In 2015, in his State of the Union address, President Obama announced, “Last year, Vice President Biden said that with a new moonshot, America can cure cancer. Tonight, I’m announcing a new national effort to get it done.” The White House Cancer Moonshot continues to engage scientists, clinicians, healthcare organizations, advocacy groups and others. A recent Popular Mechanics article called It’ll Take an Army to Kill the Emperor focused on some of the top doctors, scientists, policy makers and others who are starting to join forces to win the war against cancer. Doctors from LACMA groups such as City of Hope and Southern California Permanente Medical Group (SCPMG) are part of the effort. Here we take a closer look at what’s going on locally in the fight against cancer.
City of Hope is a logical place to look to for these advances. It is a world leader in the research and treatment of cancer and other serious diseases. It is one of only 48 comprehensive cancer centers in the U.S., as designated by the National Cancer Institute. Recent advances in immunotherapy and gene-based targeted therapy as part of a precision medicine approach have placed City of Hope in the news lately.
The National Institute of Health defines precision medicine as “an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person.”
Advances in genetic science and research have made precision medicine possible. William D. Boswell Jr., MD, FACR, interim chief medical officer and professor and chair, Department of Diagnostic Radiology, has attributed their “bench-to-bedside approach” as one key to their overall success.
He describes it as an ability to move things into action, from research to clinical, within their specialized focus. Many of their physicians are involved in both the clinical and research work at the facility. Their research findings are then applied directly at the community centers.
Steven T. Rosen, MD, is the Provost, Chief Scientific Officer, Director of the Comprehensive Cancer Center and the Beckman Research Institute for the City of Hope. He recently published an article in Oncology Times detailing the partnership between City of Hope and Translational Genomics Research Institute (TGen) out of Arizona. He points to how their areas of specialty dovetail “to fast-track the future of precision medicine and speed translational research for patients.” Dr. Rosen wrote that “precision medicine is the future of cancer care.”
If you want to see the impact EHR and data collection can have in the fight against cancer, look no further than The Permanente Medical Group. They point to the use of Electronic Health Record as “a tool for multiple physicians from different specialties to coordinate care, communicate critical clinical information, and deliver medical treatment quickly and safely.”
Dr. Michael Kanter, Regional Medical Director of Quality and Clinical Analysis, Southern California Permanente Medical Group is part of a large multi-disciplinary team working on the SCPMG Colon Cancer Moonshot. The goal, which Dr. Kanter called “large and audacious,” is to cut mortality rates from colon cancer by 50% in ten years. Three years in, they’re making good progress toward that goal with a 17% reduction in mortality rates. Another impressive feat is that they’ve gotten their colon cancer screening rates up to almost 82 percent in commercial patients. That statistic jumps to 90% with Medicare patients. The national average hangs at about 45%.
EHR is an essential element in the Moonshot project. Reminders about screenings and care gaps go out to both patient and doctor. If a patient is due for a colonoscopy and sees a dermatologist at SCPMG, a reminder will come up. Patients can also check their records for care gaps and in the case of screenings for colon cancer, get an in-home test sent right to their door.
Advances in using EHR for this project are helping the SCPMG team “review deaths with a program called E-Autopsy… and we’re also able to monitor care and care paths,” said Dr. Kanter. He acknowledges that there’s an advantage at SCPMG in that they have a defined denomination of patients with their healthcare system. He compared it to an organization such as UCLA where they take patients in who aren’t part of the network. The result is a project that spans a decade and allows the team to work toward the goal with a population-based approach. It also allows for “a little more patience” to see how interventions perform over time.
SCPMG is well-respected in the healthcare industry for their effective use of EHR. Dr. Kanter pointed to a couple factors in that success. He said that “someone has to think about how to use it. It takes systematically thinking about who needs to be screened.” Doctors are often focusing just on what has brought a patient into their office. Stepping back and looking at the need for screenings and other preventative measures has been made easier at SCPMG with the coordinated EHR system. In continuing to develop best practices with the technology, educating patients about care gaps is another factor and plays into the strategy for the Colon Cancer Moonshot.
LACMA is excited to see where our group members at SCPMG and City of Hope take precision medicine, EHR and data collection in caring for patients, treating and, ultimately, wiping out cancer.
As published in the July/August issue of Los Angeles Medicine magazine.