The Complex Calculations of Cancer Care

“Even though I can look at a lesion and I feel comfortable that it is not cancer, the patient wants assurance. And that leads to biopsies, some of which might be unnecessary.” Still, he says, “I have to stick by my clinical decision because that, to me, is the right way to practice medicine.”

Datta recounts the story of a young woman with a tiny nodule—less than 1 millimeter. He asked the radiologist not to do a biopsy. He told the patient not to let anybody stick a needle in her neck. But it’s difficult—near impossible, in fact—to convince a patient that they don’t need a fancy new machine for a tiny lesion or lump. In the mind of most patients, the words “small” and “cancer” just don’t go together.
Agarwal agrees that patient demand often drives utilization and investment in technology. “It’s incumbent on physicians to make sure we just stay balanced,” he says. “I spend a lot more time convincing my patients not to get treated with CyberKnife than it would take to treat them with the CyberKnife technology. It’s not unusual for me to tell them, ‘This is not a good treatment for you,’ and send them back to the doctors that they were working with.”

Think before you build
It is possible to build a cancer service line or run an oncology practice in a way that makes both clinical and business sense—to find that balance between serving your patients, keeping your organization competitive in the marketplace, and controlling overtesting and overutilization.

When Agarwal’s career path brought him back to South Florida, where he grew up, he wanted to bring with him some of the cancer technologies he’d used during stints in Boston and elsewhere. Broward County residents had to travel to other facilities to take advantage of a full spectrum of cancer treatment options—as long as they had the resources to do so, that is. His proposed solution: Put forth a variety of treatment offerings for Broward’s patients, tailored to their needs, so that they and their physicians could choose the best treatment from an array of options. “We said, ‘We can really build out a cutting-edge cancer program in terms of bringing state-of-the-art technologies and cancer management directly into our community.’”