The 6th Annual Community Oncology Conference, held in Las Vegas in February, brought together physicians, nurses, nurse practitioners, physician assistants, pharmacists, practice administrators, and industry representatives to discuss the latest advances and trends across all aspects of community practice—clinical, administrative, and operational. Many attendees commented on the depth and quality of the clinical presentations, and there was unanimous agreement that from administrative and operational perspectives, fundamental change has come to community cancer care.
In this issue of Community Oncology, we feature reports on some of the presentations from the conference. On the clinical side, one of the founders of geriatric oncology, Lodovico Balducci, MD, of the H. Lee Moffitt Cancer Center in Tampa, spoke on the challenges presented by a growing population of aging cancer patients and the implications for treatment and supportive care (p. 183). He emphasized the importance of factoring in the risks of mortality and toxicity when deciding on therapies for elderly patients.
Mario E. Lacouture, MD, of the Memorial Sloan-Kettering Cancer Center in New York, tackled some misconceptions about skin toxicities. After identifying and describing some specific conditions, he offered advice on therapies—some remarkably easy to use and affordable—and prevention of therapy-related dermatologic events (p. 186).
Noopur Raje, MD, of Harvard Medical School in Boston, reviewed myeloma therapies from the 2010 Annual Meeting of the American Society of Hematology. On page 181, Dr. Raje presents the Oncologist’s Viewpoint of this month’s Community Translations on two novel agents, carfilzomib and pomalidomide, which have produced encouraging phase II data.
Other clinical presentations from the conference will be featured in an upcoming supplement to this journal. They will include talks on novel HER2-targeted therapies (Jame Abraham, MD), gastrointestinal and colon cancers (Alex Grothey, MD), lymphoma (David H. Henry, MD), advanced non-small cell lung cancer (Ronald B. Natale, MD), melanoma (Steven O’Day, MD), prostate cancer and biologics (Cary N. Robertson, MD), bone-targeted agents in breast cancer patients (Alison T. Stopeck, MD), and PARP inhibitors in treating breast cancer, which I presented.
In the talks on practice operation, four themes emerged: quality measurement; the importance of collaboration within the community oncology network; consolidation between community practices, hospitals, and organizations; and patient-centered care.
Quality measurement has begun
Measuring and quantifying processes and outcomes to support quality care are no longer theoretical—they are here, and their use is growing rapidly. Process improvements include reorganizing practices, a crucial step in maintaining practice financial health in the current economic milieu. Cathy Maxwell, RN, OCN, of Advanced Medical Specialties in Miami, described how her practice improved patient satisfaction and streamlined practice efficiency after they reorganized the reinfusion room by scheduling chair time separate from the physician visit. Patients welcomed the new system, even though it meant they had to make more visits, because waiting times were dramatically reduced (p. 188).
David Fryefield, MD, of US Oncology, showed how a measured process can be improved by analyzing variances from target and identifying the cause of those variances. Dr. Fryefield leads an effort at US Oncology to improve practice quality and efficiency (PQE) by using the elements of Lean Six Sigma (LSS), a method for enhancing quality and efficiency that originated in automotive and semiconductor manufacturing. By applying the PQE−LSS process, he demonstrated how common practice problems such as staff inefficiency, patient wait time, and the use of capacity can be improved, often with a reduction in total staff.
Linda Bosserman, MD, of the Wilshire Oncology Medical Group in La Verne, California, and an Editor of this journal, described how practices can align data and incentives to improve the quality and cost-effectiveness of care. She said that with a functioning electronic medical record system in place, practices could capture and track patient demographics and data on care plans and outcomes, which would allow them to establish the best and most cost-effective course of treatment for a given cancer patient throughout the continuum of care. Dr. Bosserman stressed that clinicians should lead the care delivery model at every level: in the development and implementation of evidence-based guidelines, in the coordination of evaluations and care, and in the supervision of the delivery team and sites of care.
Collaboration is critical
Perhaps the most meaningful session was a panel discussion among representatives from across the community oncology practice spectrum. The overriding theme of the discussion between Allen S. Lichter, MD, of the American Society of Clinical Oncology; Matthew E. Brow, of the US Oncology Network; Matthew Farber, MA, of the Association of Community Cancer Centers; and Ted A. Okon, MBA, of the Community Oncology Alliance, was one of unity and collaboration: to speak with one voice for organized community oncology (p. 189). They agreed that the need for consensus is crucial, given the enormous pressures on practices from governmental regulations, health plan demands, and patient expectations.