Welcome to the Becker's HealthCare podcast.
I'm Elizabeth Gregersen,
a reporter here at Becker's, and I'm thrilled
to interview
doctor Deborah Wong. She's a medical oncologist at
City of Hope and medical director of Access
Hope.
Doctor Wong, thank you so much for joining
me. I'm so grateful to have you on
today to share your insights with our podcast
audience.
Before I dive into my questions, could you
just briefly introduce yourself and tell us a
little bit about your background and your organization?
Hi, Elizabeth. It's great to be here with
you.
By training, I'm a medical oncologist and palliative
care physician.
By nature, I'm someone who's always been driven
by making a meaningful difference in people's lives,
especially when they or a loved one is
facing cancer, which is a disease unlike any
other and has touched us all in some
way or another.
I'm assistant professor in medical oncology and therapeutics
research at City of Hope, and I help
lead the development and integration of clinical strategy
at Access Hope, which was founded by City
of Hope.
Through a novel approach to optimizing cancer care
delivery,
regardless of where someone lives or where they're
being treated,
we provide remote expert opinions to patients and
their treating oncologists wherever they call home.
Great.
That leads perfectly into kind of our discussion
today. You had a recent study come out
that highlighted how remote second opinions
from NCI
designated specialists
led to changes in treatment recommendations
for over half of the cancer cases reviewed.
What were some of the key infrastructure
or technology enablers that made this kind of,
you know, academic to community collaboration
possible at scale? You know, what did it
take to
to, kind of scale all these remote second
opinions?
First, a team based clinical network facilitated approach
where all involved have a common goal is
paramount.
Research has shown us that patient outcomes like
survival are better at NCI designated comprehensive cancer
centers,
but it isn't feasible or practical to expect
all people with cancer to be able to
travel and be cared for at one of
these centers.
We developed a model where partnerships with employers,
health plans,
local oncologists,
and other leading cancer centers enables patients and
their treating oncologists
to benefit from the latest cancer care knowledge
no matter where they live or practice.
It's this infrastructure between the different sectors,
payers, clinicians, and cancer centers of excellence
that supports a unique collaboration
between academic and community oncologists
across urban and non urban regions
and across different socioeconomic
settings
for accelerated
dissemination of information and knowledge transfer
in what is a very rapidly advancing field.
We've developed a sophisticated
health care compliant and technology enabled review system
that allows us to do this at scale.
Cancer subspecialists in our clinical network can securely
review a patient's information,
provide their expert opinion regarding testing,
treatment,
and potentially clinical trial options.
And then with skilled IT
data scientists and clinical staff, we're able to
deliver those expert opinions anywhere they're needed as
well as analyze practice patterns and outcomes.
Perfect.
And I wanted to highlight too. One of
the key findings of the study
was that patients in nonurban
or disadvantaged areas
were significantly
more likely to benefit
from those treatment changes that happened after receiving
the second opinion from an NCI designated specialist.
I'd love for you to walk us through,
you know, what that
finding tells
us about what health systems could or perhaps
what they should be doing
to better support
the frontline oncologists
that that are practicing in those resource limited
settings.
We did find that in over 5,000 cases,
remote expert opinions recommended changes in cancer treatment
more than half the time.
Moreover,
those recommendations were disproportionate.
Patients in socioeconomically
disadvantaged and nonurban areas
had about thirty percent higher odds of receiving
recommendations for changes in their cancer treatment
compared with those patients in the least disadvantaged
or urban regions.
Health systems can better support oncologists
practicing in resource limited settings by building into
the community,
and we need to better define network adequacy
so that it's not one size fits all
for different geographic and socioeconomic
regions across the nation.
Rural areas, for example, should have provisions for
access to the same number and quality of
cancer subspecialists
as urban areas do.
When that isn't possible, one mechanism to bridge
the gap is remote expert opinions,
delivering expertise from leading academic centers into the
community
so that treating oncologists in resource limited settings
have the most up to date cutting edge
cancer care knowledge at their fingertips,
and this can translate to better outcomes for
their patients.
Another important aspect is funding the right care
at the right time and with the right
supportive care.
We found that there was a thirty three
percent greater chance of patients in non urban
areas
compared with those in urban communities
receiving recommendations for supportive care. This includes palliative
medicine
or allied health services like nutrition or physical
therapy and rehabilitation.
This suggests that the resources for optimal supportive
care may not be available or accessible in
certain areas.
Supportive care is just as, if not more
important for comprehensive cancer care and helps people
not just survive cancer, but thrive while they're
facing cancer.
I feel like that's such an point important
point too and and something, you know, we
might take for granted when we think of
cancer care access. We you know, our our
default might be just we're thinking treatment. We're
thinking screening. But it's those supportive services, like
you said, that that really make a difference.
So I I appreciate how the study kind
of lined that out as well.
So, you know, in this time post COVID,
most hospital and health systems,
you know, have kind of virtual care capabilities,
you know, whether that's through telehealth, whether that's
through kind of
Zoom committees that they routine routinely run tumor
boards, things like that. So
it might not be such a technological
leap that they need to take to implement
something like this.
What advice would you have for health system
leaders, which, you know, is who are listening
to this podcast,
if they're trying to love leverage
more technology enabled care models
to bridge that gap between the academic setting
and the community setting.
Foster crosstalk to identify the key problems. What
might be a problem in one community may
not apply to others.
For example,
studies have shown that patients who are in
rural areas
do have trouble or lack of access to
technology that would enable telehealth.
And further research also shows that those populations
may have poor outcomes.
Another example is that one region may lack
appropriate clinical trials for their patient demographic.
While this is not an issue in other
regions, that may be populated with multiple academic
centers running numerous clinical trials.
So it's important to develop solutions together across
sectors that are specific to a region and
its unique population.
It's also important to make it easy for
both patients and treating oncologists.
We need to look for ways to provide
what's needed locally and deliver it efficiently and
in a timely manner rather than requiring patients
and their doctors to seek it out.
We also need to reflect,
reevaluate,
and iterate.
Make sure we're hitting the target as intended,
especially as targets move.
What's effective now will likely not be as
effective in five years.
So we need to move swiftly, anticipate change,
and evolve with change, and never be complacent
that we're doing enough to make health equitable
and accessible to all.
Last but most important,
I believe we must not lose sight of
the human element in care.
Absolutely.
And, you know, I love kind of the
idea of what you're saying with it's not
gonna be one size fits all. You know,
the needs are gonna be different based on
the organization,
kind of just like cancer treatment. Right? You
you treat the cancer that that's in front
of you. And, I I love how that
mentality can kind of be applied here when
it comes to, you know, being creative with
care delivery, and I appreciate you pulling out
all those examples as well. I think it'll
be really valuable to our listeners.
I wanna thank you again for joining me
on the podcast today.
It's been a great conversation,
extremely informative,
so I'm so grateful for your time and
for your insights.
I also invite our listeners to tune in
to more podcasts from Becker's Healthcare
by visiting our podcast page
at beckershospitalreview.com.
Thank you, and I hope you have a
wonderful rest of your day.
Thank you, Elizabeth.