When Patricia Hardenbergh, MD, left the academic environment of Duke University Medical Center in North Carolina to become director of radiation oncology in a mountain town in Colorado about 10 years ago, it was more than simply an 1800-mile change of scenery. She suddenly found herself in entirely different and unfamiliar clinical territory.
“We’re the only cancer center within about a 2 1/2-hour driving radius,” said Hardenbergh, referring to Shaw Regional Cancer Center in Edwards (population 8257). “I was trained in the world of high-powered academics. Now I had to figure out how community doctors practiced.”
Hardenbergh soon learned that necessity is indeed the mother of invention. She played a leading role in establishing the Shaw Center’s multidisciplinary approach to cancer care and is now developing a virtual networking service that aims to link radiation oncologists with specialists, state-of-the-art research, and educational resources far beyond their offices.
While the growth of technology has placed the telemedi- cine trend in the limelight, the concept is often interpreted as a high-tech lifeline that major research centers extend to isolated community practices. In contrast to that notion,Hardenbergh and other community oncologists are working from their offices to develop technological solutions to the real-world challenges they face.
Statistics indicate their efforts to provide quality care have a major impact on cancer patients overall; community oncologists handle twice as many patient visits per week as their academic peers who are spending more time on research and teaching, according to a 2007 study by the Association of American Medical Colleges.1Making Connections in Person and Online
After Hardenbergh moved to Colorado, she found herself on a journey to deliver the same kind of care that she provided at Duke. She began to develop relationships with colleagues who specialized in treating prostate cancer, or breast cancer, or head and neck cancer, and spoke with them about her cases. But soon she realized that “they didn’t have that much time for me.”
She developed a schematic to pay them for their time, and to have them look at her radiation plans through the Internet. She was trying to solve the issue of delivering the level of care that patients in the community deserve, and that she was used to delivering, without the layers of backup that clini- cians have at a large university or academic center.
“You can’t just go to the journals and say how do the ex- perts do this, because it takes years and years to develop that evidence-based medicine,” Hardenbergh said. “Out in the community you might see 20 cases a year of a certain type of problem, as opposed to when I was at Duke and I would see 10 to 15 cases a week. Without any evidence to back you up in the community on how to make decisions, we really have to rely on the people who are seeing the most cases to talk to the community physician, and bridge that gap.”
Bridging that gap will be a little easier now that Harden- bergh was recently awarded a $1.35 million grant from the ASCO Cancer Foundation and Susan G. Komen for the Cure to improve cancer treatment for those living in rural areas. Hardenbergh’s project is called Chartrounds, and it focuses on using the Internet for a Web-based radiation oncology treatment planning review program. Radiation oncologists will collaborate virtually with experts, similar to in-person patient chart reviews. A computer connection will allow direct, live, visual illustration of the planned radiation treatment in the context of the overall treatment plan.
“It’s a great way to connect the community to academia,” Hardenbergh said. “In the grant, the academicians are re- imbursed for their time. The only other time they get reim- bursed for their value is when they’re invited speakers at different conferences. What Chartrounds allows them to do is get a stipend without ever leaving their office. It’s good for them, and it’s good for the community.”
Chartrounds recently launched the service for breast cancer information; there are plans to roll out disease sites on head and neck, lung, central nervous system, prostate, gastrointestinal, and gynecologic cancers during the second half of 2011 and in 2012. The first Chartrounds session earlier this month featured a ratio of 3 to 1 as community oncologists from Texas, North Carolina, and Arkansas reviewed their cases with a department chair from the Dana-Farber Cancer Institute in Boston, Massachusetts. More than a dozen ses- sions with experts are scheduled through February.
Hardenbergh said that having lived on both sides of the street, and having learned “so much since coming out into the community,” she expects the Chartrounds experience will provide ample benefits to both community and academic on- cologists.