niederhuber, MD, CEO of ITMI. "There is much work to be done, and here at Inova we're helping lead the way into this new era of personalized cancer care." Niederhuber is also executive vice president of Inova Health System; CEO and director of Inova Comprehensive Cancer and Research Institute; adjunct professor of oncology at Johns Hopkins University School of Medicine in Baltimore; and deputy director of the Johns Hopkins Clinical Research Network.

Inova is creating a comprehensive plan to personalize care for cancer patients using four main strategies:

  • Genetic testing of tumors. For patients diagnosed with cancer and determined to need chemotherapy, ITMI is looking to do genetic testing of the tumor to help select the drug that will best treat the cancer.
  • Genetic testing of patients' genomes. Because each person absorbs and metabolizes drugs differently, ITMI plans to test the cancer patient's genome so physicians can better determine the best dose of chemotherapy. Genome testing would allow doctors to choose the right drug for each patient.
  • Radiation research. ITMI is pursuing research into the genetics of radiation therapy to help determine which patients are best served by the treatment compared to patients who might not be. By doing this, they are hoping to determine who is at higher risk for the toxicities from radiation therapy so physicians can better treat those patients with appropriate supportive measures.
  • Identifying high-risk patients. By exploring the genetics of who is at risk to get cancer—especially breast cancer—ITMI hopes to someday be able to better screen patients and detect cancers at an earlier stage, or even prevent them altogether. By documenting high-risk mutations found through genomic methodologies and helping to manage these patients within the health system through its clinical genomics team, ITMI hopes to make sure patients and research participants receive the best possible counseling and care.

"This is really cutting-edge work in the field of cancer," Niederhuber says. "Molecular analysis utilizes genetics and genomics to provide information about the biology of a cancer that can be exploited by using drugs that target these processes and pathways. Patients that undergo therapies targeted by genomics often go into remission for a time. While often the cancer finds another path that can result in recurrence, we're continuing to gain a better understanding of what drives cancer progression and are finding new ways to optimally treat it."

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