7 Keys to Developing a World Class Oncology Program

The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins was one of 30 oncology programs recently featured in Becker's Hospital Review for exceptional cancer research, care and treatment. Terry Langbaum, chief administrative officer of the Kimmel Cancer Center, shares seven characteristics that make the program outstanding.

1. Remarkably focused sub-specializations in cancer diagnostics and pathology. The Kimmel Cancer Center's  sub-specialties in cancer diagnostics and pathology are extremely narrow and specific, with specialists focusing exclusively on certain types of cancer, such as those of the breast or prostate. This has sharpened the staff’s diagnostic abilities, allowing radiologists, for example, to look at a CT scan and tell whether cancer has metastasized in the most subtle of ways. "When you put all that expertise into one place, you end up with better diagnostics and staging, which results in a better treatment plan," says Ms. Langbaum. A better treatment plan is also one that is more efficient. "That will result in lower cost and better outcomes for the patient," says Ms. Langbaum.

2. Multiple sets of eyes and minds treating each case. There is power in the number of staff involved in patient care at the Johns Hopkins Kimmel Cancer Center. Due to the fact that it's a teaching institution, layers of medical professionals are training, learning and participating in the daily activities of the center. For example, there is often more than one technician on a diagnostic machine or piece of radiation equipment, says Ms. Langbaum. Chemotherapy dosages are checked by multiple pharmacists and technicians before ever leaving the pharmacy, and patients often receive the care of an attending physician, fellow, senior resident and junior resident. With multiple sets of eyes and brains, "these environments should be safer in terms of care delivery," says Ms. Langbaum. Such rigorous enforcement of protocol and a team approach to cancer care can prevent mishaps as benign as a misspelling or as grave as a misdiagnosis.

3. A Comprehensive Cancer Center designation by the National Cancer Institute. There are 40 NCI-designated comprehensive cancer centers in the country, and the Johns Hopkins Kimmel Cancer Center was one of the first to receive that designation in the 1970s. To earn the designation and see its NCI CORE grant renewed, the Kimmel Cancer Center has demonstrated significant depth and breadth in laboratory, clinical and population-based research while providing community outreach. The Kimmel Comprehensive Cancer Center at Johns Hopkins is also a founding member of the National Comprehensive Cancer Center Network, a non-profit alliance of 21 of the world’s leading cancer centers. These centers are responsible for the NCCN Clinical Practice Guidelines, the recognized standard for clinical care in oncology. The guidelines have become the most widely used in oncology, and have been requested by cancer specialists in more than 115 countries.

4. The nursing staff is rigorously trained in oncology care.
The Kimmel Cancer Center’s specialization extends beyond pathology and diagnostics to the training and experience of its staff. There are more than 300 nurses, and all of them undergo six months of orientation, receiving intensive education and technical training in oncology before ever administering care independently. Since patients at the Kimmel Cancer Center often have rare and/or complex cancers, the patient population is of a higher acuity than many community hospitals, making the role of the nurse all the more crucial and, at times, challenging. While the center offers a palliative care team, Ms. Langbaum points out that it takes a unique person to want to work around patients who may not survive. "We are choosing people who both want to go into oncology and who have the aptitude and personality to go into it," says Ms. Langbaum. "We never, ever have a complaint with nursing."

5. Cancer is seen as a continuum with no room for weak spots. From the diagnostic phase where a patient is thinking "I might have cancer" to the death of a patient, the Kimmel Cancer Center has strengthened its expertise in every facet of diagnosis, treatment, patient care and research. "We’re striving for strength all along the continuum," says Ms. Langbaum. To measure the quality of care offered at each phase, the staff of the Kimmel Cancer Center examines a variety of factors. They review treatment plans, comparing those from the Kimmel Cancer Center to others offered at community hospitals. The staff also reviews pathology reports to examine how many patients walked into the Kimmel Cancer Center with a diagnosis with which the center’s experts disagreed. "We look at our yearly survival rate compared to the National Cancer Database and compared to other NCI-designated centers. We look at our concordance to NCCN guidelines. You will never have 100 percent concordance, but you want 90 percent concordance or better,” says Ms. Langbaum. The Kimmel Cancer Center also considers Press Ganey surveys and seeks patient feedback and participation in new program planning.   

6. Support services recognize patient needs that may not be clinical. The Kimmel Cancer Center extends cancer care beyond the confines of the facility, offering professional financial and social services to patients and families as well as educational opportunities, spiritual support and cancer counseling. The center makes a tremendous effort to alleviate additional burdens cancer patients may encounter. For example, the Hackerman-Patz Patient and Family Pavilion, a 39-suite hotel for adult cancer patients and their families, offers short-term and long-term housing for patients who may have traveled to receive care at Johns Hopkins. The pavilion was completed in Dec. 2008 and funded through philanthropy. The Kimmel Cancer Center also offers an image recovery program, which offers wigs, hats, skin and hair care to patients during cancer treatment.

7. The number and unique nature of clinical trials offered. The findings of Kimmel Cancer Center scientists have become the model for cancer care and research. In 2009, there were 325 therapeutic studies open to patient enrollment. The center also offers an extensive collection of research programs, including those in cancer biology, cancer immunology, cancer virology, female reproductive cancer and brain cancer. The Kimmel Cancer Center is a leader in the development of cancer vaccines, particularly those for cancer of the breast and pancreas. In 2006, the center’s investigators sequenced  the cancer genome for colon and breast cancers and have since developed blood tests to identify inherited genetic mutations that cause a cancer predisposition. The center is constantly releasing new developments in cancer research. In November, scientists identified a compound that could be used to starve cancers of their sugar-based building blocks and may have the potential to be used for many types of primary brain tumors.

Learn more about Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.

Read about other hospitals with excellent clinical programs:

-30 Hospitals With Great Oncology Programs

-25 Hospitals and Health Systems With Great Cardiovascular Programs

-40 Hospitals With Great Orthopedic and Spine Programs

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