Cancer care options are plentiful; get a second opinion and start locally

Living in a rural area doesn’t preclude SLO County cancer patients from receiving quality care, experts say

By Sarah Arnquist
newsroom@thetribunenews.com

Cancer.

When the word is directed at you, life flips upside down.

Cancer is complex and scary. Treating it requires a team of physicians, nurses, social workers, nutritionists and sometimes genetic counselors.

While, on average, people have a better chance of surviving cancer today than ever before, those diagnosed with the disease want assurance that they are receiving the best care possible.

The quality of cancer care varies by physician and treatment center, experts say, but that doesn’t mean people cannot expect and receive high-quality care in rural areas, such as San Luis Obispo County.

The Internet has condensed the world of cancer care, said Arroyo Grande oncologist David Palchak.

“The complexity of care in the small town has increased dramatically,” he said.

Rural doctors can now use the Internet to stay up to date on cancer research and protocols, and even enroll their patients in clinical trials, Palchak said.

Cancer patients, especially those with common cancers such as colon, breast and prostate, should feel confident in their local care, said Dr. Beverly Mitchell, deputy director of the Stanford University Cancer Center.

“The major message is that care can be equally good in the community,” Mitchell said, “but if there’s any unease or concern, there’s nothing wrong with getting a second opinion.”

And getting a second opinion, she said, doesn’t mean patients have to change where they receive their care.

Patients should pay attention to how their doctor responds to a request for a second opinion, said Dr. Peter Pronovost, professor at Johns Hopkins University School of Medicine and director of the Quality and Safety Research Group.

If a doctor bristles at your request for a second opinion, that should raise a red flag. Good doctors won’t feel threatened by a second opinion, Pronovost said, because they feel confident about their own recommendations.

Misperceptions

About 1,400 San Luis Obispo County residents will receive a cancer diagnosis this year. Through the course of their treatment, they will face many difficult decisions, but first they must decide where to seek treatment.

Between 70 percent and 80 percent of local cancer patients receive their treatment locally, according to statistics from the Office of Statewide Health Planning and Development and the California Cancer Registry.

The portion that seeks treatment elsewhere mostly goes to Santa Barbara County, Los Angeles or the Bay Area. Local experts say most of those patients can be treated closer to home.

While children with cancer and people with some rare cancers should be referred to comprehensive cancer centers, San Luis Obispo medical oncologist Thomas Spillane and Palchak estimated 95 percent of cancers could be treated locally.

“There truly is a misperception that we are living in a rural area and therefore do not have access to the latest cancer treatment advances,” Spillane said.

The 5 percent of patients requiring care at a comprehensive cancer center, Spillane said, would benefit by working with a local oncologist to select the best experts for their needs.

Access to care, however, is often dictated by a patient’s insurance. Many local residents belong to health plans that significantly limit their choice in cancer providers, Palchak said.

Cancer centers

One advantage of a comprehensive cancer center, such as Stanford’s or City of Hope near Los Angeles, is the coordination of care that develops from frequent tumor board meetings. At these meetings, doctors from many specialties discuss the pathology of a tumor and various treatment options.

“I’m a great believer in tumor boards and what we call multidisciplinary care,” Stanford’s Mitchell said. “It’s beneficial, promotes communication and prevents errors.”

Arroyo Grande Community Hospital has had an active tumor board for several years. French Hospital Medical Center in San Luis Obispo has applied to join that tumor board, hospital President Alan Iftiniuk said.

Local cancer doctors also are improving patient care coordination by using technology to share information, Spillane said.

Recently, local hospitals have shown considerable interest in expanding their cancer services.

Led by Palchak and surgeon Edwin Hayashi, Arroyo Grande hospital applied for accreditation as a community cancer center from the American College of Surgeons’ Commission on Cancer. The designation requires several things, including an active tumor board and participation in clinical trials, which Palchak already offers patients.

King City-based Mee Memorial Hospital opened what it called a cancer center in Paso Robles last fall before the hospital’s financial troubles forced it to close two months after opening. French and Sierra Vista Regional medical centers in San Luis Obispo are both planning to expand cancer services.

There is a financial motivation to becoming a cancer center, Stanford’s Mitchell said.

“Every hospital across the country wants to be a cancer center,” she said. “And the reason for that is there’s a fair amount of money involved in the use of drugs and radiation.”

Cancer centers come in many forms and sizes. At the top are 63 comprehensive cancer centers nationwide designated by the National Cancer Institute. There are also 1,400 cancer centers of varying levels of service accredited by the American College of Surgeons’ Commission on Cancer.

Any hospital can call itself a cancer center so patients should ask whether their hospital provides the level or services to justify that name, said Dr. Robert Figlin, director of the City of Hope comprehensive cancer center. Figlin said efforts to enhance the quality of local cancer care by seeking outside accreditation “can only be good for the community.”

“Cancer care cannot only be delivered in comprehensive cancer centers,” he said. “It has to be delivered throughout a spectrum, including community hospitals.”

Several local doctors, however, told The Tribune that while the entire county could possibly sustain multiple cancer centers, two in San Luis Obispo would be excessive and not a benefit to patients.