In an earlier article -
How May I Be Sure I’m Being Treated Correctly? - I explained the advantages getting a second opinion may afford. A person with a new cancer diagnosis does not always have to travel outside the immediate area to obtain a second opinion—often another care provider in the same field practices in the same community—but frequently people seek such consultation at a regional or national cancer center. Living in the mid-Atlantic, we have readily available to us several such excellent facilities, most of which have National Cancer Institute (NCI) designation as research centers. The health care practitioners who work and provide cancer care at these institutions typically possess specialized expertise and can impart a definitive assessment and recommendations as to the best ways to handle a specific cancer diagnosis. As I wrote earlier, even if a person with cancer chooses not to receive her care at a more distant cancer center, by obtaining a second opinion she gains confidence that the treatment she receives locally comports with the current standard of care. She enjoys the best of both worlds: expert care delivered in a familiar environment, close to home, with all the supports that home and community afford.
Why else might someone, despite the availability of quality cancer care in one’s own local community, seek such care at a more distant large cancer center? Are there circumstances where the advantages outweigh the benefits of staying local? Despite my own strong advocacy for remaining local whenever possible, I have practiced in both settings and know well when going to a large center is a wise decision despite some of the logistical and practical disadvantages.
Many large cancer centers have developed specialized clinics dedicated to the treatment of a specific disease. Often these are diseases in which a number of different disciplines become involved in the care of an individual patient. Calvert Health has one such specialized clinic in our Sheldon E. Goldberg Breast Cancer Center headed by Dr. Theodore Tsangaris, a leading expert in the surgical management of breast disease. In the future, we hope to develop several such specialized clinics that offer coordinated care informed by diverse expertise, all of which come together to form a solid plan that combines with optimal effectiveness all the appropriate interventions to produce the best possible outcomes. Until we do, however, a cancer patient may choose to obtain his care at, for example, a melanoma treatment center or a dedicated sarcoma service. Such specialized clinics frequently develop through concentration of cases over time deeper knowledge and experience in the management of such cases that greatly exceed that of more generalized cancer care facilities.
Along similar lines, a large center can often offer care for unusual types of cancer, the sorts of diagnoses rarely encountered in community oncology practices. For example, several of the cancers that occur in the brain and spinal cord are very uncommon. Likewise, malignancies of the bones, muscles, tendons, and other supportive structures of the body, typically designated as sarcomas, can be unusual enough and tricky enough to treat that receiving care in a sarcoma expertise facility makes a great deal of sense.
There are some aggressive forms of cancer that present with serious symptoms, often quite debilitating, and require intensive treatment delivered to someone who is already unwell. The acute leukemias form the most common clinical scenarios for such dangerous cases. Due to the complex nature of the required treatment and the need for far more support, including staffing and equipment, than a community center can provide, someone with a new diagnosis such as this can and should expect to receive at least his initial treatment at a specialized facility. Often after stabilization it is possible to return home and continue treatment locally; sometimes the nature of the disease requires ongoing care delivery at the larger center.
Finally, an excellent reason to go to a larger center, typically one affiliated with a teaching hospital and medical school, is to participate in a clinical or investigational trial, treatment that has not yet become standard but may offer a better result than more conventional or standard options, especially if the latter has been exhausted. Calvert Health plans to develop local availability of some clinical trials in the near future. For now, however, persons interested in such treatment will need to travel to a larger center to receive such care.
The ideal for any person with a challenging cancer diagnosis is a partnership between local caregivers and more distant expertise. The whole can be greater than the sum of the parts.