One upon a time, most cancer sufferers sought out specialists at one of the 48 cancer hospitals accredited by the National Cancer Institute (NCI) in big cities like New York, Chicago and Los Angeles. But with the number of trained oncologists shrinking annually and the demand for “patient-centered” care rising just as fast, larger metropolitan hospitals are increasingly looking to local cancer treatment facilities to bring new patients through the door.
And they are getting some unexpected help from a growing number of local funders—many of them newcomers to the healthcare field—who are providing critical seed money for “bricks-and-mortar” projects from southern California to New England.
In Maine, for example, the Harold Alfond Foundation recently pledged $10 million to establish the MaineHealth Cancer Care Network, which links cancer treatment facilities in Maine and northern New Hampshire to Boston's NCI-accredited Dana-Farber Cancer Institute. The idea is to make Farber’s premier oncologists available to patients throughout the expanded network while boosting local care infrastructure in areas like palliative care where highly trained specialists aren’t really needed. Cancer patients are provided with a “patient navigator” that helps them identify their specific treatment needs and to coordinate a team of diverse providers in different locales. Those that need a second opinion or highly specialized cancer care might still have to travel outside their immediate treatment area—but otherwise, the bulk of their care is located nearby—either immediately onsite, face-to-face, or through video teleconferencing.
"Our network includes nearly 300 providers across Maine and the Mount Washington Valley," said Dr. Scot C. Remick, chief of oncology for Maine Medical Center and MaineHealth, in an interview with MaineBiz.
The MaineHealth “coordinated care” model is an extension of the approach taken at MaineGeneral, one of its affiliates based in Augusta. Greg Powell, chairman of the Harold Alfond Foundation, says the new network will build on the success of both MaineGeneral's Harold Alfond Center for Cancer Care (HACCC) and the Maine Medical Center Cancer Institute, two award-winning clinics also funded by philanthropic gifts. In 2010, HACCC became one of the first 16 cancer practices in the United States–and the first site in Maine—to be recognized by the American Society of Clinical Oncology's Quality Oncology Practice Initiative (QOPI) certification program.
Another local experiment is unfolding in Baltimore, where builders are nearing completion of a patient care annex to the Sidney Kimmel Cancer Center at Johns Hopkins Hospital. Funded with a $65 million gift from the estate of Albert P. "Skip" Viragh, Jr., a mutual fund investment manager and philanthropist who died of pancreatic cancer at Johns Hopkins in 2003, the new building includes a cancer diagnostic and treatment planning center where patients receive coordination of diagnostics for new cancer cases, advanced cancer imaging services and spaces for family conferences and tumor board meetings.
"Skip was an innovator in his world of personal finance, and, through his legacy gifts, he continues to partner with Johns Hopkins innovators in cancer care," Kimmel Cancer Center Director William G. Nelson said in news release. "The new building will be far more than a place for physician visits and diagnostic scans. It will be the place where we'll explore novel ways to deliver cancer care and cures."
Experts say it is difficult to assess these claims. Coordinated cancer care modalities have received high marks in the past, but according to an investigative report, industry critics worry that hospitals and philanthropies may be misleading patients about the quality of care they can expect to receive. Many new patients, especially those from underserved communities, also lack the knowledge and expertise to assess the claims of competing providers.
Some of the local cancer centers may be engaged in deceptive marketing practices. For example, it is commonplace for newer facilities to suggest that the “comprehensive” services they offer are on par with those of big-city hospitals, which may be true in some treatment areas, but not in many others. A new cancer center being built in Santa Barbara with an $8.2 million gift from philanthropist and Pacific Air President and CEO Lady Leslie Ridley-Tree makes just such an expansive claim. The idea of a one-stop “community-centered” cancer treatment facility has advertising appeal, critics say, but most patients may require diagnosis or treatment from an oncology specialist that is only available elsewhere.
Despite a general consensus that “coordinated” cancer care is helpful, there is also little consensus on which of several popular models works best. At least one recent meta-study found no evidence that the three most common coordinated care models actually led to improved outcomes. Other studies have found the main achievements to be reduced hospitalizations and higher patient satisfaction. The Commission on Cancer of the American Council of Surgeons lists 1,500 separate accredited cancer programs, but takes no position on how well they actually serve cancer patients in the field.
The new cancer treatment drive fueled by local funders is visible in all parts of the country. In Berlin, Maryland, the John H “Jack” Burbage Regional Cancer Care Center—named for an eminent local banker and real estate developer—is scheduled for completion in the spring of 2018. Another impressive new effort is the University of Tennessee’s West Cancer Institute, which supports new cancer research and outpatient services through an expanding network of 18 facilities throughout the state. The West Cancer Institute, which bills itself as “the region’s comprehensive leader in adult cancer care and research, delivering a complete continuum of care to more than 30,000 individuals each year,” is primarily funded by two local philanthropies—Kemmons Wilson Family Foundation and the Plough Foundation–and by corporate and individual donors active in the medical supply industry.
In some regions, religious charities funded by individual church contribution are taking the lead. A good example is Baptist Health Foundation in Paducah, Kentucky, which just launched a new $20 million cancer center to be named for its lead donors, Kay and Ray Eckstein, who recently lost family members to cancer (Kay Eckstein herself died on June 20). The Kay and Ray Eckstein Family Charitable Trust, established in 2005, supports the work of religious charities on a non-denominational basis. However, its funding support for Baptist Health was its first capital grant under the foundation’s new “Vibrant Communities” program.
In recent years, local philanthropies have increased their public visibility and standing by jumping into cancer care. However, not all of these charities have the kind of strong background in healthcare—let alone cancer care—to ensure that their visually impressive "state-of-the-art" projects are set up to deliver quality care. At their best, perhaps, these projects lessen some of the fragmentation and confusion that has long plagued cancer care. At their worst, they can leave desperate cancer sufferers stuck in the middle of nowhere, trying to access sub-standard care.
The need exists—the number of cancer diagnoses is expected to mushroom by 45 percent in the next two decades. However, philanthropies need to tread carefully in this space, taking care not to over-promise and to follow up with rigorous evaluations to determine how their prestigious new centers are actually being used—by whom, and with what impact on patient disease condition.