A few days ago I decided that since I have been officially retired for two months, it was time to change my profile on the LinkedIn social network. After all, the purpose of that network is to link business and professional people to potential opportunities and ideas. I needed to let contacts know that I am no longer with the University where I practiced for the last seven years, while at the same time, just labeling myself “retired” seemed far too final. LinkedIn, as it turns out, has a “prompt” on each member’s profile page which encourages us to say succinctly what we’re all about. The prompt is “I am passionate about…” It took a few moments for my brain to dispel romantic visions of the great love stories of all time–Catherine and Heathcliff? Zhivago and Lara? Scarlett and Rhett? The realization dawned on me that what LinkedIn was alluding to was professional and not physical.
What I am passionate about, and remain so despite the significant burn out that led to early retirement, is community based cancer care. Contrary to what I believed during my residency, when I referred to patients being admitted by LMD’s (local medical doctors) from St. Elsewhere, over the course of a long career I have come to believe that most cancer patients are served best by being treated in their own communities. Certainly there will always be patients whose presentations, diseases and complications merit immediate referral to a tertiary care center, however most patients with typical presentations of common cancers are also people who have jobs, who have children and/or elderly parents to care for, who have concerns about the financial burdens of treatment, and for many elderly patients concerns about transportation to and from treatment. Our job, as community based cancer specialists, is to make sure that the treatment being provided measures up to the standards of care and safety that we have learned from our colleagues in major academic practices. In communities with limited resources, this can be challenging.
For physicians and community leaders interested in creating a community cancer center the key ingredients are simple. First, you need a mission. Decide what the goals of your center will be and write them down. Create a statement. An example could be: “Our mission is to deliver medically and technologically advanced cancer care to residents of this community in a supportive environment close to home.” These goals will be your guiding light as you proceed. Second, you need a building. Although many of the functions of a tertiary cancer center can be spread out into the community, we are not yet at a point where we can deliver “virtual cancer treatment.” Many pre-existing buildings can be modified to accommodate chemotherapy and even radiation therapy, at a fraction of the cost of new construction. Third, you need equipment. Specifically, in order to deliver radiation therapy you need a multipurpose linear accelerator, capable of delivering highly focused stereotactic radiation as well as standard of care intensity modulated radiation therapy and superficial electron therapy for skin cancers. Although it makes a good PR campaign to have the latest “sexy” name in equipment, much of this highly specialized equipment is not designed for a general practice. You will need infusion equipment and likely some laboratory equipment. Fourth, you need highly trained and certified personnel to administer chemotherapy and radiation therapy, and particularly in the case of radiation, to insure quality. Fifth, it is my opinion that community cancer centers benefit greatly from affiliation with university practices in terms of access to clinical trials, to tumor boards, to advanced pathological diagnosis and to the expertise of specialists in each disease site. Finally, and perhaps most importantly, you need the support of the community. To paraphrase Hillary Rodham Clinton who said, “It takes a village to raise a child”, I would say that it takes the dedication of a community to create a successful cancer center.
The future of cancer treatment, indeed of medicine in general, is unclear however we must not lose sight of the fact that patients are more than their cancer diagnosis, their chemotherapy recipe or their radiation dose prescription. We need to keep them in their jobs, with their families, functioning as normally as possible under difficult circumstances, throughout their treatment and afterwards. My own experience has shown that this is achievable in a personalized setting in the patient’s community. That is what I am passionate about.
This piece is condensed from a longer talk I gave in Jamaica in October 2013. For the full transcript feel free to email me and I will send it on.