Specialized, Coordinated Care

Photo Credit: Mass General Cancer Center

No one physician can be an expert on all types of cancer, because not all cancers are alike. Each type has its own unique features, symptoms, and treatment needs.

Over the past 10 years, researchers at Massachusetts General Hospital Cancer Center have studied the differences among cancers, learned how specific cancers operate, and as a result are changing the way cancer is treated today.

Gone are one-size-fits all cancer treatments. Instead, today, physicians fighting cancer realize that, if possible, they have to stick to a specific area of expertise to most effectively treat patients. This ensures that patients receive the right diagnosis and the right treatment as soon as possible—which gives patients the best shot at a positive outcome.

Cancer Sub specialties

Cancer is actually not just one, but many diseases, each with different causes, patterns, and treatments. Breast cancer is different from bone cancer, which is different from lung cancer. And even two patients with breast cancer may have very different types of the disease.

To treat each type most effectively, physicians need to find out specifically which subtype a patient has. For example, there are four main types of breast cancer. Each kind requires different treatments. To determine which kind a patient has practitioners need to perform an in-depth molecular analysis to find out if targeted therapy, immunotherapy, hormonal therapy, biologic agents, or chemotherapy is best.

The experts at the Mass General Cancer Center understand the complexity of individual types of cancer and have devoted their careers to developing deep knowledge of specific cancers and their various subtypes.

And it’s not just the treating physicians who are specialists. The pathology department, which examines specimens based on their histology and also genetic molecular characteristics, has 13 sub-specialties. The radiology/imaging department has 12.

Pathologists specializing in melanoma, for example, understand the disease in a very detailed way. This allows them to give patients a more precise diagnosis and prognosis. Similarly, a radiology sub specialist with an expertise in breast cancers is highly skilled in detecting abnormalities on breast images.

On the Forefront

But it’s not enough just to develop an expertise; practitioners also have to be constantly learning and evolving with rapid scientific and clinical advances. Physicians at the Mass General Cancer Center are on the front line of sub-specialty research and innovation. Through the Center for Cancer Research, oncologists and other physicians and medical professionals are always adding to their knowledge thanks to an ongoing collaboration with scientists who are working to gain a deeper understanding how cancer affects a person and how it operates at the molecular, cellular, and tissue levels.

The ultimate goal is to create more effective treatments for cancer and to learn how to prevent it. Researchers also collaborate with engineers, neuroscientists, molecular biologists, chemists, and other experts at the Massachusetts Institute of Technology and elsewhere in a search for ways and tools to diagnose cancer more effectively and to find devices and surgical techniques that can stop it in its tracks.

Mass General’s Termeer Center for Targeted Therapies conducts phase I clinical trials to quickly bring successful strategies and discoveries to the patients that need them most. Many of these trials, as well as phase II and III trials, look at ways to target specific cancers using genetic information. For example, Lecia Sequist, MD, and Alice Shaw, MD, have performed detailed research looking at specific subtypes of non-small cell lung cancer. Their work led to the design of treatments that could help patient with specific types of that disease.

Trials also offer opportunities to patients, not only to try innovative therapies, but also to meet with physicians who are experts in their specific type of cancer.

Coordinated Teams

In order to successfully treat cancer, different specialists need to work together. At the Mass General Cancer Center, patients receive treatment from a team that includes different specialists all working toward the same goal. There are eight sub specialty teams, including gastrointestinal, thoracic, genitourinary, sarcoma, head and neck, lymphoma and gynecologic cancers.

Patients who come to the cancer center meet with the entire team on their first visit. The team then works together to tailor a care and treatment plan based not only on what is best approach to target the cancer that patient has, but one that also respects the individual’s needs and preferences. The team continues to monitor that patient’s progress in weekly clinics and meetings with the patient.

Members of a patient’s care team might include:

Pathology and radiology sub-specialists to precisely diagnose the cancer;

Medical oncologist to prescribe the appropriate biologic agents, immunotherapy, hormonal therapies , – and chemotherapies, including novel therapies;

Surgeons experienced in new approaches and technologies;

Radiation oncologists practiced in delivering high therapeutic doses while protecting healthy tissue;

Oncology nurses and nurse practitioners who provide patient-centered care;

Other team members may include a bone marrow transplant team, interventional radiologist, palliative care nurse, nutritionist, psychiatrist, social worker, and/or chaplain.

As cancer becomes increasing specialized, the enormous resources available at a major academic research hospital, working together with community hospitals, may put patients in the best position to beat their disease.

Recreating Sub specialized Teams in the Community

Many cancer patients want a local doctor to treat their cancer, but don’t want to miss out on the expertise of an academic medical center. To allow patients this convenience without sacrificing quality, Mass General Cancer Center has established a network of affiliated centers and satellite hospitals that are linked with the main campus in Boston. This medical oncology program is led by Joel Schwartz, MD, and is based, in part, on a template he developed at the Mass General/North Shore Center for Outpatient Care in Danvers, Massachusetts.

Oncologists in the affiliated centers are encouraged to specialize in one to three areas of cancer, and each specialist interacts with the corresponding sub-specialized multidisciplinary team at the main campus. For example, in a three-physician practice, one oncologist might focus on breast cancer and gynecological malignancies, another in gastrointestinal and lung cancers, and the third in hematologic cancers. The breast oncologist would discuss a patient’s case with the Cancer Center’s breast cancer team and attend weekly tumor conferences.  Through those interactions, they have access to the most advanced therapeutic strategies, protocols, and clinical trials. Patients may participate in some clinical trials in the community settings, and/or can be seamlessly referred to trials that are only taking place on the main campus.

In addition, the affiliated cancer centers are developing multidisciplinary clinics, modeled on the Mass General Cancer Center’s multi-disciplinary clinics downtown, where other team members, such as radiologists and pathologists, also participate. As on the main campus, team members make a coordinated decision about the best treatment plan for the patient, and can consult with their colleagues in Boston to stay abreast of the latest advances.

While many patients may get most or all of their treatment in the community setting, others may be referred to the main campus for specific tests, treatments, or clinical trials. For cases that are too rare or that develop complications, patients can be quickly transferred to the Mass General Cancer Center, where the entire multidisciplinary, sub-specialized coordinated team can take over their care.

For patients this program gives them the best of both worlds, the convenience of their local physician and the resources of a big academic center.