A Small Town With Big City Care
When Dr. Scott Schneider, a radiation oncologist in Vancouver,
Washington, was faced with a complicated breast cancer case last
year, he presented the case to a specialist on the other side of
the country - without ever leaving his office. That meeting with
Dr. Jay Harris, a radiation oncologist at Brigham and Women's
Hospital in Boston, took place via Chartrounds, a new online
network linking radiation oncologists in small practices with
disease-site specialists from around the country. One suggestion
during that hour-long meeting changed a woman's prognosis and
treatment. It changed her life, really.
"(Dr. Harris) made suggestions about radiation fields, and helped me with that, but then he made this comment offhand that changed her medical oncology treatment as well, even though that wasn't the purpose of the call," said Dr. Schneider, who works at Compass Oncology at the Vancouver Cancer Center.
Dr. Harris suggested that Dr. Schneider retest the patient's pathology.
Turns out the initial test had returned a false negative for the woman's HER-2/neu status, a predictive biomarker that helps doctors chose the appropriate chemotherapy. Because the patient's HER-2/neu status was positive after all, she was prescribed Herceptin, a drug that improves survival in patients who are eligible to get it.
"It opened up a new treatment path for her that wasn't open before," Schneider said. "It changed her treatment and her prognosis quite a bit, and only because I happened to mention it to him on Chartrounds. There was no reason to check it again; you kind of believe the path(ology) you get."
Straddling two worlds
Chartrounds has been around for nearly a year now. It was the brainchild of Dr. Patricia Hardenbergh, a radiation oncologist at Shaw Regional Cancer Center in Edwards. In 2010, Hardenbergh received one of the first-ever Improving Cancer Care Grants from the Conquer Cancer Foundation and Susan G. Komen for the Cure to develop the online network.
The idea for the network stemmed from Hardenbergh's move from Duke University Medical Center to a solo practice at Shaw Regional Cancer Center in 2001. She missed having colleagues right down the hall with whom she could discuss her patients with, so, with the support of Vail Valley Medical Center, she began talking to colleagues at the University of Colorado, discussing cases and treatment options.
"They would pay radiation oncology specialists at the University of Colorado to help me review cases," she said. "We'd do peer reviews on the Internet.
"I knew it made me a better doctor and made my patients get better treatment," Hardenbergh continued. "I thought, 'Wow, everyone should be doing what I'm doing. It's so great, and improves my patients' care.'"
So Hardenbergh applied for a grant in December 2009 to do just that - "get community doctors talking to disease site experts, sharing, communicating and opening an otherwise totally blocked pathway," she said.
Three months later, in March 2010, Hardenbergh learned she'd gotten a three-year grant, totaling $1.35 million, the largest grant disbursed to date by the Conquer Cancer Foundation.
"I was really surprised that they had the vision and the trust in the community physicians to carry this out," Hardenbergh said. "But in retrospect, I believe it had to come from a community physician, like myself, who had straddled both worlds, being both the disease site expert and being in the community and realizing how the two worlds were so separate and how connecting them made for better care for patients."
The pilot program was limited to breast cancer but given the success of those sessions, and feedback from Chartrounds members, the site now includes discussions of head and neck cancers, gastrointestinal malignancies, lymphoma, prostate and lung cancer, Hardenbergh said.
There are around 420 Chartrounds members right now, including 15 international doctors - even though Hardenbergh hasn't even begun to market Chartrounds internationally yet.
Initially one doctor a week joined; now around 20 or so doctors sign up each week.
"It's gaining momentum, but this isn't Facebook," she said. "This is a place doctors go to a trusted community of physicians trying to improve cancer care. It needs to remain intimate. We can really only effectively handle 15-20 members on each call."
Some doctors just like to listen, while others, like Schneider, use it almost exclusively to present difficult cases.
At the end of every session, participants are asked to fill out a feedback form that asks if the session was relevant to their daily practice.
"We've done more than 150 sessions and the average is 4.7 out of 5, with 1 being not relevant and 5 being very relevant," Hardenbergh said. "Another question is, 'Will you make changes in your daily practice because of this session?' and the average score is 4.5."
The future of Chartrounds
Dr. Hardenbergh is adding a clinical trials component to the program. An easy-to-use trial database within the Chartrounds site helps members keep abreast of clinical trials their patients might be eligible to enter.
"Small community cancer centers don't see research as part of their mission statement, so they don't budget to have a clinical research associate on their staff," she said. "Physicians are pulled in so many directions, they have to have administrative help to be able to enter patients and follow them on trial."
That's why Hardenbergh has hired a clinical trials associate to support community oncologists who would like to help their patients enroll in trials.
Also new, the American Board of Radiology recently recognized Chartrounds as qualified ongoing education to help physicians maintain board certification.
"If members participate in Chartrounds, and present cases, they are given credit for ongoing education," she said.
Just a year into the program, Schneider and many other doctors around the country say the project has changed the way they practice medicine.
"The service is fantastic," Schneider said. "These are the icons in the field of radiation who are participating. If you go to a national meeting, there are hundreds of people in the room and you won't get a chance to talk to them afterward. Chartrounds provides this venue where you, and three or four other people, and this icon, are all on the phone for an hour, chatting. He can see your patient's images, treatment plan and everything. It's like they're right there with you in the room.
"That stuff is priceless - you can't buy that."