Houston-based University of Texas MD Anderson Cancer Center recently opened a colorectal cancer center, bringing subspecialty care teams together in one location.
Y. Nancy You, MD, professor in the department of colon and rectal surgery and director of MD Anderson’s Young-Onset Colorectal Cancer Program, shared more about the new facility with Becker’s, including what the new care model may signal for health systems across the U.S.
Editor’s note: Responses have been lightly edited for style and clarity.
Question: How does consolidating colorectal services into a single, purpose-built space change day-to-day care delivery?
Dr. Y. Nancy You: Consolidating colorectal services into a single, purpose-built center allows us to operationalize what we truly believe is the basis of optimal cancer care: coordinated, multidisciplinary care centered on the individual patient.
Instead of patients navigating a complex system across multiple locations, the care team comes together around the patient in one place. On a daily basis, this means more immediate collaboration across surgical, medical and radiation oncology, as well as genetics, nutrition and social work services. Clinical decision-making becomes more efficient and better aligned and we are able to reduce redundant or overlapping workflows. The space itself was designed intentionally to support a potentially stressful medical encounter in a more humane and artistic environment that is responsive to what patients are going through in that moment.
Q: How does the new center specifically support the needs of younger patients beyond clinical care?
YNY: Young-onset colorectal cancer patients are navigating a diagnosis at a unique life stage, with what I call multidimensional needs extending beyond their disease itself. Many are building careers, raising young families, caring for elderly parents or marching through major milestones of adulthood, so the impact of cancer is profound and upsetting.
At MD Anderson, we see about 650 new cases of colorectal cancer among young adults under age 50 a year. We have a dedicated Young-onset Colorectal Cancer Program called BRACE-CRC (Bridging Research Innovation with Advocacy and Clinical Excellence in young-onset Colorectal Cancer).
We proactively connect patients to consultative support services such as genetic counseling, fertility and sexual health discussions, psychosocial support at the onset so that we can best provide whole-person care. Having a space with modern design concepts that embraces technical advances helps to deliver the message to younger patients that they are not here alone, that we are here to walk through the cancer journey with them and that their needs are understood and anticipated, helps foster a sense of community and support.
Q: What are the biggest unmet needs in this patient population that other hospital and health system executives should be aware of?
YNY: There are several unmet needs.
First is timely access to care and diagnosis. Most young patients are diagnosed once symptomatic. There is often under recognition of symptoms from both the patient and front-line providers and there can be barriers to access to care. The guideline for screening of asymptomatic young adults supports starting some form of colorectal cancer screening at age 45, but the uptake rate is only about 20% among individuals in their 40s. All of these areas can be improved to help decrease the initial stage at diagnosis and the incidence.
There is also a gap in coordination of care for young adults. They face multiple life demands and are not as experienced in navigating the healthcare system, so bundling and coordinating care components for them goes a long way toward personalized and less fragmented care.
The third area is continuity of care. Care for younger cancer patients does not end with cancer treatment; survivorship care is needed. Often patients are transitioned to their primary care physicians, so health systems need to have care transition pathways and “receiving” care providers in place.
Q: Are there measurable improvements you expect to see as a result of a more integrated model?
YNY: We are excited to see meaningful improvements. We anticipate shorter times from diagnosis to treatment initiation, as well as more efficient coordination of multidisciplinary care. We anticipate better patient satisfaction on the day-to-day patient encounters, less wait times between appointments, a more pleasant and less stressful environment, and a place where they can remain productive between appointments. We also expect greater provider satisfaction. All of these have the potential to positively influence clinical outcomes as well.
Q: Do you expect more cancer centers to move toward disease-specific, highly specialized facilities? What barriers may other health systems encounter when trying to replicate this model?
YNY: There has been a long-standing trend among the medical community toward disease-specific specialization, particularly in cancers like colorectal cancer where multidisciplinary care is becoming more complex. The center model allows more cohesive delivery of expert care that wraps around the patent. Barriers do exist. Physical space and infrastructure needs are real barriers. When multiple specialties are housed under the same roof and within the same institution, a sustained institutional commitment has been instrumental in aligning efforts. However, the barriers are likely greater than differential specialties and services being housed under different practice groups, locations, payment/reimbursement systems. Despite those barriers, I believe health systems can adopt a commitment to the care of young onset cancer patients and to improving care coordination by integrating supportive services earlier to improve the lived experience of the patients we serve.
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