Clinical Care and Research: Journeys of Partnership

A growing presence. The American Cancer Society (ACS) projects that more than 1.4 million new cases of cancer will be diagnosed in 2009—not including the estimated 1 million cases of skin cancer that will go unreported. Lung cancer will continue to be the most prevalent and most deadly form of cancer, accounting for 28 percent of all cancer deaths.

Next to skin cancer, breast cancer will remain the second most frequently diagnosed cancer in women. Thanks to advances in diagnosis and treatment, however, the five-year survival rate for breast cancer stands at 89 percent today, up from 63 percent in the 1960s. Prostate cancer remains the most commonly diagnosed cancer in men, second only to lung cancer in its mortality rate. These figures begin to explain why the Palo Alto Medical Foundation (PAMF) has made its Cancer Care Program a top priority.

Living with Cancer

As our population ages and life expectancy increases, there will be more people who have cancer as a chronic disease than ever before. For these patients, living with cancer will require ongoing disease management. Indeed, nearly 25 percent of all patient care delivered today by PAMF is related in some way to cancer.

"Cancer requires care across multiple departments and engages our staff on many levels," PAMF medical oncologist Edmund Tai said.

"If you live to the age of 80, your chances of developing cancer are one in three," PAMF medical oncologist David Leibowitz said. "Certainly, we are driven to find a cure for cancer, but I believe that before we can cure most cancers, we will be able to treat them," he continued. "Our goal is to give our patients every opportunity to live a long, meaningful life."

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A Relevant Model of Care

Today, more than 90 percent of cancer care is delivered on an outpatient basis. As one of the largest multispecialty, outpatient group practices in Northern California, PAMF employs more than 850 physicians who care for more than 600,000 patients throughout Alameda, San Mateo, Santa Clara and Santa Cruz counties.

Now that our clinical, technical and administrative systems are fully integrated, our organizational structure mirrors the commitment our physicians have shared for decades: to deliver personalized, coordinated care to our patients each and every day. For patients facing the physical and emotional challenges of a cancer diagnosis, this level of coordinated care is exceedingly important.

"The traditional model of fragmented health care not only wastes precious time and resources," Dr. Leibowitz said, "it also detracts from the patient's experience of care and can ultimately impact health outcomes."

Dr. Tai noted that the freedom to personalize care for each patient is a key reason he chooses to work at PAMF. For instance, he said that not every case of stage II breast cancer is the same, and that PAMF's cancer care specialists have the knowledge to recognize the nuances. "For many patients, cancer is a life-and-death situation," he said. "We use every tool at our disposal to tailor therapy that has the best chance of success while doing the least harm. We consult with our colleagues whenever needed, whether their offices are down the hall or at another PAMF location."
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Focused on Patients

Providing the optimal experience of care for every patient is a goal shared by everyone who works at PAMF. "We offer state-of-the art medical care to our patients, but we also give that extra piece," PAMF medical oncologist Paula Kushlan said.

"There is a pride of purpose shared by everyone on our staff, from the volunteer who greets you at the door to the infusion nurse and lab technician. People here consider it a privilege to serve our patients." Dr. Tai concurred. "We respect our patients' lives and their time," he added. "When you call with a question, you get an answer from a physician who is directly involved in your case. That may sound logical, but it's not the norm at many other medical organizations."

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Care Close to Home

A core vision of PAMF's Cancer Care Program is to make every level of service available across all of our locations. "People need and deserve the best care right in their own community," Dr. Tai said. "When you are battling cancer, you don't want to spend hours in traffic to get your treatments. You need your medical team nearby, ready to take care of you."

Although local care is ideal, PAMF's cancer care team will refer patients to experts in other parts of the country if warranted. "We have already proven that our model of multidisciplinary group care works," Dr. Leibowitz said. "Now we need community support to bring all the components of primary and specialty care to cancer patients at all of PAMF's locations."

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A Continuum of Care

Once diagnosed, many PAMF cancer patients are assigned a nurse navigator who guides each step of the care process, helping to coordinate appointments, laboratory tests and other procedures. As treatment progresses, patients can take advantage of services from nurse educators, social workers, dietitians, physical therapists and counselors.

After treatment ends, PAMF's patient-designed survivorship program helps cancer survivors transition back to normal life. "We cannot guarantee a certain outcome for each patient, but we can guarantee how we treat you," Dr. Tai said.

"There is no beginning or end to the care we provide at PAMF. It is all part of a continuum," Dr. Kushlan concurred. "You must always have hope, if not to be cured then to live to see the next day or the next big event in your life," she said. "Our patients' lives are uncertain, but everyone's life is uncertain. Whatever happens, we are here to support our patients from day one until the end of time."
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