The news is peppered with stories of the latest studies of new ways to treat or prevent cancer. What do most of those studies have in common? The majority were conducted in large, academic medical centers, leading many to believe that those institutions are where most patients with cancer are receiving their care.
In reality, that isn’t the case: nearly 85% of patients with cancer are diagnosed and treated at local community cancer centers, ones within a short drive of their own homes. The location and reach of community cancer centers can’t be rivaled by their academic siblings. However, they often lack the same financial resources and ability to enroll patients in clinical trials: typically, less than 3% of patients in community sites are enrolled in clinical trials.
There’s an initiative through the National Cancer Institute (NCI) to design and implement partnerships between academic and community sites for shared access to resources, information, data, programs, and treatment breakthroughs. The NCI Community Cancer Center Program, now known as the NCI Community Oncology Research Program, has led this program around the country. The linchpin in these partnerships are the nurses and healthcare providers who diligently act to implement new changes to better serve their patients with cancer.
Developing Working Relationships
ONS member Tracy Gosselin, PhD, RN, AOCN®, associate chief nursing officer at Duke University Health System in Durham, NC, works on the academic side of a number of partnerships. “Duke University Health System recognized the need for collaboration and access to local communities,” she explains. “Our Duke Cancer Network was established in 1993 to facilitate interaction with a number of affiliate cancer centers in the community. The network started as the Duke Oncology Outreach Service.”
The importance of collaboration is clear to Gosselin. “I think it comes down to learning from one another and sharing best ideas and practices,” she says. “Our community sites are critical to our nursing practice council, as we all want to ensure patients receive the right care that is evidence based.”
Creating these partnerships can come with a number of obstacles, mostly related to communication, visibility, understanding, and the direction of the program, Gosselin says. But nothing is insurmountable.
“Distance and the ability to be visible are two common challenges when new sites of care are introduced,” she says. “But as our technology improved, we began using WebEx [an online meeting service] to minimize time on the road for all parties involved.” Electronic medical records and other online capabilities have facilitated access and the ability to share pertinent information and data.
Communication between sites is key, Gosselin says. “When I have the opportunity to be on site, I like to hear from staff. And we have an oncology nursing newsletter that goes to all our oncology nurses across our health system.”
But not all community sites will have the same needs when it comes to communication and implementation. She notes, “We look for opportunities on how to standardize the work we do, but it comes down to building relationships and getting to know people on both sides.”
An important component of academic-community partnerships is access and enrollment in clinical trials. Clinical trials have long been regarded as integral components to move cancer treatment research forward.
“By having additional sites open to patient enrollment, we are able to recruit patients to our studies sooner which benefits everyone in the end,” Gosselin says.
The extended reach of enrollment provides researchers with more subjects in their trials, while providing clinicians access to research experts and consultations. Not only do these partnerships enhance patient care, but they inspire new generations of researchers.
Moreover, partnerships with academic cancer facilities increase the quality of care given across the cancer care continuum. According to a recent study, “optimum cancer care is best delivered as a continuum from prevention, screening, early detection, and diagnosis to treatment, surveillance, survivorship, palliative care, and end-of-life care.” In the past, however, many of these assets haven’t been nearly as accessible in community cancer centers.
Community Cancer Centers Meet the Need
The Cancer Center at Maria Parham Medical Center in Henderson, NC, a Duke LifePoint Hospital, is one such community cancer center that has benefitted from its relationship with Duke. “We definitely have better access to resources,” ONS member Julia Falkner, BSN, RN, OCN®, manager of Maria Parham Cancer Center, says. “We have access to continuing education, clinical practice support, and program development. In addition, our providers are able to quickly access the Duke medical record as well as discuss cases in real time with experts from Duke.”
Recognizing the capabilities of a community-based cancer center and addressing its needs to implement change is an important first step when creating a partnership. According to Falkner, “When partnering with academic-based cancer centers, you are provided with resources that otherwise wouldn’t be there. Beyond clinical trial access, we also have disease experts for all cancer specialties.”
For many of these local sites, access to clinical trials is just the beginning. Receiving support from an academic center can help sustain and implement a number of other programs. “We are able to meet or exceed the goals for the American College of Surgeons Commission on Cancer accreditation, which has been tied to improved patient outcomes,” ONS member Amy Boswell, MSN, RN, OCN®, director of Maria Parham Cancer Center, says. “It also provides an avenue for access to expert faculty either through one-on-one consultations, tumor boards, further education, or patient referrals. We’ve also recently begun embedding Duke staff, such as my position, into the program to add to the onsite collaboration between Maria Parham and Duke.”
The relationship between academic and community cancer centers offers the best of both worlds in a convenient location. “We are able to provide an excellent patient experience and quality of care close to the patient’s home while having access to all of the benefits and resources of Duke,” Boswell says. “The standard of patient care in the community has absolutely improved through our partnership.”
With the new focus on the moonshot to cure cancer, one of the initiative’s main efforts will be increasing enrollment in clinical trials. It’s expected that academic-community cancer center partnerships will play a significant role in that recruitment as more of such partnerships are cultivated, developed, and implemented in the future.