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Delivering Women's Cancer Care Closer to Home

  • From Turning Point 2017

    by Michael Rafferty

  • map of Boston, Massachusetts area
  • Boston’s Longwood Medical Area stretches over 213 acres surrounding the quadrangle of Harvard Medical School. It includes Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Boston Children’s Hospital, and a dozen other hospitals and research institutions.

    In other words, Longwood is a nexus of scientific research and innovative clinical care matched by only a handful of other medical centers in the world. If you are an up-and-coming medical researcher, or a young doctor eager to train at one of the best hospitals in the world, Longwood is where you want to be.

    If, however, you or someone close to you has a serious diagnosis, you may be torn between wanting to be where the cutting-edge clinical care and research are located, or enjoy an easier commute. Eric P. Winer, MD, director of Breast Oncology in the Susan F. Smith Center for Women’s Cancers at Dana-Farber, understands these circumstances. "It is very important to me, as an oncologist, to know my patient as a person," Dr. Winer says. "I tell her that I may be the 'cancer expert,' but she is the expert on herself. The ultimate treatment decisions that we make together may differ from person to person. That process includes choosing the best place for her to receive care. It's not always Longwood."

    Breast Cancer Care Beyond Longwood

    In addition to his leadership role in the Susan F. Smith Center for Women’s Cancers, Dr. Winer also serves as Dana-Farber’s chief clinical strategy officer. In that job, he takes a broader view to see where Dana-Farber has – or should have – partnerships with community providers.

    Through a combination of strategies – care collaborations, satellite centers at local hospitals, partnerships with physician practices, and community outreach – Dana-Farber’s leadership in women’s cancers is currently being felt in locations from Maine to Rhode Island, and as far away as Brazil and China.

    The overarching objective of these affiliations, Dr. Winer says, "is to bring the most current approaches to treatment to various communities. The treatment of breast cancer is a good example of why this is so important for an individual patient.

    "Twenty years ago or so, the options for treating a woman with breast cancer were very limited: surgery, chemotherapy and radiation," Dr. Winer adds. "By today's standards of precision, these are blunt instruments. We have learned so much about drug development and other newer individualized treatment options. We also know more about risk, prevention and early intervention. It is our responsibility to engage with oncologists in communities beyond Longwood so their patients have access to these options."

    Reaching Young Women

  • Joyce White (left) with Meredith Faggen, MD

    Meredith Faggen, MD (right), delivers care to breast cancer patient, Joyce White at Dana-Farber/Brigham and Women's Cancer Center in clinical affiliation with South Shore Hospital, South Weymouth, Mass.

  • As Dana-Farber expanded its geographic reach through partnerships, the Program for Young Women with Breast Cancer was already poised to spread out. "We embraced the satellite concept," says Ann Partridge, MD, MPH, founder and director of the program. "We imagined it as a replicable clinical service from the very beginning."

    Launched in 2005, the program was built in response to issues that Dr. Partridge and her colleagues were seeing among women age 45 and younger in the clinic. "We realized that the younger women with breast cancer were having the hardest time. One day, they have their whole lives ahead of them – career, relationships, motherhood, education – and then they see it potentially put on hold. One 32-year-old woman described her breast cancer diagnosis as a roadblock to everything else."

    The program attracted a lot of attention and, in 2014, the Centers for Disease Control awarded the program, now called Young and Strong, a $1.75 million 5-year grant to expand its reach throughout New England. Dr. Partridge hopes to bring that multidisciplinary and augmented supportive care approach to benefit young women with breast cancer where they live and work.

    As a result, a new Young and Strong program is in the works at Lifespan Cancer Centers in Rhode Island as well as plans for partnerships in Stamford, Conn., and Worcester, Mass.

    Addressing Gynecologic Cancer

    Ursula Matulonis, MD, director of Gynecologic Oncology at the Susan F. Smith Center, offers her perspective on the value of community partnerships. "If a patient feels strongly that she wants to be closer to home for her treatment and she has a trusting relationship with her oncologist, then our responsibility is to partner with that oncologist in every way we can," says Dr. Matulonis.

    Dr. Matulonis visits the satellite Dana-Farber/Brigham and Women’s Cancer Center at Milford Regional Medical Center on a regular basis, where she sees some of her own patients with gynecologic cancer, and consults on others. But, she says, "I really want to work with the members of the medical team as much as possible.

    "Dana-Farber has made a commitment to these communities, and to these patients, to deliver the highest standards of cancer care,” Dr. Matulonis says. “That means that we also have made a commitment to our colleagues in those communities."

    Assessing Risk

    Katherine Schneider, MPH, LGC, a senior genetic counselor in Dana-Farber’s Center for Cancer Genetics and Prevention, waited a long time for the Institute’s network strategy to take shape.

    "About 16 years ago, I was on a task force charged with finding ways to serve individuals across a spectrum of cancer experience, including those at high risk based on family history," Schneider says. "We realized that offering genetic counseling and testing at our satellites and affiliates would allow more people to get this important information."

    To judge by their interest, people living in those communities were ready to learn. Schneider and her team of colleagues from Dana-Farber take turns travelling to South Shore, Milford, Londonderry, and inner-city Boston 1-4 times a month for on-site genetic counseling and testing clinics for individuals who have personal and family histories of cancer. Schneider and her team also provide state of the art telehealth genetic counseling and testing services to hospitals in Concord, New Hampshire, and Bangor, Maine.

    "These days, a lot of people are very aware of the role of genetics in cancer risk, especially women with a family history of breast or gynecological cancers," Schneider said. "They really want the whole story – and that often means having a multi-gene panel test to clarify their risks.

    "While learning you are at risk isn’t good news, by any means, it gives you a chance to be proactive. Armed with that knowledge, the families I’ve worked with have felt more in control of their future."

    Turning Point 2017 Table of Contents

Posted on October 02, 2017

  • Gynecologic Cancer
  • Breast Cancer
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