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Becker’s Healthcare Podcast
Dr. Debra A. Wong, Medical Oncologist at City of Hope and Medical Director at AccessHope
00:10:12
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- [00:01]
A
Welcome to the Beckers Healthcare Podcast. I'm Elizabeth Gregerson, a reporter here at Beckers and I'm thrilled to interview Dr. Deborah Wong. She's a medical oncologist at City of Hope and medical director of access hope. Dr. 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.
- [00:33]
B
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 an assistant professor in medical oncology and Therapeutics research at City of Hope and 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.
- [01:19]
A
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?
- [01:57]
B
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 healthcare 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.
- [03:34]
A
Perfect. And I wanted to highlight too one of the key findings of the study was that patients in non urban 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.
- [04:16]
B
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 non urban areas had about 30% 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 33% 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.
- [06:16]
A
I feel like that's such an important point too, and something we might take for granted when we think of cancer care access. Our default Might be just we're thinking treatment, we're thinking screening, but it's those supportive services, like you said, that really make a difference. 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 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 leverage more technology enabled care models to bridge that gap between the academic setting and the community setting?
- [07:26]
B
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 poorer 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 changes, 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.
- [09:00]
A
Absolutely. And you know, I love kind of the idea of what you're saying with it's not going to be one size fits all, you know, the needs are going to be different based on the organization. Kind of just like cancer treatment, right? 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 want to 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 into more podcasts from Becker's Healthcare by visiting our podcast page@beckershospitalreview.com thank you and I hope you have a wonderful rest of your day.
- [09:54]
B
Thank you. Elizabeth.