Actualizing high-quality coordinated cancer care

Russell Gollard, MD­, Medical Director, Optum Care Cancer Care

Southwest Medical, part of Optum Care, is one of Nevada’s largest multi-specialty medical groups. We’ve been caring for southern Nevadans since 1972. We have decades of experience and a drive to better our patients' lives. 

By combining technology and information, we give our patients the right care in the right setting. We provide primary, specialty, urgent, senior, ob/gyn, pediatric and convenient care. 

Over 15 million people were estimated to be living with cancer of any site in the United States in 2016.¹ Over 1.75 million new cases of cancer are estimated to be diagnosed in 2019.1 The burden of cancer is large, with profound psychosocial and economic impacts on society. 

Cancer care delivery is a daunting and complex challenge. Indeed, the Institute of Medicine (IOM) identified a need for a new course of cancer care, based on what it labelled “a crisis in cancer care delivery” in a 2013 report.²

The IOM committee pinpointed numerous barriers in delivering optimal cancer care for all patients, including the rise in demand for cancer care, a shrinking provider workforce, growing healthcare costs, and an increasingly complex disease and treatment landscape. 

In their report, the IOM committee also proposed a conceptual framework and strategies for improving cancer care delivery including: 

• Patient engagement 
• Adequately staffed, trained, and coordinated workforce 
• Evidence-based care 
• Translation of evidence into routine clinical practice
• Improvements in healthcare information technology
• Accessible and affordable care 

The recently launched Cancer Center in the Las Vegas Medical District incorporates IOM recommendations, offering interconnected components delivering high-quality cancer care for better patient outcomes. 

The expansion of services anticipated in the second phase of development will further the goal of delivering cutting-edge coordinated cancer care in this region; an expanded breast care department, imaging center, patient and family resource library and café are planned in the second phase of development.

The right people

The Cancer Center uses an integrated model of care, delivering care centered on the patient’s needs. A robust staff is utilized, including 10 medical oncologists, 2 breast surgeons and 5 radiation oncologists focusing on the oncological treatment. 

We recognize that cancer impacts more than just the body; therefore, we utilize staff that care for the holistic effect of cancer and its treatments. Six oncology nurse practitioners coordinate and enhance care delivery from diagnosis to survivorship. 

A clinical psychologist is also available to provide mental health services specific to cancer patients, in addition to a doctor of pharmacy to assist with maintaining evidence-based protocols.

Advancing with the field

Cancer research is a fast-moving field dependent on good clinical team work. There is a significant focus in the program on integrating current literature and developments into patient care. 

A Breast Tumor Board that convenes every two weeks puts clinicians in the same room, facilitating multidisciplinary decision-making and management plan adjustments. 

Designed and built with the patient’s care experience and comfort in mind, the Cancer Center features 26 semi-private infusion suites for patients undergoing chemotherapy. 

Treatment services offered include medical oncology, hematology, radiation oncology, surgical oncology, chemotherapy, immunotherapy, breast care, imaging, genetic counseling, palliative care, and laboratory services, with additional services anticipated in the future. 

Both high tech and high touch, treatment at the Cancer Center is truly patient centered. Tailoring treatment for each patient based on their specific disease profile, personal goals and preferences means that our staff must have good comprehension of our patients as people. 

In addition, specialized molecular diagnostics to help us deliver personalized cancer care based on the most recent guidelines for molecular testing and assessments allows us to know them on a cellular level, as well.

Integrating palliative care 

For cancer patients, coping with treatment side effects can be as great a burden as the disease. 

While traditional oncology practice relies on a tumor-directed approach, which focuses primarily on treating the disease, palliative care banks on a host-directed approach, focusing on the person with the disease instead.

Included at the Cancer Center, palliative care may offer solutions for pain, nausea, fatigue, and other symptoms. 

The patient-centric approach in palliative care has been shown to provide benefits over traditional oncology, including better quality of life, improved symptom management, reduced anxiety and depression, less caregiver distress, and more patient preference-concordant care.⁵

In addition to improving outcomes for patients with advanced cancer, palliative care in oncology has broad research and guideline support and has proven cost effective. 

An integrated oncology practice that has palliative care built into the framework, with services and support provided in-clinic where treatment decisions are being made and implemented on a routine basis allows us to deliver optimal care to our patients. 

Looking ahead: Value of shared insights in oncology practice 

By participating in numerous studies in various types of cancers and developing clinical studies in-house, we improve patient access to care and stay current with emerging treatments in oncology.

 An oncology fellowship program in association with our group is another component to add. Finally, we are pioneering value driven care, aligning our treatments with evidence and eliminating waste.

We are developing closer relationships with other oncology groups within Optum Care. Shared insights on best practices with specialists and groups spread throughout the country can benefit all stakeholders in the oncology community at Optum Care.