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Welcome to the Becker's HealthCare podcast.

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I'm Elizabeth Gregersen,

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a reporter here at Becker's, and I'm thrilled

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to interview

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doctor Deborah Wong. She's a medical oncologist at

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City of Hope and medical director of Access

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Hope.

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Doctor Wong, thank you so much for joining

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me. I'm so grateful to have you on

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today to share your insights with our podcast

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audience.

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Before I dive into my questions, could you

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just briefly introduce yourself and tell us a

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little bit about your background and your organization?

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Hi, Elizabeth. It's great to be here with

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you.

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By training, I'm a medical oncologist and palliative

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care physician.

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By nature, I'm someone who's always been driven

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by making a meaningful difference in people's lives,

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especially when they or a loved one is

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facing cancer, which is a disease unlike any

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other and has touched us all in some

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way or another.

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I'm assistant professor in medical oncology and therapeutics

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research at City of Hope, and I help

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lead the development and integration of clinical strategy

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at Access Hope, which was founded by City

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of Hope.

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Through a novel approach to optimizing cancer care

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delivery,

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regardless of where someone lives or where they're

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being treated,

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we provide remote expert opinions to patients and

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their treating oncologists wherever they call home.

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Great.

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That leads perfectly into kind of our discussion

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today. You had a recent study come out

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that highlighted how remote second opinions

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from NCI

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designated specialists

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led to changes in treatment recommendations

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for over half of the cancer cases reviewed.

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What were some of the key infrastructure

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or technology enablers that made this kind of,

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you know, academic to community collaboration

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possible at scale? You know, what did it

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take to

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to, kind of scale all these remote second

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opinions?

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First, a team based clinical network facilitated approach

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where all involved have a common goal is

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paramount.

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Research has shown us that patient outcomes like

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survival are better at NCI designated comprehensive cancer

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centers,

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but it isn't feasible or practical to expect

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all people with cancer to be able to

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travel and be cared for at one of

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these centers.

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We developed a model where partnerships with employers,

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health plans,

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local oncologists,

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and other leading cancer centers enables patients and

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their treating oncologists

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to benefit from the latest cancer care knowledge

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no matter where they live or practice.

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It's this infrastructure between the different sectors,

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payers, clinicians, and cancer centers of excellence

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that supports a unique collaboration

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between academic and community oncologists

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across urban and non urban regions

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and across different socioeconomic

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settings

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for accelerated

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dissemination of information and knowledge transfer

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in what is a very rapidly advancing field.

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We've developed a sophisticated

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health care compliant and technology enabled review system

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that allows us to do this at scale.

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Cancer subspecialists in our clinical network can securely

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review a patient's information,

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provide their expert opinion regarding testing,

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treatment,

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and potentially clinical trial options.

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And then with skilled IT

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data scientists and clinical staff, we're able to

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deliver those expert opinions anywhere they're needed as

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well as analyze practice patterns and outcomes.

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Perfect.

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And I wanted to highlight too. One of

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the key findings of the study

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was that patients in nonurban

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or disadvantaged areas

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were significantly

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more likely to benefit

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from those treatment changes that happened after receiving

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the second opinion from an NCI designated specialist.

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I'd love for you to walk us through,

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you know, what that

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finding tells

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us about what health systems could or perhaps

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what they should be doing

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to better support

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the frontline oncologists

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that that are practicing in those resource limited

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settings.

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We did find that in over 5,000 cases,

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remote expert opinions recommended changes in cancer treatment

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more than half the time.

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Moreover,

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those recommendations were disproportionate.

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Patients in socioeconomically

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disadvantaged and nonurban areas

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had about thirty percent higher odds of receiving

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recommendations for changes in their cancer treatment

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compared with those patients in the least disadvantaged

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or urban regions.

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Health systems can better support oncologists

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practicing in resource limited settings by building into

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the community,

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and we need to better define network adequacy

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so that it's not one size fits all

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for different geographic and socioeconomic

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regions across the nation.

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Rural areas, for example, should have provisions for

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access to the same number and quality of

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cancer subspecialists

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as urban areas do.

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When that isn't possible, one mechanism to bridge

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the gap is remote expert opinions,

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delivering expertise from leading academic centers into the

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community

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so that treating oncologists in resource limited settings

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have the most up to date cutting edge

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cancer care knowledge at their fingertips,

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and this can translate to better outcomes for

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their patients.

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Another important aspect is funding the right care

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at the right time and with the right

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supportive care.

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We found that there was a thirty three

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percent greater chance of patients in non urban

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areas

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compared with those in urban communities

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receiving recommendations for supportive care. This includes

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palliative medicine

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or allied health services like nutrition or physical

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therapy and rehabilitation.

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This suggests that the resources for optimal supportive

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care may not be available or accessible in

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certain areas.

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Supportive care is just as, if not more

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important for comprehensive cancer care and helps people

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not just survive cancer, but thrive while they're

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facing cancer.

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I feel like that's such an point important

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point too and and something, you know, we

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might take for granted when we think of

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cancer care access. We you know, our our

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default might be just we're thinking treatment. We're

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thinking screening. But it's those supportive services, like

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you said, that that really make a difference.

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So I I appreciate how the study kind

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of lined that out as well.

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So, you know, in this time post COVID,

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most hospital and health systems,

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you know, have kind of virtual care capabilities,

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you know, whether that's through telehealth, whether that's

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through kind of

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Zoom committees that they routine routinely run tumor

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boards, things like that. So

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it might not be such a technological

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leap that they need to take to implement

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something like this.

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What advice would you have for health system

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leaders, which, you know, is who are listening

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to this podcast,

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if they're trying to love leverage

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more technology enabled care models

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to bridge that gap between the academic setting

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and the community setting.

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Foster crosstalk to identify the key problems. What

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might be a problem in one community may

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not apply to others.

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For example,

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studies have shown that patients who are in

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rural areas

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do have trouble or lack of access to

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technology that would enable telehealth.

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And further research also shows that those populations

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may have poor outcomes.

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Another example is that one region may lack

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appropriate clinical trials for their patient demographic.

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While this is not an issue in other

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regions, that may be populated with multiple academic

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centers running numerous clinical trials.

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So it's important to develop solutions together across

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sectors that are specific to a region and

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its unique population.

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It's also important to make it easy for

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both patients and treating oncologists.

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We need to look for ways to provide

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what's needed locally and deliver it efficiently and

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in a timely manner rather than requiring patients

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and their doctors to seek it out.

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We also need to reflect,

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reevaluate,

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and iterate.

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Make sure we're hitting the target as intended,

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especially as targets move.

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What's effective now will likely not be as

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effective in five years.

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So we need to move swiftly, anticipate change,

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and evolve with change, and never be complacent

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that we're doing enough to make health equitable

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and accessible to all.

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Last but most important,

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I believe we must not lose sight of

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the human element in care.

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Absolutely.

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And, you know, I love kind of the

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idea of what you're saying with it's not

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gonna be one size fits all. You know,

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the needs are gonna be different based on

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the organization,

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kind of just like cancer treatment. Right? You

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you treat the cancer that that's in front

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of you. And, I I love how that

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mentality can kind of be applied here when

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it comes to, you know, being creative with

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care delivery, and I appreciate you pulling out

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all those examples as well. I think it'll

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be really valuable to our listeners.

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I wanna thank you again for joining me

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on the podcast today.

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It's been a great conversation,

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extremely informative,

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so I'm so grateful for your time and

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for your insights.

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I also invite our listeners to tune in

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to more podcasts from Becker's Healthcare

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by visiting our podcast page

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at beckershospitalreview.com.

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Thank you, and I hope you have a

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wonderful rest of your day.

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Thank you, Elizabeth.