Connecting the Dots

Story by Anna Waters | Photos courtesy of UAB Medicine

Patients are often expected to fully understand the complex structure of their provider’s medical institution, the various treatments and therapies that are available to them and how to navigate through this system on their own in order to, ultimately, get the right treatment from the right specialists at the right time.

These are the problems UAB aims to solve with what it calls the Cancer Service Line – an operative clinical mechanism for treating cancer that seeks to improve the experiences of patients over the lifetime of their care.

“A young woman with breast cancer does not want to come in on Monday to see the radiation oncologist, then come on Wednesday to see the medical oncologist, then come on Friday to see the surgical oncologist, just to get a slightly different story from each one of them and miss three days of work,” said Barry Sleckman, M.D., Ph.D., director of the O’Neal Comprehensive Cancer Center at UAB.

A big part of Sleckman’s job as the director of the O’Neal Comprehensive Cancer Center is to spearhead its research enterprise, but it is also to ensure that patients are properly and effectively treated when they need it most.

“When you have three doctors in a room together, you know there’s a consensus of opinion, and you feel like everyone agrees, which they do,” Sleckman said. “When you talk to all three of them separately, you may actually get the same conclusion from each of them, but it will sound different, depending on the kind of specialist you’re talking to.

“That was really the start of the idea that all cancer care, most of which is multidisciplinary, should be done in a team approach. Service lines started in a very care-centric way.”

The Cancer Service Line originally evolved at UAB in early 2018 and serves as the operational arm responsible for the delivery of cancer care within UAB Medicine and throughout the entire UAB Health System.

Although the Cancer Service Line and the O’Neal Comprehensive Cancer Center share similar clinical and academic goals, as well as many of the same faculty and staff, a sense of separation has historically existed between the two. This separation is due, at least in part, to the inherent differences between the organizational structure of the University, which houses the research-oriented Cancer Center, and that of the UAB Health System, which houses the patient-facing service line.

But now, in a game-changing effort to marry its clinical and research missions and to further reduce the burden of care for patients, the UAB Health System has revamped the Cancer Service Line and is working to wholly integrate it into the O’Neal Cancer Center, which will require transcending the traditionally independent structures of the two entities.

To help bridge that gap, Warner K. Huh, M.D., director of the UAB Division of Gynecologic Oncology and senior scientist at the Cancer Center, was named senior medical officer of the Cancer Service Line in 2018.

“We felt that in order for the O’Neal Cancer Center to fully excel and have an impact on the community it serves, the clinical care, research, education and advocacy pieces of our mission needed to come together under the same roof, so that, operationally, all things cancer are aligned under the Cancer Center,” Huh said.

Huh says that access to care and timeliness of care are at the top of the Cancer Service Line’s priorities.

“It’s imperative to have processes that allow patients who want or need to be seen at UAB to do so in an expeditious manner with unfettered access to our specialists, especially if those patients are already part of the UAB community,” Huh said. “What differentiates us from our community partners is the disease-specific expertise of our specialists and the unparalleled access to them that we can provide for UAB employees and for the community at large.”

The ’signature’ line

In its move to revitalize the Cancer Service Line, UAB Medicine recently designated it as one of its three “signature” service lines.

Jordan DeMoss, MSHA, the vice president of the UAB Cancer Service Line, explains that this designation will streamline care for patients by unifying the historically stratified resources of the hospital and the University into one cohesive operational structure.

“We’re an academic medical center, so we always focus on all three missions: research, education and patient care,” DeMoss said. “But for the signature service lines, it’s really about more closely integrating those three and creating programs that are uniquely differentiated so we can become just that – a signature program for the state of Alabama and beyond.”

This distinction allows the Cancer Service Line to draw from the O’Neal Comprehensive Cancer Center’s diverse set of resources, programs and experts to accomplish the shared goals of the service line and the Cancer Center.

Sleckman adds that some of the challenges that many hospitals, patients, providers and researchers face are intrinsic to large academic medical centers across the country but that embracing the idea of a dedicated, fully integrated cancer service line is the key to solving many of those problems.

“I think what the O’Neal Cancer Center brings to the Cancer Service Line is not only the idea of using a team-based approach to patient care, but also, now, the opportunity to bring other activities into that care,” Sleckman said. “The O’Neal Cancer Center is home to so many basic science researchers who are working on cancer and who want to understand more about how what they’re doing impacts disease. Through the Cancer Service Line, those researchers will have a disease management team focused on treating the problems they’re trying to solve, which also allows us to bring other resources to the table, such as clinical trials and community outreach and engagement.”

Prior to moving to UAB, Sleckman spent most of his career developing integrated cancer programs at institutions like the Meyer Cancer Center at Weill Cornell Medicine and the Siteman Cancer Center at Washington University in St. Louis, Missouri, where he witnessed the impact of research-driven treatments and clinical trials for cancer patients.

“Offering patients the opportunity to enroll in clinical trials as part of their overall treatment plan is just one example of what the O’Neal Cancer Center can do through the Cancer Service Line to give patients a genuinely comprehensive experience,” Sleckman said. “Clinical trials are now standard of care for cancer, and they can and should be offered to every patient at UAB who could benefit from them.”

Sleckman says it is imperative that patients understand the life-saving potential of these clinical trials, as well as the many other cancer therapies and treatments that are available at UAB.

“If you are diagnosed with cancer and aren’t sure what to do next, it’s OK,” Sleckman said. “You don’t have to know exactly what to do. You just have to know where to go. And if you have the option to go to the NCI-designated O’Neal Comprehensive Cancer Center at UAB, where you’d have access to the best multidisciplinary cancer care and the latest cutting-edge trials, you should know that it matters where you go first.”

Blurring the lines

The various life-saving clinical trials and therapies that have become standard for cancer care are only made available at UAB through the efforts of about 400 scientists and physician-scientists whose research has found a home in the O’Neal Cancer Center. 

“Having scientists who are discovering and who then translate those discoveries from the lab bench to the patient’s bedside makes us unique. Offering novel therapies, such as CAR T-cell therapy, are critical to our role as a comprehensive cancer center,” DeMoss said. “So it’s that complex, comprehensive cancer care that’s unique to us and where we can really differentiate ourselves for our patients.”

Scientists depend on the O’Neal Comprehensive Cancer Center to support and invest in clinical trials and basic research, and the Cancer Center depends on the Cancer Service Line to populate those trials and studies with patients who, in turn, benefit from having access to the most advanced treatments and therapies available today.

“That’s the beauty of academic medicine,” DeMoss said. “Clinicians can’t thrive without research and discovery, and research and discovery can’t thrive without clinical care.”

While the relationship between research and patient care might not be immediately apparent in an academic medical center like UAB, Huh says that the lines separating the two in the past have since blurred and that this positive relationship should be reflected in the organization of the new Cancer Service Line.

“If you don’t maintain and grow the clinical mission, you cannot maintain and grow the academic mission because they are synergistic,” Huh said.

The line leaders

With an integrated signature Cancer Service Line, the O’Neal Comprehensive Cancer Center and UAB Medicine plan to provide patients who seek cancer treatment at UAB with their own dedicated teams of multidisciplinary cancer specialists, individualized treatment plans developed by these teams of disease-specific experts and clinical navigators who will guide each patient through every step of his or her treatment plan.

This practice originally began with a pilot of the Cancer Service Line’s oncology care model. Now, the Cancer Service Line is building out that model to serve all cancer patients by introducing a team of 20 nurse navigators and seven patient navigators to support patients across all cancer types.

The role of the O’Neal Comprehensive Cancer Center in the Cancer Service Line will be similar to that of these cancer navigators. For both, the objective is to help coordinate the many clinical trials, advocacy efforts, patient resources and scientific expertise already present within the Cancer Center and then use them to inform the way cancer is treated at every level of disease management at UAB, from prevention and diagnosis to treatment and survivorship.

“That’s really the goal of the Cancer Service Line,” DeMoss said. “The parts are there. It’s bringing them all together in an integrated way, and that takes a lot of systematic work, it takes a lot of planning, it takes a lot of infrastructure and it takes a lot of communication and marketing.

“It’s really all about connecting the dots, but that’s what we’re doing. We’re connecting the dots of cancer care so that our patients have access to the best cancer treatment available without leaving Alabama.”

Kendra Carter contributed to this report.