Thinking outside the box: Bringing primary care into the cancer center
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Two statements on my office desk — “Think outside the box” and “Only those who see the invisible can do the impossible” — center around thinking in an original or creative way.
I’ve used the phrases many times in my career — at meetings that were set up to develop new projects for patient care, educational opportunities for training programs or initiatives to improve the quality of care.
At these meetings, I’ve emphasized that when thinking outside the box, you should not let the question of resources stifle your ideas. It’s better to think through the process of a new project and then consider the needed resources. On countless occasions I have seen good ideas dropped because individuals convinced themselves that resources would not be available to see the project through.
A novel approach
I bring up the idea of thinking outside the box because at a recent multidisciplinary team meeting at ChristianaCare's Helen F. Graham Cancer Center & Research Institute, we discovered that many of our patients do not have a primary care physician. An informal survey among our patients with cancer indicated that as many as 30% do not have a PCP.
I believe this is an issue that many cancer institutions face across the country. Patients with cancer who don’t have a PCP usually end up in the ED for nonemergency problems. The ED is not the place for evaluation of a sore throat, earache, skin rash or cough.
The other issue is getting a timely appointment with a PCP, whether virtual or in person.
As these issues were discussed, we considered the concept of placing a PCP office in the cancer center itself. As our director of quality and safety explained, we would want to take care of primary care problems that arise during cancer treatment to reduce urgent care or ED visits and, secondly, after cancer treatment, to help our patients continue to have their primary care needs addressed.
Because cancer has evolved into a chronic disease, a considerable number of patients diagnosed with cancer have other comorbid conditions, including heart disease, hypertension and diabetes. What better place for a patient with cancer to see a PCP than at the cancer center?
Under this care concept, the PCP is fully immersed in the cancer center environment, which becomes an educational setting for them. Easy access to our tumor boards and multidisciplinary disease site centers makes the PCP a member of the multidisciplinary cancer team. We tend to think of the surgical, medical and radiation oncologists as key members of the multidisciplinary cancer team; however, there is no question that the PCP should be part of that team, too.
By adding a PCP onsite at the cancer center, we are taking a novel approach to providing both the latest cancer treatments and care designed to improve our patients’ long-term health.
Focus on cancer survivorship
Speaking of education, here’s another outside-of-the-box thought: Why not consider a primary care oncology fellowship?
The number of people living with a cancer diagnosis is expected to reach almost 19 million by 2024, up from 14 million in 2014. We can’t expect oncologists to take care of all these survivors. This is a great opportunity to involve PCPs.
A primary care oncology fellowship would be a unique approach to cancer survivorship. To our knowledge, there are no fellowships or specialty training programs for providers who specialize in both primary care and oncology care.
In January, with the approval of our hospital administration, we placed a PCP office in our cancer center. If this is successful, we will seriously consider a primary care oncology fellowship. We hope other institutions will do the same so that patients with cancer will continue to have their primary care needs addressed during and after cancer treatment.
If you don’t think this is a good concept or doubt that it would work at your cancer center, I refer you back to the statement, “Only those who see the invisible can do the impossible.”
For more information:
Nicholas J. Petrelli, MD, FACS, can be reached at npetrelli@christianacare.org.
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