Avoiding 'analysis paralysis': How Levine Cancer Institute is building a cancer center of the future

At Charlotte, N.C.-based Levine Cancer Institute, part of Atrium Health, president Derek Raghavan, MD, PhD, works hard to ensure research is paired with action. That helps avoid a problem he labels "analysis paralysis." 

The tendency to over analyze something that's already a known problem — health disparities, for example — is "an awful problem throughout the world," Dr. Raghavan told Becker's

"What we do is we say, 'OK, we know there are problems here. Measuring it is a pointless exercise. Let's do something to fix it," he said. 

For Dr. Raghavan, part of designing a cancer center of the future is avoiding analysis paralysis. At Levine, the team does that by trying out different solutions that could alleviate existing problems. For example, it was already well established that Charlotte's Hispanic community was underserved when it comes to cancer care and prevention. So instead of issuing more surveys and documenting their findings, Levine created a Spanish educational program on breast cancer. 

Predicting people wouldn't travel to the center for such a program, the team instead brought it to the Latina community, where residents had the choice of going to a local church for the program or hosting a living room session, where the host could invite friends and family to the program. 

The research team conducted a survey for participants three months before and after the program. 

"We saw big increments in knowledge there," Dr. Raghavan said. "With that, we found a bunch of them came in to get mammography, and we discovered in that process, one of their biggest problems was that they didn't have primary care [physicians.]"  

So the team connected participants with Spanish-speaking primary care physicians. 

"Rather than just sitting by and saying, 'Well geez, here's a problem,' let's analyze it, we will do something to try to see if it works," he said. 

That's part of what Dr. Raghavan envisions as a cancer center of the future. Here are other components that make up a progressive cancer center, Dr. Raghavan told Becker's

Localize care and clinical trials 

While Levine's main center is in Charlotte, there are more than two dozen branches scattered through the Carolinas and Georgia, with a large focus on saving patients from having to travel. A few high-risk services such as bone marrow transplants and CAR-T cell therapy are localized at the main center, though most other care is accessible across Levine's 25 branches. 

"The concept is that instead of people having to come to Charlotte, we do almost everything locally," Dr. Raghavan said. "The mantra … is to integrate high-quality clinical work with research, and provide both of those close to home with social support," Dr. Raghavan said. 

With so many branches, it can be difficult to imagine how a cancer center maintains consistent  quality and standards of care. At Levine, part of that is the pathway-based system it developed. It's "a standard cookbook for cancer [care] that's electronically downloadable," Dr. Raghavan said. This allows oncologists at the smaller branches further from the flagship in Charlotte to access the evidence-based pathways from their devices. 

"They [oncologists] can't be experts in everything, but they can actually see a patient, look it up on the pathways and it'll say, 'You can do this, you can do this, but you can't do that,'" Dr. Raghavan said, adding that the pathways system will also notify physicians of the clinical trial options that are available. 

Expanding access to clinical trials is another priority at Levine, which has a phase 1 clinical trials unit. While the main unit is in Charlotte, Concord, N.C., is home to a secondary unit. While separate locations, they work together as a single entity — another way Levine keeps patients from having to travel to Charlotte. 

Make programs accessible 

When patients have an unmet need, that's an opportunity to create something that fills the gap, Dr. Raghavan said. For example, Levine is getting ready to launch what it calls the "flying squad."

"If someone is sick at home, we can send a mobile unit to them and take care of them at home so they don't even have to leave if they are feeling unwell," Dr. Raghavan said, adding that it saves patients from a trip to the emergency department and being admitted. 

Working with Samsung, the center also developed what Dr. Raghavan believes is the country's first mobile CAT scanning unit to screen residents for lung cancer. 

"We've focused it on underserved and underinsured patients. We've screened 1,200 uninsured people for lung cancer and the way we've gotten to them is we've sent the scanning unit to them out in the rural environments and into underserved environments, and we've actually found curable lung cancers," he said. 

The initiative led to the detection of 30 lung cancers, 17 of which were early. 

"Now that population without insurance, without health education — they never show up early," he said. "So they would normally all have arrived with metastatic cancer and would have died."

"That's what I think is the center of the future," Dr. Raghavan said. "It's very simple medical care [combined] with laboratory research, epidemiology and decentralized, but with a common set of standards."

Address patients' financial challenges

Taking patients' financial situation into account is critical in today's environment, Dr. Raghavan said. 

"That's the final piece of the healthcare of the future — is not just saying, 'Oh, I'm a doctor. I'm too pure to worry about the financial costs,'" he said, proposing the following scenario: If there's a million-dollar treatment and an insured patient needed to pay a 10 percent co-pay, that's $100,000. 

''So it becomes increasingly important for physicians to think about the bang for the buck that patients are getting. Are we doing the right thing for them in expending large amounts of money?" Dr. Raghavan said.

"It's not for me to make that decision, but it is for me to tell the patient the truth: If you take this $2 million dollar drug, it'll give you an extra year," he said, adding that while some patients would want to take it, others may say, "Hell no. I'm not going to give up my two kids' college education just for an extra year of life. I don't want that drug." 

Additionally, Levine launched what it calls a financial toxicity tumor board in 2019 to help patients struggling with the cost of their cancer care. 

"The idea is to bring down the personal costs and expenditures of patients," Dr. Raghavan said. 

The board members meet once a month to come up with plans for difficult cases, while the simpler cases are managed by the center's financial counselor. A simple case, for example, would be a patient who didn't enroll in Medicare when they turned 65. 

"But if there's someone who is getting challenged by their insurance company or a drug has suddenly gone off listing, then we work to, in fact, save them money," Dr. Raghavan said. 

For two years in a row since launch, the board has saved patients nearly $60 million each year. In the case the financial toxicity tumor board can't resolve the problem, patients are directed to the center's assistance program where "we can at least ameliorate their expenditure," he said. 

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