April 10, 2015
4 min read

Better cancer care: My ‘one thing’ to learn more about this week

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In the past few weeks, I have been fortunate enough to be involved in several strategic retreats.

These retreats have involved different groups of individuals from different parts of our organization, but there have been many common themes — reassuring to know that the diverse components of our complex enterprise are aligned.

The required reading for one of these events was a book, titled “The One Thing” by Dan Keller. This book provides strategies for maintaining focus in our professional and personal lives, identifying clear goals and planning a clear path to achieve those goals to the exclusion of any potential distractions.

John Sweetenham, MD, PhD

John Sweetenham

Overall, I could not relate to the philosophy of the author. It seems to me to be a road map for self-interest and the fulfillment of ambition, ignoring the demands and needs of others — not really something that those of us in health care can easily embrace.

Putting aside the self-improvement theme of this book, it did bring home the magnitude of the challenge to maintain focus at a professional and organizational level, given the many demands on our time and resources. For me, the most important take-home message from the book was very simple: Every time we say “yes” to something, we are saying “no” to something else.

Partnerships and pathways

As we discussed our strategic priorities, this message resonated. I’m not sure that I emerged from any of these meetings with our institutional “one thing” clearly defined, but high on the list is our need to develop partnerships to deliver community-based cancer care, ensure consistently high-quality care across our catchment populations, and also ensure that those patients who need access to clinical trials or to tertiary and quaternary cancer care can get it quickly and easily.

Saying “yes” to this concept is easy. Most of us would agree that this is an important priority and that the consolidation in health care currently taking place as a result of the Affordable Care Act is facilitating the move toward community/academic partnerships in oncology. We are starting to see a growing number of affiliate networks in which large cancer centers are partnering with community-based oncology groups — either through acquisition or various other models — to extend their reach and enhance their brand in anticipation that this will drive referrals for complex cancer care.

If well organized, patients stand to benefit enormously from highly coordinated and consistent cancer care, delivered close to their homes whenever possible. Central to the success of these partnerships are common approaches to treatment and a shared culture around quality and value. Developing and following care pathways is likely to be a key component of successful, lasting partnerships.

As I am writing this editorial, I am traveling to the National Comprehensive Cancer Network’s 20th Annual Meeting in Hollywood, Florida.

ASCO and NCCN have been the leaders in developing evidence-based guidelines for cancer care in the United States and internationally. Most of us who are involved in developing institutional care pathways will agree that consistency with these guidelines is an absolute requirement, not only because of the evidence-based quality of the guidelines, but also because third-party payers look to these guidelines when making coverage decisions.

The benefits of pathway-based treatment have been widely published. Multiple publications have shown that when patients with cancer are treated in a consistent fashion on agreed, evidence-based pathways, reduced variability in care results in improved quality, better outcomes and reduced cost — all of which are essential as we move toward a value-based health care model.

So, there is little disagreement that pathway-based treatment is better and that shared pathways are central to successful cancer care networks. The challenge is in developing agreed care pathways, providing IT decision-support to direct physicians and other providers to the appropriate care pathways, and having the ability to monitor adherence and deviation from these pathways as part of a quality oversight program.


All of this is difficult within the context of a single institution. To do this across a network of hospitals and practice groups of varying sizes with different resources becomes an even greater challenge.

‘An iterative process’

As I participate in the NCCN meeting during the next few days, more than anything else, I am hoping to learn best practices from those groups that are already having success at developing shared pathways across large networks of cancer centers.

My impression to date has been that we are all at different points along the learning curve of how to build successful affiliate models. Furthermore, there are already many examples of unsuccessful attempts to build such relationships. Many of these appear to be based on “brand sharing” alone, and seem to last for 2 to 3 years at most.

There seems to be an emerging theme that the ability to align cultures and to reach consensus over care pathways is an important component of successful affiliation networks. Reaching agreement on pathways is — as we have found at our own institution — an iterative process, at times challenging but highly valuable in developing relevant approaches as well as a team approach to cancer care. Whether this converts into true patient benefit is still unknown, but as support for big data collection efforts improves, the impact on outcomes will become apparent.

So, if we are saying “yes” to the concept of affiliate networks and shared care, what are we saying “no” to?

From the academic cancer center perspective, we will need to accept less academic freedom over treatment choices in favor of evidence-based approaches. Additionally, we may need to accept that many of the clinical services we provide at large centers may be more effectively delivered in a community-based manner, freeing up resources for tertiary and quaternary cancer care.

From the community oncology perspective, a balance will need to be struck between productivity and the need to further clinical research and refer appropriate patients for specialized care according to agreed protocols.

I expect to return home with new insights into how we can build pathways and partnerships that will be of true benefit to patients with cancer across our community. This will be my “one thing” for now.

For more information:

John Sweetenham, MD, is HemOnc Today’s Chief Medical Editor for Hematology. He also is senior director of clinical affairs and executive medical director at Huntsman Cancer Institute at the University of Utah. He can be reached at john.sweetenham@hci.utah.edu.

Disclosure: Sweetenham reports no relevant financial disclosures.