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Prepare for the Cancer Boom

Elyas Bakhtiari, for HealthLeaders Magazine, July 10, 2009
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With cancer diagnoses set to climb dramatically in the coming decades, aligning the right cancer care team and utilizing the appropriate technology become essential for maintaining a patient-centered service line.

Cancer care is in some ways inherently more recession proof than other service lines. While hospitals have been hit hard by a decline in elective surgeries and procedures that patients are putting off until better financial times, treatment for cancer simply isn't something people believe they can afford to delay.

But oncology may experience a lag in recession-related problems that other service areas won't. Experts began warning early in the year about patients possibly forgoing important screenings and checkups after losing insurance coverage. It may be early for solid evidence to support this trend, but the fear is that patients are missing early detection opportunities and could show up with more advanced, less treatable cancer at a later date.

Yet if the financial climate causes a wave of new cancer cases in the short term, that is only a high tide compared to the tsunami of new diagnoses coming behind it. A recent University of Texas M.D. Anderson Cancer Center study projects the number of cancer cases to increase by 45% over the next 20 years, hitting 1.6 million per year in 2010 and 2.3 million in 2030.

Cancer care is, by many measures, one of the most complicated service lines to deliver, and managing this complex treatment pathway would be difficult enough if it were an even fight—but it increasingly isn't. As the number of cancer cases is on the rise, the supply of medical and radiation oncologists is not keeping up with demand. The American Society for Clinical Oncology projects a shortage of about 4,000 cancer doctors by 2020.

A large chunk of oncologists' workload involves following up with cancer survivors, and with survivorship rates improving, oncologists' own success is increasing the strain on their profession.

Fortunately, cancer care doesn't just hinge on the number of oncologists. It is a multidisciplinary effort, and while oncologists play a vital role, success ultimately depends on the strength of the overall care team.

The entire process, from diagnosis to treatment to recovery, involves a diverse and ever-changing cast of providers: primary care doctors, pharmacists, nurses, radiologists, surgeons, specialists, technicians, physical and medicine therapists, social workers, and more.

"Multidisciplinary care is a hallmark of an excellent cancer program—one in which you have the right specialists of different types who are working together in a collaborative fashion for the benefit of the patient to determine collectively what is the most appropriate treatment plan," says Richard Emery, executive director of the Trinitas Comprehensive Cancer Center, which is part of the 531-bed Trinitas Regional Medical Center in Elizabeth, NJ.

Service line leaders, in that sense, are like coaches. To be successful, they have to get the entire team working together with the right tools and processes to perform up to their maximum potential.

Service Line Success Key #1: Pick the Right Strategy
Every team has strengths and weaknesses, and those that succeed often have learned to identify and emphasize what they do best.

While the reputation and quality of an overall cancer program is important, not every hospital can be an M.D. Anderson or a Memorial Sloan-Kettering Cancer Center, known around the world for their top-of-the-line cancer care. But most hospitals can achieve that kind of status at a different scale—either as a comprehensive destination center within a smaller region or as a top program for a specific type of cancer.

Breast cancer, prostate cancer, leukemia, and other forms of cancer are in many ways very different diseases and require unique resources and care approaches. Although many hospitals may strive to develop top-notch programs for all site-specific cancer types, that isn't realistic for most.

Those strategic decisions depend on the existing marketplace—the level of competition, expected patient volumes, and subspecialty recruitment capabilities—says Craig Comish, the executive director for cancer services at Carolinas Medical Center, a 874-licensed-bed medical center in Charlotte.

"Clearly if you're in a rural area with a far-flung demographic, a low population density demographic, you're not going to develop a neuro-oncology program with a surgical specialist, because they're not going to be available to practice in a market of that size," says Comish. "Programs in high-volume areas like breast or prostate or lung or colorectal are somewhat more amenable to development in medium-sized marketplace environments."

Carolinas runs a specialty breast clinic, a specialty gynecological cancer clinic, a head and neck clinic, and a specialty melanoma clinic out of its main downtown center. While the subspecialty areas are priorities, market limitations prevent the system from expanding some of those clinics further into its rural hospitals.

"You can't be everything to everybody," says John Ridley, executive director of oncology services for Decatur Memorial Hospital, a 357-licensed-bed hospital in Illinois. "We know what our core business is and know what we're good at. We focus on that and provide a kind of a comprehensive package as a hospital. It's important to know when to take a patient and recognize a situation that requires intervention we're not capable of providing, and transferring the patient."

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