The TOP (lung cancer) team includes, from left: Jeffrey Bogart, MD, radiation oncology; Terri Harrington, RN; Carolyn Walczyk, tobacco treatment counselor; Ernest Scalzetti, MD, radiology (seated); Michael Archer, DO, thoracic surgery; Manju Paul, MD, pulmonology; Stephen Graziano, MD, oncology (seated); Erin Bingham, clinical research associate; Jason Wallen, MD, thoracic surgery; Mark Crye, MD, thoracic surgery; Leslie Kohman, MD, director emerita (seated); Michael Mix, MD, radiation oncology (seated); Heather Smith, RN; and Ginger Cowan, NP. (photo by Susan Kahn and William Mueller)

This is one of a series of articles focusing on lung cancer.

BY AMBER SMITH

Upstate debuted its Thoracic Oncology Program20 years ago. It’s defined by a multidisciplinary team approach — which other medical providers at the Upstate Cancer Center have since adopted — and which has been shown to significantly boost a patient’s survival.

A multidisciplinary team is comprised of specialists from multiple disciplines who collaborate on the care of individual thoracic oncology patients. Team members include medical, surgical and radiation oncologists, pathologists, imaging specialists, pulmonary specialists, nurse practitioners with specialized training, nutritionists, social workers and patient navigators.

It’s a big team. But they’ve got a big table in a big conference room where they gather every week. Typically the team discusses care for six or eight new patients, along with up to 20 brief updates on established patients.

Contrast the team approach with “traditional care,” which is serial and not so coordinated: A primary care doctor whose patient has an abnormal chest X-ray may refer that patient to a pulmonologist, who may then send him or her to a surgeon or to an oncologist. Each specialist may not know (or agree with) what the other recommends.

(Hear Leslie Kohman, MD, discuss how the Thoracic Oncology Program helps patients dealing with lung cancer.)

“Most of us feel that complicated decisions on cancer care should not be made by a single doctor,” says Jason Wallen, MD, the medical director for the Thoracic Oncology Program. The team approach means every patient has every option open for discussion. “It’s kind of like getting eight or 10 second opinions all at once.”

For doctors, the team meetings “ensure that we’re always learning,” Wallen says.

With the rapid pace and volume of medical research, it can be difficult for one doctor to keep up on every detail. Regular collaboration among such a large group of experts means everyone shares information from his or her own field, Wallen says. “So we all grow, and I think that allows us to provide even better care to patients as time goes on.”

Such team care is natural at an academic medical center, where doctors and caregivers are encouraged to seek input from one another.

The Stony Brook Cancer Center follows a multidisciplinary approach with its lung cancer patients, too — and officials there have found that patients live longer because of it.

Examining data from 2002 to 2016, Stony Brook officials compared the care of 4,000 patients, about half receiving multidisciplinary care and half receiving traditional care.

They found the team approach has a 30% survival advantage over standard care.

“There is near universal interest in deploying multidisciplinary structures of care to improve outcomes in lung cancer, but to date implementation of such models has been slow because of the lack of supporting data,” says Thomas Bilfinger, MD, director of Stony Brook’s Lung Cancer Evaluation Center. “Our findings show that outcomes are improved with a multidisciplinary care and communications model and should be considered as a ‘best practice’ guideline for treating all lung cancer patients.

Leslie Kohman, MD, championed the team concept at Upstate 20 years ago “because it gives better care to the patient, and it saves the patients a tremendous amount of time getting around to all of those different appointments,” she says.

What was named the Thoracic Oncology Program, or TOP, at Upstate was modeled after programs at leading cancer institutes: Dana Farber and Brigham and Women’s in Boston, and the University of North Carolina.

“Not only does it save patients time, but almost all cancer patients today — and even beginning back then — need more than one modality. Very few patients are treated with just surgery, or just chemotherapy or just radiation,” Kohman says. “To have experts from all those disciplines discuss treatment up front is very beneficial to the patient.”

Cancer teams at Upstate

The Upstate Cancer Center is part of an academic medical center, where medical providers are accustomed to collaborating on patient care. These groups have formalized that process with multidisciplinary care teams:

• Breast: 315-464-3510
• Gastric and Esophageal (including liver, pancreas and gallbladder): 315-464-6295
• Head and Neck (including ear, nose and throat): 315-464-3510
• Lung: 315-464-3509
• Pediatrics: 315-464-5294

This article appears in the fall 2019 issue of Cancer Care magazine.