What Scripps MD Anderson Means for Cancer Care in Southern California (podcast)

Immediately we want to be there for people, and help them recognize that where you get your cancer treatment really matters. We want to welcome them to Scripps MD Anderson Cancer Center, and we want to do so in a very patient-centric way.

We've started to employ a nurse navigator system, and in fact have doubled the number of nurse navigators we have available for patients. So, right away a cancer patient will be greeted by a warm and caring medical professional, who's 100 percent dedicated to cancer and not only has that medical expertise but also a nursing degree, someone who gives that empathy, that warmth both for the patient and their family and can help assure that they find the right treating team, in the right location at the right time. We want to immediately provide access to the health care professionals. And by working with nurse navigators, they can help arrange initial evaluations in what we call multidisciplinary clinics.

The nurse navigators hold your hand. They walk you through the process. But also their expertise can allow insight to get you to the right providers at the right time.

I mentioned these multidisciplinary clinics. These are a new way of delivering cancer care here in Southern California. Whereas previously a cancer patient would come and receive fragmented opinions, maybe in different geographic locations, or different periods in a calendar week, now all the doctors are coming together around the patient in a very patient-centric way.

In one appointment now, a newly diagnosed patient can see a surgeon, a medical oncologist and a radiation oncologist. A patient could actually see and appreciate the importance of these disciplines working closely together to come up with a treatment plan that is most comprehensive for the individual patient.

The nurse navigator helps to coordinate that we have the right specialists in the room to give the most comprehensive immediate feedback to the patient. They're with them through the journey... While they're not going to be calling your insurance company for you, they'll be working with our expertise here in our business finance office, for example, to assure that we eliminate the financial burden of your care as well.

We hope that patients feel like they could just reach out to Scripps on a 1-800 number. Or certainly their primary care doctor can be referring them to Scripps. And they could just say "I'm a new breast cancer patient. I'm in need of the best care possible. I want to come to Scripps MD Anderson." And almost immediately, we hope within the same day, or clearly by the next day, they'll be receiving a call from a nurse navigator, who's specialized not just in cancer, but in breast cancer care.

We have the good fortune of having a health care system that spans the majority of San Diego County. So, we're developing multidisciplinary programs as far south right now into central San Diego, and as far north to Encinitas, with our major epicenter of cancer focus here in the La Jolla region in Scripps Green Hospital.

We're very excited about the construction of a new physical building, to be called Scripps MD Anderson Cancer Center at Mercy. But in the meantime, of course, we're still continuing to offer Scripps MD Anderson cancer care on our Mercy campus during this construction period.

We want to bring the cancer care to the patient. There are going to be times when perhaps we feel a surgical procedure should be done in a particular location because of its complexity and the support of care. But there are other times, too, when you have to undergo a sequence of treatments for months. Radiation therapy, for example — I'm a radiation doctor — frequently that entails daily treatments that can extend over five, six weeks of time. To have the availability to give that close to their home, close to their workplace environment, such that they don't have to battle traffic everyday, we want to offer those services.

It's really an outstanding, close, interactive relationship. I've worked at MD Anderson for some time, so I have a personal relationship with all the leading cancer physicians there in Houston. We could, for instance, offer or gain a second opinion on a challenging case for a patient, without them having to ever buy a plane ticket.

We have specific web-based physician-to-physician liaison programs that will tap into the expertise of physicians who solely focus perhaps on a very rare type of cancer, and will be able to help us assure that we're choosing the right treatment for the patient.

Cancer is complex even in the most common types. No two cancer cases are ever alike. So, one of the things we want to do here too is to begin to further subspecialize. As we grow our program, we're going to have our doctors really pick one or two disease sites, and go deep. Now, that's been a model again that's been at MD Anderson for some time, where each of the physicians at MD Anderson choose a particular disease site and really become international experts in that field. So, that's one potential advantage of this relationship.

But it's not just the common cancers that we're dealing with here. Already at Scripps, we're a regional referral center for the more unusual things. We offer specialized programs, say in stem cell transplant for some forms of leukemia and other blood type of cancers. We have leaders in sarcoma, or soft tissue or bone tumors that are again pretty unusual. We have a very active liver transplant program for liver cancer, really one of the leading in the world. So we've always treated at Scripps both common malignancies, like breast, lung, colon cancer, prostrate cancer, skin cancer, and a variety of unusual diseases as well.

Certainly, we have the ability in our close relationship to have people seen in Houston, but at the same time I think we're going to be bringing some of their expertise here to San Diego.

I'm as passionate about academics as I am about clinical care. This is arguably the most exciting time in cancer history. Over my short professional life, I've been able to truly witness transformation in outcomes of cancer. Patients that I see today and optimistically tell them and their small school age children that you have a 90 percent chance of cure, maybe at the start of my career, I would recognize they really didn't have more than six months to live. And it's really because of this discovery research and the clinical trials, leading to new therapeutics, new lines of treatment, that really are making a major impact.

At Scripps we don't just want to be the first to implement; we want to be the ones who discover and lead others to implement. We have a rich environment. We actually have a rich tradition at Scripps. Some of our colleagues throughout the greater bioscience communities and Scripps partner together for some of the first drugs that were effective in leukemia, particular types of leukemia that still are standards of care today. That's a truly exciting concept, to be a part of such an organization.

So, yes we are going to be collaborating with Houston. We are going to identify which clinical trials fit best within our portfolio, and offer patients here enrollment in such trials.

There are still going to be trials that we have to conduct that won't be available in Houston, and likewise there are going to be trials where patients would still have to receive the treatment in Houston. But having this relationship can only facilitate those cross fertilizations. And if we identify a clinical trial that we think is a good fit for a patient, we could readily access and facilitate them going to Houston and still receive the components of care back here in San Diego.

First, the exciting good news about declining death rates. As I mentioned there's been a host of new advances. It's really across all disciplines. Surgery is getting better. It's getting better utilized. It's causing less morbidity. My field, radiation oncology, is being proven to be an important component of cure. And likewise our technologies have improved, such that the toxicity or side effects are going way down. And then you have systemic treatments. We used to have chemotherapy, and then targeted therapy, and now we have immunotherapy, where we're getting the body's own immune system to fight against the cancer. So, all these contribute to decreasing death rates.

In addition, early detection, public education, cancer prevention efforts like tobacco cessation — one of the greatest success stories we've seen is decreasing rates of tobacco use, which can promote some of the more deadly forms of cancer such as lung cancer — all these things have contributed."

So, why do we see a decrease in death rates, even though there is an increase in incidents? That in part is a good news story, too. I always joke and I say it's because of the cardiologists.

Cardiologists are the greatest risk factor now for getting cancer, and it's not really the cardiologists. They help prevent death from cardiovascular disease. And as we're getting better at treating cancer, and cardiologists are getting better at preventing deaths from cardiovascular disease, then people are aging. Still, the number one risk factor for getting cancer is age. And as people get into their 70s and 80s more commonly now, we're going to see still new cancers developing.

We hope to treat it somewhat like a chronic disease state. Sometimes we'll appropriate a treatment approach that's really customized to the individual, and try to just arrest the disease so that it's not their most life-threatening problem.

I think you're going to find a warm, caring environment. I think you're going to find an environment where you have great confidence in your care team. Most importantly you're going to find a holistic approach to cancer. You're going to be able to physically see your surgeon talking to your radiation oncologist, and talking to your medical oncologist. And as you watch those interactions, you'll appreciate the complexity of the decision making, and how not just each of these has to be an important skill set, but the coordination and integration of these have to be optimized to get the best outcome.

You're going to see interactions with dieticians. You're going to see interactions with social workers and our outstanding nursing staff. You're going to see a great degree of caring, too. You're going to see a great degree of caring and hope.

I love that logo and that tag line of "Making Cancer History®." You wake up as a cancer doctor each day, recognizing the urgency of what we do. To just meet young families, and optimistically share good news to them, and recognize that without this degree of urgency and this effort put forward, that suddenly you could have a child without a mother. Or you could close the door as a doctor and have a very uncomfortable and sad situation.

We're witnessing history being made right here, right now in San Diego. We're witnessing the impact that research can have, that outstanding clinical care can have, that cancer prevention efforts can have, and it's a tremendously rewarding profession in which I work. And it's a privilege to be here and to help lead this effort.