Considerations for Community Cancer Centers Exploring a Clinical Affiliation

Oncology is an ever-changing field as researchers continually discover new facets of the disease, which are now leading to individualized treatment plans for an increasing number of cancer patients. George Weiner, MD, director of the Holden Comprehensive Cancer Center at the University of Iowa Hospital & Clinics in Iowa City, says that as oncology becomes more complicated, affiliations with academic medical centers is one way for community cancer centers to provide the latest and most advanced treatments. "As cancer diagnosis and therapy gets more complex, community cancer centers will benefit from affiliating with a robust academic center to enhance their ability to provide state-of-the-art care" says Dr. Weiner.

However, community cancer center leaders must also consider the challenges that are inherent when affiliating with an academic center.

According to Dr. Weiner, oncology is becoming increasingly sub-specialized, and academic cancer centers generally have access to expertise in different sub-specialties that community cancer centers lack. In academic medical centers, physicians in different cancer sub-specialties can provide care side by side. Sub-specialization also allows the oncologists in academic centers to focus their efforts on understanding the molecular complexity of individual cancer types and how it impacts choice of treatment. Through an affiliation, a community cancer center will also be able to provide sub-specialized treatment opinions to its patients, he says. Without being able to offer these options, community cancer centers could lose patients to more comprehensive facilities.

Another advantage to an affiliation is increased access to expertise in molecular pathology and bioinformatics, which community cancer centers may not have without a partner.  Bioinformatics allows for the analysis of complex molecular data, which is important when trying to understand how to tackle a multi-faceted disease such as cancer. Interpretation of molecular data can help physicians make more informed decisions about which treatment might work for a particular patient, says Dr. Weiner. Additionally, cancer patients are increasingly seeking molecular testing as part of their diagnosis and treatment. Access to both the testing and interpretation of the results may be a factor as some patients select treatment centers.  

One of the challenges that community cancer centers need to keep in mind when considering an affiliation with an academic medical center is that there might be differences in priorities, says Dr. Weiner. For example, in an academic medical center, a physician may need to balance patient care with research or educational responsibilities, while community cancer centers are generally more focused on direct patient care.  

This is not an insurmountable challenge, however. When entering into an affiliation, a community cancer center needs to understand the needs of the research institution but must also ensure that the institution understands its needs. Perhaps this is a point that can be clarified in the initial agreement itself. "Ultimately, academicians need to realize that the hospital has to be efficient, and the hospital has to realize that the academicians need time to pursue their research and educational interests," says Dr. Weiner.

Another challenge that community cancer centers need to be aware of before entering into an affiliation is that the academic culture and the clinical culture are have different goals and rewards, which could potentially lead to problems. For example, community cancer centers often look at the financial bottom line and outcomes as the basis for success, while an academic center would also be concerned with education and growing knowledge. It is also hard to compare the performance of physicians who have purely clinical interests and physicians who have clinical as well as academic interests, which could lead to misunderstandings when developing incentive plans, says Dr. Weiner.

A community cancer center needs to ensure that there will be close communication between itself and its partner. A joint appreciation of the challenges that both organizations face is also important, says Dr. Weiner.  

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