Spokane Journal of Business

Integrated cancer care: Best future path for patients

Targeted treatments along with better understanding of genetics driving progress

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Integrated cancer care: Best future path for patients

We are prevailing in the war against cancer, driven by a better understanding of genetics and the development of new targeted treatments specific to each individual patient.

There have been tremendous advances in cancer care in the last decade. Overall survival rates for all cancers have been increasing, due to better detection and treatment. Compared to even five years ago, patients are living longer with cancer and enjoying healthier and fuller lives.

Scientific discoveries are helping us understand cancer at its basic cellular level. Innovation in pharmaceuticals and biologic compounds and advances in diagnostic and treatment technology are giving us better tools to treat cancer. With innovations in the fields of radiation therapy, minimally invasive and robotic surgical procedures, and cellular level genetic testing, patients have more options than ever before.

The need for integration

With these advances, cancer care has become more complex, more targeted, and more specialized. Cancer care is moving from one size fits all to personalized medicine. Treatments are becoming targeted to the specific type, and sub-type, of cancer, allowing for better treatments and outcomes. It's common for cancer physicians these days to talk about the "tumor biology" of individual cancers, and tailoring therapy to the individual.

As our knowledge of cancer biology increases and more treatments are developed, cancer physicians are also becoming more specialized. Specialists are now being trained to become experts at treating very specific types of cancer. For patients to receive the best care, integrated multidisciplinary teams of cancer specialists will be required.

Today in Spokane, cancer physicians from across the community meet several times each week to review individual cancer cases and to develop treatment recommendations and plans. These meetings are called tumor boards and are open to any physician involved with cancer treatment. As part of the multidisciplinary care patients need, physicians bring cases to their cancer care colleagues to solicit opinions from multiple specialties, including surgery, medical, radiation, and interventional radiology.

With the explosion of knowledge in cancer diagnostics and treatment occurring in all fields, it's impossible for any one physician to know everything. For any patient undergoing cancer treatment, it is vitally important that your physician participate in tumor boards to ensure that you have the advantage of the expertise of multidisciplinary cancer specialists.

To achieve the best diagnosis and most appropriate therapy, a multidisciplinary team approach must be followed for each patient. As patients become better informed about treatment options and of the importance of tumor boards, it won't be long before they recognize the importance of these case discussions. They may even want to participate in person.

Taking multidisciplinary tumor boards one step further, multidisciplinary clinics bring together all the treating physicians with the patient into a specialized cancer clinic, such as a prostate cancer clinic, or a lung cancer clinic. Multidisciplinary clinics are designed so that each patient can meet with several cancer specialists consecutively and obtain whatever lab and diagnostic services that are indicated.

This allows a patient an opportunity to interact with multiple cancer specialists in one clinic, under one roof, all at the same time. The physicians in the clinic are working together throughout the day, and review and discuss each patient in a daily tumor board. While this system exists in university settings dedicated to research and medical training, all community cancer care will be provided in this fashion in the future.

Organizing a multidisciplinary clinic to coordinate patients and multiple doctors can be challenging in the community setting, but is achievable. The Spokane Valley Cancer Center will be the first cancer center of its kind, an open community facility that will provide for participation by any interested cancer physician who seeks the opportunity to work with a variety of cancer specialists to care for patients together.

Genetic testing

The future of cancer care is moving towards genetic evaluation of each patient's cancer to create a treatment plan specific to that individual. Cancer physicians understand that every cancer is different and behaves differently in each person. Individualized treatment, based on the genetic profile of cancer cells, has been the Holy Grail for cancer specialists. Each year, we are getting closer, in large part due to better genetic testing.

Genetic testing is used to find the genetic and molecular alterations in each cancer cell. Cancer physicians use the information to develop individualized treatment plans for each patient. It is now increasingly important for oncologists, pathologists, and molecular biologists to work together. Forward looking multidisciplinary cancer centers are developing tools to identify the molecular profile of cancer at initial diagnosis, and at different stages of treatment.

Advanced imaging, radiation

Another important trend in cancer treatment is in more targeted radiation therapy. Advances in technology have enabled radiation oncologists to reduce radiation exposure, while treating tumors faster and with better destruction of cancer tissue.

As these advances continue, radiation treatment will be narrowly focused and imaging guided, using PET/CT technology to target the cancer cells. This allows for more tumor kill and less destruction of normal tissue. In the future, this cutting edge technology should be readily available to patients, but Spokane lags behind many other communities.

To ensure patients in our region have access to this type of treatment, the Spokane Valley Cancer Center is introducing the CyberKnife Robotic Radiosurgery System, a noninvasive alternative to surgery for the treatment of tumors anywhere in the body, including the prostate, lung, brain, spine, liver, pancreas, and kidney. Presently, the closest CyberKnife is in Seattle, and many patients don't have the resources, time, and family support to travel elsewhere for this state-of-the-art cancer treatment.

Traditional chemotherapy agents, new agents, and new biologic compounds are all making rapid advances in targeting specific cancer types. Each year, more effective pharmaceuticals are being developed. We now can even offer vaccines for a few cancers.

These advances will continue, and drug research and clinical trials will result in more treatment choices to patients. An integrated cancer center has a strong focus on participating in research and clinical trials, to offer patients the most advanced treatments available. Clinical trials gives a patient the opportunity to try untested therapies, which otherwise wouldn't be available or approved for use.

Even today, doctors and patients should both be looking at participating in clinical trials as the first option of any therapy for cancer. In the future, patients should have the opportunity to participate in clinical trials at various stages of their treatment.

To tie together the complex and highly specialized care each cancer patient receives, cancer centers in the future will need robust health information exchange systems to centralize each patient's medical information. Today, each cancer specialist has his or her own treatment record and also needs records from hospitals, labs, and other cancer specialists. The future of integrated cancer care depends on sharing patient-specific medical information between diverse cancer specialists in real time.

By so doing, critical medical data is accessible to all members of each patient's treatment team when it's needed. It serves to reduce duplication and prevents critical delays in medical decision making. Integrated health information systems will be used to create sophisticated, personalized treatment plans, and assist with medical case management, patient education, and communication between patients and members of the treatment team

The Spokane Valley Cancer Center will be introducing technology that brings together complex clinical information from a variety of sources into a central database. This will significantly improve timely medical decision making and care coordination, and will enable treating physicians to care for the patient efficiently by having real-time medical information readily available.

Cancer care is complex and is becoming even more so as medical technology and treatment options rapidly expand.

High-quality cancer care involves a large number of cancer specialists who work together to bring the best array of treatments for each patient. Clinical innovation and specialization will continue to shift care away from hospitals into outpatient cancer centers.

To effectively provide the best care possible, teams of health care providers will work together in a comprehensive cancer center to give patients access to the entire complement of diagnostic and treatment services in one facility, improving positive treatment results.

  • Dr. Arvind Chaudhry

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