‘Team Cancer’
Published: August 26, 2010
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Waiting for answers was once the cancer patient’s lot.
A cancer diagnosis never brings with it a one-size-fits-all plan for treatment. Quick and easy answers are rendered impossible by too many steps and too many medical disciplines in between a suspicious test and a comprehensive plan to combat the illness.
Cancer, after all, is not a single disease with a single treatment. Cancer is as varied as the people who battle it. It comes in types and stages and degrees of aggression. It comes to young, otherwise healthy, people and it comes to the old, the frail, the already compromised. Diagnosing and treating cancer requires multiple medical specialties, multiple tests, multiple treatment modalities.
In short, fighting cancer is a team sport that for far too long has played out more like a relay race. The surgeon would pass the baton to the radiation oncologist who might in turn pass off to a medical oncologist and so on. The relay continued until all the answers were known and a plan devised — during which time the patient waited and worried in a grim state of uncertainty, his life on hold.
Those days are over for patients in northeastern Pennsylvania, thanks to a “community of professionals” gathered under the name “Northeast Regional Oncology Center,” where, as Harmar Brereton, M.D. says, “The time frame from worry to certainty has been shortened.”
Northeast Regional Oncology Center unites 15 oncologists from two well-known medical groups: Hematology and Oncology Associates of NEPA (HEMONC) and Northeast Radiation Oncology Center.
HEMONC and NROC always enjoyed a close working relationship, with spectacular new offices adjoining one another on Meade Street in Dunmore (each practice also has other offices throughout northeastern Pennsylvania). However, the new partnership aims to blend more than office space. Plans are underway to merge record-keeping and research. Moreover, HEMONC’s onsite lab is now available to the NROC side of “the house.” But it is patient care the team emphasizes most and it is from concern for the patient that all other team decisions flow.
For example, the group has instituted patient satisfaction surveys and it takes the results most seriously, even changing the configuration of the waiting rooms to address privacy concerns mentioned on one patient’s survey.
Moreover, NROC does not intend to stop at the union of medical oncologists with radiation oncologists. The new NROC invites all medical professionals to seize what Dr. Brereton calls “the wisdom of the group,” which convenes regularly via patient management conferences. These conferences are attended by primary care providers, pathologists, surgeons and radiologists, in addition to the oncologists. At the conferences, films and laboratory reports are reviewed together by the gathered team of professionals and decisions are made in concert with one another.
In the past, explains medical oncologist, Richard Emanuelson, M.D., the same films might be reviewed by three different doctors who would discuss them with one another at varying times, often modifying the treatment plan during each separate consultation. “Now it all happens in one place,” he says.
The most important consequence for cancer patients is that a comprehensive treatment plan no longer requires several doctor appointments strung out over several weeks. Instead, patients will get all of their answers in one place, at one time.
The NROC team has already begun this “one-stop” process with lung cancer patients, who can now spend about five hours at NROC with multiple specialists and emerge with a complete plan for surgery, radiation and chemotherapy. NROC plans to do the same for breast and colon cancer patients in the immediate future.
Inevitably, the question about NEPA’s habit of going to Philadelphia for treatment arises. Radiation oncologist, Chris Peters, M.D., who once worked at a major hospital in New York City, says he has been continually amazed at the breadth and depth of medical expertise in northeast Pa. “There are more options here than in Manhattan,” he says. Dr. Brereton agrees, pointing out that it’s “easier to heal at home than three hours away.” However, he adds, “We’re not against Philadelphia. Patients know they can get modern, appropriate care here and, if they need to go to Philadelphia, it’s our job to get them there.”
Fortunately, there aren’t many cancer cases the NROC team can’t handle. Dr. Emanuelson enumerates them: pediatric cases, certain liver resections and certain gynecological cancer surgeries. However, the group hopes to address that last issue by attracting a specialist in the field of gynecological oncology.
Cutting-edge research also gets a boost from the NROC partnership, which participates in trials run by the National Cancer Institute Cooperative Trials, the Jefferson Kimmel Cancer Network and others. It helps trial participants to have a unified team of doctors engaged in ongoing communication because certain protocols being tested can cut across medical specialties — for example, certain kinds of radiation can preclude chemotherapy or the two modalities must occur in a certain way together.
The “community of professionals” isn’t limited to MDs. The doctors of NROC know that cancer doesn’t just invade bodies, it attacks minds, moods and families. That’s why patients also have access to a nutritionist, a social worker, a family therapist — even an adorable fluff of black canine fur known as “Rudy, the therapy dog.”
Marriage and family therapist Oliver Morgan, Ph.D. has been associated with the newly united NROC team for about six months. He says in that time his practice has “picked up substantially,” necessitating the addition of two more therapists. He says the patients who come to him through NROC have a variety of issues to work through — ranging from people who can’t cope with their devastating diagnosis to people grappling with metastatic disease and their own mortality.
Dr. Morgan says that the NROC physicians will even join the family during a counseling session. “I invite them in,” Dr. Morgan says. “The doctors are very good at helping patients and their families, but sometimes patients need help to be more upfront with their doctors about their concerns.”
Social worker Kathryn Cramer, LSW, CHT helps patients who run the gamut from elderly folks who need a ride to their daily radiation treatments to women with breast cancer who are dealing with a suddenly distant spouse. Sadly, husbands leaving stricken wives happens far too often. “Our work,” Dr. Morgan says, “helps inoculate marriages — it forestalls a family collapse.”
The doctors, the nurses, the physicians’ assistants, the counselors, the social worker, the nutritionist — even the dog — are gathered in one place for one reason: to be ‘team cancer’ for any person in northeastern Pennsylvania unfortunate enough to have heard those words, “You have cancer.” The words are frightening, but the power and the “wisdom of the group” mean no one has to face them alone.
