A Tremendous Team Effort: Pancreatic Cancer Care at Sylvester
Article Summary
- Pancreatic cancer care at Sylvester operates on a “hub and spoke” model. Patients can access care at a satellite location while benefitting from a full team.
- Physicians collaborate closely in formal meetings and informal consultations.
- The result is coordinated care tailored to each patient near where they live and continuing access to deep expertise throughout treatment.
Peter Hosein, M.D., knows cases of patients he has never met. That’s because of the tight communication among his oncology colleagues at Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine.
Dr. Hosein helps oversee pancreatic cancer care at Sylvester as co-leader of its Gastrointestinal Cancers Site Disease Group. He and his fellow physicians consult on each other’s patients and all of them hear updates and discuss patient treatment at meetings that involve care teams across specialties.
The model enables pancreatic cancer patients to be seen at any of Sylvester’s 10 satellite clinics while receiving the same quality of care that they would at the main Miami location.
“If a patient is seeing any of us, it’s the same as if they’re seeing the entire group,” said Dr. Hosein, also associate director for clinical research for Sylvester’s Pancreatic Cancer Research Institute.
Meeting Cancer Patients Where They Live
Steven Bialick, D.O., a Sylvester oncologist, works in the Sylvester clinics at Plantation and Deerfield Beach, reaching patients who would otherwise drive hours to Sylvester’s main campus in Miami.
The convenience helps patients live fuller lives and focus on their treatment, said Dr. Bialick. All the while, their care is supported by a larger team.
Sylvester strives to have uniform practice approaches among all physicians in the pancreatic cancer group so each will apply the same principles when developing a care plan, said Dr. Hosein. All of Sylvester’s physicians have more access to expertise than most community doctors treating the same condition, he added.
Provider interactions go beyond formal meetings. Oncologists will often consult with their colleagues, sometimes in long text threads, said Dr. Bialick.
“We are all really close in that we can get quick input from multiple members of our group,” he said.
Route to Remission
That coordinated attention made a life-saving difference to Manuel Garcia. When he was only 26, Garcia was referred to Sylvester for stage 4 metastatic pancreatic cancer. Metastatic tumors had entered his lungs, lymph nodes, spine and brain. He had lost 40 pounds and was near death.
Garcia was too weak for conventional chemotherapy. Instead, Sylvester’s physicians carefully calibrated his treatment, initiating a low-intensity chemotherapy regimen combined with immunotherapy drugs.
“It was apparent to me when I was diagnosed that there’s a tremendous team effort that I saw from all providers, specifically with how they’ll collaborate on a patient’s case,” said Garcia. “This had a profound, positive impact on the level of care I was able to receive.”
Garcia has now been cancer-free for more than five years, prevailing over a disease that is hard to beat. Only about 13% of people diagnosed with pancreatic cancer in the U.S. survive to five years.
A Team of Pancreatic Cancer Experts
Every Monday at 4 p.m., Sylvester physician Gretel Terrero, M.D., assistant professor of clinical medicine in the Division of Medical Oncology, connects online with dozens of colleagues for a key event: the meeting of the Pancreatic Cancer Tumor Board.
There, Sylvester experts discuss patient care and swap perspectives and opinions. Specialists in a wide range of areas tune in, including gastrointestinal pathologists, hepatobiliary surgeons, gastrointestinal radiation oncologists, interventional radiologists and gastrointestinal medical oncologists.
The atmosphere is collegial.
“We hear everyone’s opinions and we learn from each other,” said Dr. Terrero. “It’s clear there is a lot of respect.”
Dr. Terrero was preparing for a meeting of the tumor board, where she would seek input on a patient with new imaging results after several months of treatment. The imaging showed a new spot in the liver. It could be metastatic disease or something less ominous that was there before treatment.
As part of her presentation, Dr. Terrero provided the patient’s age, past medical history, type of pancreatic cancer and treatment plan to date. She looked forward to consulting with colleagues in radiation oncology who are familiar with the patient’s previous images.
“It doesn’t take just one discipline to try to achieve a cure,” said Dr. Terrero, especially for patients who require multiple treatment steps, like radiation or surgery.
Collaborative Cancer Expertise
Cancer treatment centers typically host tumor boards in broad areas such as breast or gastrointestinal cancers. However, Sylvester also offers subspecialty boards for pancreatic, rectal, neuroendocrine and other less common tumor types.
Dr. Bialick emphasized the collaborative expertise of various specialists in developing a personalized and comprehensive care plan for each patient. According to Dr. Bialick, this approach is imperative in modern oncology care.
Clinicians usually discuss the cases of about eight to 10 pancreatic cancer patients at tumor board meetings each week. Each patient typically has a unique treatment plan based on individual interests and goals, the state of disease, genetics and other factors, said Dr. Bialick.
Eligible patients also have access to a host of clinical trials. These are discussed at the tumor boards and also at separate site disease group meetings. Sylvester-led studies, for instance, are testing new cancer vaccines and immunotherapy approaches. Another, led by Dr. Terrero, is assessing if tumor DNA present in the bloodstream can help guide treatment.
“We have high-level expertise in our local clinics and we are spreading research opportunities across the network,” said Dr. Hosein, who calls it a hub-and-spoke model of care.
If a patient needs access to a phase 1 trial, typically only available at the main campus, providers will strive to conduct as many tests and follow-up appointments closer to the patient’s home, added Dr. Hosein.
Garcia said he could sense the team behind him during his treatment at Sylvester. He was confident that his oncologist and support staff would coordinate with the specialist doctors involved in his recovery, he said. And he was touched when a team member took over the role of coordinating with his insurance company.
“When I met other providers, I wouldn’t have to explain too much. It’s like they already knew,” said Garcia. “I was at the right place at the right time. Sylvester is writing the book on how to take care of cancer patients. It is cut from a different cloth.”
Tags: Dr. Peter Hosein, Dr. Steve Bialick, Gastrointestinal Cancers Site Disease Group, pancreatic cancer, Sylvester Comprehensive Cancer Center, tumor board