Innovation in oncology is moving faster than ever, but technology is only half the battle. To truly change the game, clinicians must marry state-of-the-art tools with seamless, interdisciplinary collaboration. From AI-driven diagnostics to robotic surgery and cellular therapies, this session will look at the trends driving the next decade of progress. Join several clinical leaders for a candid discussion on what’s working, what’s next, and how we can collectively improve outcomes and the patient experience.
Well, welcome everyone. I am Michael Morella, managing editor of events at US News and World Report. Today we're looking at the future of collaborative cancer care. We have a panel of experts here with us who I'm excited, excited to speak with soon, but before I welcome them, I want to play an excerpt of a video from a recent conversation I had on innovation in cancer care. Let's take a listen. So I'm pleased to be joined by Doctor Inderal Sarkaria, Chief of the Division of Thoracic Surgery and a professor in the Department of Cardiovascular and thoracic Surgery at UT Southwestern Medical Center. Doctor Sarkaria, thanks so much for being with us today. Thank you. Thank you for the invitation. Now, you've been a major force in advancing thoracic surgery, particularly with minimally invasive and robotic assisted techniques. From your perspective, how are those kinds of technologies and, and things like the single port robotic surgery that you've been pioneering, changing patient recovery and outcomes? You know, whenever we introduce new technology, and I've been interested in robotics for a long time, we always have to go back to basic principles. What are we trying to improve upon with any new technology? That's really the broader question, you know, robotics is something I've been interested in for a long time. I've been involved in developing new operations, new technologies, assessing and trying to understand where the value is in adopting these technologies. You know, you specifically ask about SP or single port robotics. You know, many robotic systems right now have multiple access points, allow for terrific visualization, manipulation of tissue, precision, really just allows surgeons to have far more control over the conduct of the operation. I think that's where that technology really has terrific value and maybe improve the conduct and not only the conduct, but the quality of the operation that we're performing. Less trauma to the patients, improved recovery and less pain. As we look at the evolution of robotics, that's exactly where we're trying to achieve value when we adopt these, these systems. Should be with the thought process behind it again. Are we maintaining the basic principles of the operation is the most important thing. We don't need a glitzy new toy to do something if we're not doing it as well as we did before and maintaining the quality of the operation. That's always the base principle we have to work from. But if we get these new technologies and they do improve upon what we do, then we take a hard look and say, can we improve outcomes for our patients? When it comes to robotics, I think we do. I think we do that to a tremendous. Uh, I think advancement from what we've done before, say from open surgery where we made large incisions to then minimally invasive operations where, you know, still the same operation internally again, important that we're maintaining the quality, but small access points and now small access points but with tremendous control over the conduct of the operation internally. SP or single port now takes it down to a single incision. And to be quite fair, I've been involved in a lot of these technologies, but in running a division, in working with many colleagues, this is far from a single individual's effort in helping to develop. There's, there's a large team behind these, these endeavors always and a community that's investigating, and my partners and I and really some of my partners who've been really moving this forward, Dr. Noguchi, Dr. Salami. Been looking at single port in the context of larger adoption in the US for lung operations, so lung resections for, say, lung cancer, and potentially even for other operations like esophagectomy, where we're removing parts of the esophagus for esophageal cancers. The The idea is that if we can decrease the number of incisions and not work through the chest, through the ribs, this is an approach that allows us to approach through the diaphragm, another organ that separates these spaces with less painful incisions. Now I'll tell you that the anecdotal evidence that we have seen, as well as trials, large national trials that have looked at this. Do suggest that we are improving the pain profile of patients, meaning they get up and out of bed day one, less pain, less tubes in the chest or tubes that come out earlier, and ultimately getting them back to their daily lives faster, back to work, back to what whatever the things they love to do earlier and getting them moved along the care spectrum faster. That's, I think, where we're seeing a lot of the benefit from these platforms. Whether we're improving the actual cancer care, as long as we are doing as good a job, that's still a terrific value proposition to get people back to their daily lives faster, uh, and that's ultimately what we're here for, to get them past this if we can. Cancer is a very sort of uh variable disease process, but for those that just require surgery, can we get them past that episode of care back to their lives? Uh, and get it behind them. That's really the ultimate goal for many of these, I think, technologies and especially in robotics, trying to decrease or minimize the impact of the operation on the patient and get them to earlier recovery. I think the long term outcomes have to be maintained. Are we doing a good cancer operation that prevents the cancers from coming back as best we can and minimizes complications to those patients? Now, you, you mentioned, um, some of your colleagues, and, and, you know, the theme of this event is the future of collaborative cancer care. Uh, you know, we know that technology isn't the, the only solution or the silver bullet solution. It's often how we use it and how we integrate it into a system. Um, you know, how has the integration of, say, interventional pulmonologists and surgical teams changed the time to treatment, uh, that, that window between biopsy and procedure for your patients? Well, there's a lot packaged into that question, I will tell you, and there is a host of things that have to be looked at when it comes to, say, approach to a patient before they ever get to the hospital, the diagnosis, when was a nodule, for example, first seen in the context of lung cancer, interventional pulmonary, sorry, interventional pulmonologists, thoracic surgeons, medical oncologists, radiation oncologist, there's a whole, whole ecosystem of docs out there that really have to bring their expertise to bear. To appropriately bring these patients through, but let's take a simple nodule. It's the infrastructure of how we create the service line. Is it multiple access points? Is it a single access point within that institution that can really. Create efficiencies for how we bring patients through the system, I think is very important. Access to care. Can we get them in in a timely manner? Is it going to take 1 week, 23 weeks to even get that patient for their first touch with us? That's the most critical time point in which we establish a relationship, trust, start to gather the appropriate information, and then truly start to act on what we see and what we need to do as next steps. So having that single infrastructure, single intake, and easy access to the system, I think is the first most important thing. How we've structured that here is by having multiple abilities or multiple access points for the patient to call in, but really a single focal point by which we schedule, and the mandate is to schedule within 3 days. Patient will always get a call back within 24 hours and we will schedule an appointment within 3 days. Now that may mean you may not have all the information you need to make a definite decision, but what we do by getting someone in within 3 days is alleviate the stress, the anxiety, and the. That that opportunity for the first touch, the first establishment of the relationship. Look, we can get CAT scans, we can get all that and other information and start to work on that immediately, but we have to establish that first relationship with the patient as soon as possible, and that I think is the most critical first step. But you mentioned interventional pulmonary, thoracic surgery. We are very much two sides of the same coin when it comes to lung cancer. And establishing us under a single management, a single service line, most importantly, we are co-localized. Putting the right team together in the same physical space, I think is of critical importance. I work very closely with my interventional pulmonary colleagues and vice versa. On every clinic day we probably have 5 to 10 patients. We just walk over to each other because we have structured our clinics in such a way that we are in the exact same space. We may have our independent clinics, but when the appropriate patients come up and we need the feedback from each other, it's right there in real time. 2, we are under a single. Scheduling structure and management structure, meaning the same schedulers schedule into the interventional pulmonary procedure room where a lot of these biopsies are done or with the thoracic surgeon or sometimes in the same room when we need to do procedures together to really expedite the care and you can see how that co-localization really starts to expand the opportunities for efficiency. Meaning I talked to my interventional pulmonary colleague. We need a biopsy tomorrow. Let's look at the schedule together with our schedule. What are the opportunities? Do we need to schedule with which practitioner or in which OR or in which suite to get that biopsy done? And do we agree on a plan? Meaning, can we do the biopsy and the surgery maybe the same day? Can we do the biopsy and the surgery on day 1, day 2? What other tests do we need and how quickly can we get it done? But our goal is to get from time of first contact to biopsy and if appropriate for that patient, definitive surgery within 2 weeks. That is a standard by which if we can do that for the majority of patients. Maybe we can start to do that at 1 week. Maybe we can start to do that 3 days, and in some very rare instances, maybe we can do that in 24 hours. So we also have a lot of outreach into our communities, access points, different clinics by which UT Southwestern can take patients into the thoracic and IP service line. Hopefully decreasing the time to referral as best we can, that education that is so necessary to the community to say if there's a nodule, get them to the experts right away, because that time from first identification to the nodule to definitive treatment, if it is cancer, is absolutely critical to the survival of that patient. So education, infrastructure, the right collegial and collaborative approach to patient care, and agreeing on what those pathways need to be. I I think the secret sauce to really getting patients through the system in a an efficient manner that is really best for the quality of care, especially in when we're talking about lung cancer, and then bringing to bear all those technologies you talked about, whether it's robotic bronchoscopy, the advanced endoscopy suite, the surgical robotics that we employ, sometimes none of that is needed, and we have to identify that appropriately, but using the entire spectrum of what we have at our. You know, within our toolbox, so to speak, is important, and that's best done when the experts are in the room together. I, I, my, my final question is, you know, another sort of big picture perspective question, uh, you know, for, for the healthcare, health system executives, hospital executives in our audience who are thinking about, you know, making the right technology investments, thinking about changing their workflows, perhaps, uh, to, to embrace collaboration and interdisciplinary, uh, cross-pollination. You know, what, what are some of the sort of, what's, what's one or two sort of key takeaways or, or kind of a call to action for them to think about minding all the things you've shared and, and the, the interesting things happening at UT Southwestern. I wonder if you were to sort of build kind of a futureproofed thoracic or oncology center that, that, you know, has, that, that has a positive impact for as many people as possible, you know, what, what might that look like? Well, I would start by saying that nothing is futureproofed, you know, as best we can, but you're right. How best to do that, that's a great question. I think number one, having the right intel, the right experts in the room, in the room to as best as possible, understand the future scape of what's occurring. What are the technologies coming down the pike? What do we do now? What are the areas of need that will have the greatest value? Is it early stage lung cancer? Is it advanced? esophageal cancer, is it therapeutics, what have you? What is coming that can truly move the needle on some of the things we do? That's not so clear to see all the time. But if you focus in an area, and a lot of these technologies come with a big price tag, I think that's probably the You know, the source of most agita. Otherwise everybody would acquire them and we would just use them and identify the opportunities. Number one, you have to maintain equipoise around these technologies, meaning, don't just assume the shiny new tool is going to do a better job. Have evidence around it and have the experts in the room that are going to be available to evaluate that appropriately. But as an executive bringing it on, listen to your experts. And understand your own institution. What are the abilities? Who are the players that are there? Do you need to bring in additional, or do you have the Collegiality and the collaborators who are going to come together and do this as a group. So that's, that's important. The local culture of an institution is critical. And creating that culture of collaborative care, understanding the value proposition, does it meet and jive with the mission? Is it in line with the mission of the institution? You know, a great example of that is, you know, every institution says we're going to strive for excellence. OK, well, show me the institution that says it's not going to strive for excellence, right? It's, it's a generic code word we want quality and excellence. Pick the value propositions that you think you can impact the most. Is it length of stay? Is it rate of resection or negative margin, whatever those quality indicators are that you are really trying to impact. Identify them, show the value, and then create the teams that really understand that value proposition and and can execute the mission. I think that is key also for those executives to have to some degree boots on the ground. You have to have champions. If you don't have champions for these pathways. Those individuals or groups of people who are going to identify the value proposition, the mission, etc. all the things, and most importantly, the plan. Whether it's a business plan, whether it's a clinical plan to execute and bring together the right team and to execute that plan, then most importantly, what are the metrics by which you're going to gauge the success of that plan, because if you can say we're going to execute this plan, but if you don't know how to measure it, you really can't get a great handle on your success or areas of potential improvement opportunity. So for the health care executive, I think many of them are well educated in this, but you have to have your local champions. You have to listen to them and partner with them, and you've got to understand it really from the base level up. Boots on the ground. What are your physical plant structure? Do you have the appropriate teams co-localized? Do you have the technology on board that you want? And if there's opportunities to gain technology, Make sure you have the right team on board to use that technology the appropriate way. I think those are sort of the key takeaways for me. In improving, not just improving, but you know, Culture change management is really what it comes down to and bringing teams together in a cohesive, collaborative, and collegial way to execute what you think is an appropriate value for your institution. I think that's great perspective. I think the point on measuring and sort of tracking those outcomes too, you know, as challenging as it can be, is, is one to underscore as well. So, thank you for sharing that. And thank you for your time, Doctor Sarkaria. I really appreciate it, and I know our audience will really benefit from your insights. My pleasure. Thank you for the opportunity. Thanks to Dr. Sarkaria and to UT Southwestern Medical Center for their support of today's session. Now, I'd like to welcome our panel who will take us even deeper into the theme of how clinicians and care partners can best work together and break down silos to improve patient care and outcomes. I'd ask you all with us to please join me in welcoming Dr. Alex Kim, an assistant professor of surgery at UT Southwestern Medical Center who specializes in complex gastrointestinal oncology. Doctor Sarah Meyers, a surgical oncologist who specializes in treating patients with breast cancer, an assistant clinical professor of surgery at the Ohio State University Comprehensive Cancer Center, and Doctor Archana Radhakrishnan, an assistant professor in the Department of Medicine at the University of Michigan, who is a cancer health services researcher and a general internist practicing at the Ann Arbor VA. Thank you all so much for being with us today. Let's dive right in. Um, I'd love to start by defining what we mean by collaborative care. I think there's a lot of different definitions that we can unpack. Um, you know, we often talk about multidisciplinary care as a standard or a goal, but it can look very different in practice. I, I wonder if each of you could Share just a little bit more about your roles and the focus of your work, but also answer the question of kind of what collaborative care actually looks like at your institutions and your daily workflow. You know, how are you ensuring care is both integrated and effective. Um, Dr. Myers, maybe we could start with you, but I'd love to hear from each of you. Sure. So, uh, in my clinical capacity, I carry, uh, interest in groups with early onset and young adult cancers. Uh, I direct the, uh, early onset program for Ohio State. It is termed BRIG, Building Research, Innovation and Care Delivery for groups with early onset cancer. And in this capacity, groups with cancer diagnosed it at ages earlier than one might expect, earlier than the average age of onset really does require collaborative care. They are multidisciplinary teams sometimes and ideally would be in the same place, but many times it's not. Younger individuals are dealing with traveling long distances to come to us either for clinical trials or other things. And so being able to collaborate within our team here at Ohio State, but also with their teams closer to home is really critical to optimize the outcomes for this patient group. From an academic standpoint, I'm a health services and implementation scientist, and as Dr. Sarkaria had mentioned on his video, It's not good enough to make the innovation. You have to make sure that you're implementing it and integrating it into your practices, and to do that takes in a, a whole team of people with different areas of expertise, sometimes outside of the traditional healthcare space. So, those are the aspects of collaborative care that we try very hard to engage with uh and uphold at OSU. Great. Thank you and welcome. Um, Doctor Kim, maybe we turn to you next. Hi, everyone. Um, so, at UT Southwestern, I serve as one of the, uh, cancer surgeons or surgical oncologists, and, uh, I am also a, uh, director for peritoneal surface malignancy multidisciplinary Program, uh, which entails for me, uh, taking care of patients, uh, together with other specialists, uh, for patients afflicted with advanced or metastatic cancers. Oftentimes that has spread inside the belly cavity, uh, from, uh, gastrointestinal in origin. Um, so, you know, in terms of multidisciplinary care or collaborative care has been a central philosophy, uh, in our approach, taking care of our patients, but it's also a main pillar that, uh, that, uh, serves, uh, for us as a, as a, um, as a focal point for servicing, um, these, uh, novel therapeutics and treatments for patients that have otherwise. No other options. In addition to delivering, um, specialized care for these patients, I also serve as, uh, a, uh, principal investigator on multiple trials, um, clinical trials, uh, all the way leading from investigator initiated trials where we have an NCI, uh, funding and our-level funding to all the way to a, uh, collaborative trial in a multi-institutional fashion. And more, uh, importantly, in order to get us into the clinical trial space or novel therapeutics or novel biomarkers. We have to innovate in our translational or basic science space. So I also lead our team of, of experts and have a translation lab that focuses on looking at the molecular etiology or the causes behind why colorectal cancer oftentimes spread into the peritoneal cavity, where we have recently discovered, um, use, you know, through a collaborative approach from various different, uh, scientific, uh, disciplines. Uh, identified a, what we consider a tumor marker environment that consists of not just a tumor, but also the supporting cells that actually contribute to the uh, the progression of the disease, but also, um, that causes for, uh, current therapeutic resistance and also, uh, uh, um, progression while you're on, uh, current standard therapies. So, in that sense, you know, we've tried to bridge a comprehensive but also collaborative care through all those, each individual, um uh uh uh pillars, including not just the clinical care, but clinical trials, as well as translational research uh involving various different disciplines and specialists so that we could provide um novel and optimal care for our patients. Wonderful. I definitely want to get back to some of what you mentioned and, and, uh, dig into it further, but Doctor Radakrishnan, nice to, to welcome you as well. Could you talk a little bit about collaborative care and, and your work? Sure, sure. So thank you so much for the opportunity to be here and um join Dr. Myers and Kim. So, um, as a clinician, I I am a general internist, like I said, um, and I see, um, so as a primary care physician, I see patients, um, in my continuity clinic and practice only at the Ann Arbor VA. And so in that role, I actually also direct, um, a cancer survivorship clinic for veterans with cancer. And I, and on the flip side, I'm also a cancer health services researcher. And so as part of being a part of the University of Michigan and the Rogel Cancer Center, Jewel. A lot of research around how do we optimize cancer care delivery and outcomes and and that and that goes from doing observational work where we're doing surveys and qualitative methods all the way to designing clinical trials, including, you know, designing actually the intervention, whether that's a technology-based intervention or something that actually changes clinical workflow to doing the trial and trying to understand the results and contextualize it. And I think in all kind of aspects of that care, um, of whether it's delivering clinical care or doing the research collaboration and a collaborative care model is kind of central to everything that I've been doing, and it's just a part of the culture that we're, that we inhabit here, whether it's be at the VA or at the uh at the university and at the Roy Cancer Center. And so, I think what we've really focused on is we know that nothing can happen within a silo, um, and so how do we kind of break down those silos to Be able to, you know, at the end of the day, provide the best, best care we can for our patients with cancer. And so whether that means working across different specialties, so working with our surgeons or our oncologists, whomever it may be, to also working with different professionals from our nutritionists to our mental health specialists to our social workers, how do we kind of, how do we as a team function at a high level to be able to make sure that we get the care we want, we provide the care, we want to, to our patients. Uh, maybe we could stay with that point about breaking down silos because I think that's a, that's a, that's a theme we can explore over the course of this time and well beyond it. Um, you know, many hospitals have excellent individual departments, but bridging the gaps between surgery, medical oncology, radiation oncology, internal medicine. And so forth, can, can be a, a real challenge. Um, you know, I wonder if any particularly effective strategies or, or best practices, even if they may seem small, but they've proven effective, um, to get the, the departments kind of working together, speaking the same language, if anything comes to mind from the work you all are doing, uh, you know, again, we Doctor Sarkaria talk about some examples, co-location and collaboration on scheduling and so forth. But, uh, I wonder if any, for any of you, uh, you know, sort of open question to any of you, um, if something comes to mind about how, you know, something you've been doing to break down those silos and increase that collaboration that's been proving effective. I want to speak over Doctor Kim, but I think we both, we may both have the same answer for you. Um, in the oncology world, we do come together somewhat organically with our multidisciplinary tumor boards. Uh, I believe that with, uh, increased technology and virtual platforms, that has become More simpler to do, to come together, even if you are not co-locating and oftentimes we do invite some of our community partners to come onto the calls. If, if it is a primary care provider or if somebody is getting their treatment closer to home, they will jump on the call for the discussion of their particular patient that we are co-managing. And that has been very helpful. It also allows individuals even from the same area of expertise to hear about different approaches to the same care. I think all of us train at very different places with different areas of expertise, and so coming together to create the right plan for a particular patient is the direction of customized and tailored medicine. Uh, and I, so I think that's probably the, the example that we see every day. I don't know, Dr. Kim, if you'd agree. I, I completely agree with Doctor Myers regarding, um, you know, in terms of her thoughts. Um, the other approach, uh, utilizing exactly what Doctor Myers just said, um, at UT Southwestern, um, I've been here for 2 years. I was actually with Ohio State prior to that. And uh on my arrival here, what we did to uh establish a collaborative, comprehensive multidisciplinary care was to actually knock down those silos. So, how do we do that? And I think especially in a center where you have a philosophy and a focus and a disease site that you recognize as a really, really important site to tackle together as a collaborative group, you identify the, the, the. Interest, the common interest that exists between individuals. For here at our center, uh, our interests align, um, simply behind innovation and, and optimization of care for these patients that do not have other, otherwise, um, additional, uh, options or therapies that are effective. So in that sense, you know, uh, academic missions, the research mission, the Innovation mission with all going back to optimization of patient care and prognosis was the, was the goal of knocking down these silos. And those, you know, if you, if you think about the definition of silos, is, is, is taking, you know, housing something that is unique. But what was unique among our individuals was that exact philosophy of trying to um uh approach and innovation and research with the goal of optimization of patients and their care. Yeah, I would just add, I think, you know, I think multidisciplinary tumor boards and all these ways are very kind of natural and expected ways that we think about breaking down those silos and getting that collaboration. Um, you know, I think oftentimes, uh, in the cancer world, primary care isn't involved, so, you know, wearing that hat. I do think one of the biggest things we've focused a lot on is how do we, how do we have that communication when if, if there are people who are not at the table, right, who are not at that during that visit or in that meeting or whatever it is, and so how do we communicate with them? And so I think we've, you know, a lot of research has shown and our own research has shown that, you know, the lack of kind of Clarity around what should my role be in the care for this patient leads to a lot of the confusion, both on the provider end and for the patient. And so, what do we need to try to bridge that gap? And so, we've worked really a lot on, you know, when we, we oftentimes send our notes, right? Like, 11 provider is sending their notes to the other, or, or, which is our most common kind of way of communicating. But when we're sending notes, can we be a lot more thoughtful about what it is that we're expecting. the other person to do? Is this just an FYI? Is this, am I sending you something with like, actually, this is what your role is going to be, this is what I want you to follow up on. I'm going to manage this. And so, um, here we've been kind of playing, uh, playing around with, can we have some templated notes, um, can we have some standardization that helps, especially on the primary care end, to know, this is just an FYI. We want you to know this going, we want this, we want you to know, um, this about your patient as it's going on. But also, Some more things about, like, actually, we want you to take this on, right? We want you to be able to follow whatever it may be, whether it's cancer related or not, or this is a side effect that I want you to kind of help me monitor, especially if there's things like, I started a medication for oncology, but now the side effect is that the, uh, the patient's having elevated blood pressures. Well, can you as primary care, help with that? And so, um, I think just kind of more of like a very practical boots on the ground kind of thought of is, how do we communicate what each Our kind of roles as in the, in the patient's care, um, and how do we make sure that we're all on the same page towards that and how do we actually do that on the patient then, right? And so how do they know that this is the doctor that they should go to for this versus this is the doctor they should go to for that. So I think we've, um, we've tried to be more thoughtful about what is it that we're, you know, we're all inundated with a lot of notes and messages and so on and so forth. And so, um, when you are getting it, how can we make sure that there's, you know, a bang for the buck there. Yeah. Um, Doctor Meyers, you, you have a specific focus on improving clinical and quality of life outcomes for young adults with, with breast cancer. Uh, I wonder if you could kind of reflect on that, share, what can you kind of share about the theme of working across disciplines and toward better care for those individuals? You mentioned the bridge program, uh, a little bit earlier, but maybe you could tell us a little bit more about that and, and, you know, how that's an example of some of the, the kind of collaboration and best practices we've been, we've been talking about so far. Yeah, I, I would, I feel very privileged to be taking care of this population of individuals and uh the care of this group is extremely complex. The types of cancers that younger individuals get can vary substantially from those that are seen at average age of onset. And because of that, uh, it does require expertise from multiple disciplines. And also, some of these individuals, uh, have established relationships with providers in their community, their pediatrician, their primary care doctor, if they're recently transitioned into adulthood that know much more about their care than we do when we're first meeting them and engaging in the workup. There's also an absence of data. There is an increasing population of individuals with young adult cancers, and because there is relatively less data for this group than individuals who have average onset and make the majority of the population with cancer, it does require people from medical oncology, radiation oncology. surgical oncology, and also other providers that can help support the different treatments to come together to decide what's right for that patient. So, we do these multidisciplinary tumor boards. We do a lot of communication with the primary care provider. If they don't have one cause they've never been ill prior to having their cancer diagnosis. We try very hard. To find an individual who can fill that role and, and be very clear that once their cancer is treated, they will require maintenance, surveillance, um, addressing some treatment-related adverse events that might be common for those younger patients. Uh. And then the other aspect of it is that there are certain supportive care services that may be beneficial early on in treatment and others that come later on. And to engage individuals at the very beginning of a patient's care and understanding these aspects is very important. I'll give you an example of mental health. So, at some points, a patient might feel overwhelmed with a diagnosis. They may need. Uh, advice on how to handle certain feelings that come from having a cancer diagnosis, how to communicate with their loved ones, how to support their care partners in the process while their care partners support them. But later on, they may need to be re-engaged for certain services for mental health, on how to deal with how their life might have changed after their treatment. And so, these things are not the same, but by having conversations with other individuals on the care team early on, we ensure that people are getting the care they need at appropriate time intervals. Doctor Kim, um, you know, you alluded to some, some of your work, you know, and, and I, I guess I'm curious about some of the innovations on the surgical front and in the realm of, of complex GI oncology that, that are particularly exciting to you and maybe even are emblematic of some of these kind of collaborative themes. Um, you know, HIPEC is, is one example. I wonder if you could talk a little bit about some of, some of that work and what is is exciting to you and, and, and bearing fruit. Yeah, absolutely. So, you know, um, I could give one example is one of our clinical trials that we have on, on site right here. Um, it's a phase one trial. Um, it's actually exactly goes along with what we're talking about in terms of multidisciplinary care, comprehensive care. Um, so that trial is, um, is what we consider investigator initiated trial that was written, um, by myself as well as one of my, uh, KPIs who's still at Ohio State. And, um, it's, it's, it's a collaborative trial between medical oncology as well as surgical oncology to Uh, to, um, understand, um, the, uh, delivery of the therapeutics in a different route. So, in that trial, in essence, what we're testing is, uh, you know, historically for patients that are diagnosed with advanced colorectal cancer, as using as an example, um, get a traditional chemotherapeutic regimen called FOLFOox. And the delivery mechanism is through what we consider intravenous or through the bloodstream. And that's always been the traditional route. But over the last decade and uh in the last several years, we start to understand that the penetration when we deliver these drugs by the bloodstream doesn't necessarily affect the cancer that may be within the abdominal cavity or the lining or the peritoneum, OK? So then we asked a simple question together in a collaborative setting to say, what if we bypass that bloodstream and we just deliver it directly into the belly cavity? And that was a result of, uh, you know, of that hypothesis or that thought, um, that, uh, evolved into um involvement of other experts and specialists, including medical oncology, radiology, as well as pathology. Um, leading up to a, a, a proposal or grant proposal, which was, uh, birthed out of that hypothesis, um, that exactly exemplify, you know, this multidisciplinary care. Um, and with that, um, in terms of innovation, I think innovation is not based on just one individual anymore. You know, this is not like the 1950s where everybody siloed out. The information highway, the, the distribution and the communication just like what, uh, Doctor Radhakrishnan has alluded to earlier, has opened up the possibility of communication and break truly breaking down those silos. So, for example, one of the examples That I provided earlier for our translational research where we were, uh, understanding the tumor microenvironment. From my lab, we were strictly coming from an aspect of just understanding the tumor. But what we started to find out, um, as well as working together with cell biologists within UT Southwestern, was that it's not the tumor alone that actually affects, you know, how patients respond to treatment or maybe even resistance to treatment. Um, and that they're supporting cells and without breaking down these silos and going and talking with individuals and communicating with the goal of innovating and truly providing these patients other additional options, I think, I think that's what we have to do. And I think Dr. Christianan earlier had alluded to in a beauty, you know, very, very succinct and very organized manner of how we do that. And I completely agree with, you know, her sentiments. I'd, I'd wonder, um, thank you, Doctor Kim and, and Dr. Radhakrishnan. Yeah, you, you did share some great insights in terms of the, the practicality, like, you know, the practical mechanics of, of this relationship, uh, or, you know, helping people kind of navigate their care journey and those care partners, whoever they might be. Um, I guess I wonder, you know, are there any other sort of Tools or, or, you know, efforts that, to ensure that kind of primary care providers are active participants in, in an individual's care from that day of diagnosis through survivorship that, that, you know, you, that come to mind and that you've seen, you know, in your own practice or, or more broadly in the field? Yeah, I think that's a great question. Um, and I think some of the stuff we've alluded to is where the field's currently at, and we're trying to leverage as much as we can in the communications that we provide. And now because, um, because of virtual care delivery and our ability to communicate so much easier in certain ways with other systems, um, we're trying to do the best we can, you know, we can share charts, and charts, charts can be shared now, which wasn't something we were doing before you had to fax everything and um. the other, and so I think, you know, the things that we talked about are probably are, are a lot of the ways that we're doing it. Um, I think we, we're also trying to leverage things like electronic consults. So, um, not necessarily that you have to go back and see your other provider, but can I, hey, can I ask you a question? And I think integral to that is, is having these established relationships, which allows all of us to kind of communicate with each other without feeling, you know, um, without feeling like, Oh, I, I can't reach the specialist or I can't reach their PCPs. So I think nurturing these relationships and these collaborations has also allowed just to be able to ask these questions and get responses right away. I think one thing that we've thought a lot about is what's the role of the patient in all of this, and what's kind of the role of the patient and their family members. And so, how do we involve the patient and Being the purveyor of that information, um, especially, you know, a lot of the patients that I see get their care within the VA, but then also get their care outside the VA, and sometimes I can't communicate with the outside provider, uh, readily. And so what's the, what's the patient's role in, in, in being a messenger? Um, and I think that's really hard, right? And so figuring out to get, you know, how to, how to Help them help us and help themselves, um, has been a challenge, um, that I think we work a lot on. And similarly, what's the role of oftentimes patients just don't come to us by themselves, they're coming with their, with their partners, their spouses, their family members, their children, whomever it may be, or just a, a, a friend who's been there all this time. And so how do we leverage kind of the, the, the team for the patient, um, to manage their care, I think is the other way to think about how do we, uh, you know, Bridge these kind of um gaps. Um, I've got some more questions I want to ask, but I do want to say to those of you in our audience, um, we, I hope to make some time for your questions too. So please feel free to enter them into the, the chat in Zoom if you're with us live, and I'll try to give voice to some of those. Um, Technology, we, we've talked about it in a number of ways, but, you know, AI, of course, is a huge point of conversation in healthcare and, and in pretty much every facet of society these days. Um, you know, we're seeing these advances in robotic surgery, AI-driven diagnostics, and so forth. I wonder if that's something or is that something that you've Seen as, as a tool, or, you know, uh, uh, Doctor Kim, thinking about AI as kind of almost another teammate, if you will, in, in the process of collaborating and caring for an individual. Um, is that something that any of you all are seeing? And, and, yeah, maybe Doctor Kim can start with you, but welcome thoughts from any of you. Yeah, I think AI is, it, it, you know, just like what Doctor Sarkaria said earlier, right? You can't, you can't futureproof, right? And AI advancement is happening and it's been happening. And one of the thoughts that is out there and currently in, in the AI stratosphere is that AI is, you know, there's, there's a uh thought that AI should be utilized as a tool. But, you know, what we're starting to approach, um, and these, these are kind of conversations that we're having at UT Southwestern, is that AI is gonna reach uh something called a singularity, OK? And the prediction, you know, at a national and international level is that the singularity or autonomization of AI is gonna happen probably. As early as 2029 or 2045. With that, I think we have to switch the way we're viewing AI. Um, it is a tool that has become autonomous and has a singularity. And with that, I think we could start to view AI as a collaborator. An example that I could give you is when we employ AI as part of our research, uh, portfolio, is that, you know, we're not just telling the AI just to go and do one task. We actually orchestrate and we give multiple tasks, so that we can have a back and forth conversation, uh, with our active human researchers, but also the AI collaborator on the other side. And I think, uh, putting those two efforts together, I think potentially you could optimize in terms of efficiency of workflow, but also utilizing the advancement of our technology and incorporation as a collaborator rather than utilizing it as a tool. It The, the question of sort of access and equity is another one I, I wanna jump into. And, and again, feel free, um, uh, to, to jump in on, on the AI point too. But, but Doctor Myers, you know, you've mentioned, I think, that, that the standard of sort of multidisciplinary teams, team science, team-based care can't, shouldn't be limited to just NCI designated centers and, and, you know, getting the care to individuals who need it in the settings that, that, where they are and, you know, meeting them where they are is, is so important. I wonder if you could kind of talk a little bit about that, especially for, say, the, the, you know, the community hospital leaders in our audience. What's, what's sort of a scalable, realistic way to kind of adapt. Uh, or adopt some of the, the best practices and tenets of, of, you know, an NCCN aligned, uh, place or, or institution without needing like the full infrastructure or, you know, for those that can't make the massive investments, uh, that, that certain institutions can. Yeah, I, I think a lot of this, Dr. Radhakrishnan has already, um, alluded to. But there are a couple of ways. First of all, at the national level, there are organizations in the oncology world. We have organizations like the American Society of Clinical Oncology where we do have community oncology practice cohorts that come together. There's community physicians, there's primary care physicians interested in oncology. There's oncologists and academic centers, and we get together, we try to think about programming to benefit not just a single patient, but an entire population that we're interested in caring for. So there are national platforms, there are webinars, the, the ways, ways to stay up to date to make sure that You understand not only where the field is going, but how patients might need access to certain specialized resources. So, that's the first, the first thing. I think as an academic NCI designated cancer center, we do have to do a better job advertising the menu of options that we can provide to augment care. That individuals are getting closer to home. At Ohio State, we have the James Cancer Network and we distribute ourselves and make certain resources available, but people cannot take advantage of resources that they don't know exist or they don't know are important. So I think that's another aspect that's really crucial. Many of the young adult and early onset patients who are referred to us are referred for clinical trial purposes, and there is a large group of individuals who are trying to increase access to clinical trials by using platforms like telehealth or other virtual platforms so that certain aspects of the clinical trial care can be delivered in a way that is more accessible to patients. So I would say those are probably the three ways that we can Be more Accessible. Yeah. Uh, I don't know if Doctor Radhakrishnan has other ideas about it. No, um, I think that's exactly, I think our approach as well. Um, and I do have to say, at least on the VA and, we've really, um, embraced virtual care delivery post-COVID especially. Um, and I think there is something to be said about kind of having your main center and then having these satellite clinics. And so, um, you know, how do we, and how can we offer that care? So, um, for veterans, uh, what they're, if they are, you know, I'm in Michigan and, you know, there's a Whole region up north that I just feel like it's anything over Ann Arbor. But, um, you know, for if you're in kind of these satellite clinics, uh, the VA offers the patients to just go to their satellite clinics, and then we're able to do virtual care with them. So if they don't have good broadband, if they are, don't have good internet, to be able to do kind of these video visits or whatnot at home, they're able to come to their local clinics and still kind of have that face to face, at least be able to see the person's face. And so I think those kind of options. Make it feel, uh, make, make improve accessibility. Sure, it's not the same as being able to come to the office and do it, but at least it saves you a 4-hour drive and, and you're still getting to be able to say, uh, to see the provider. And then what we, what we're able to do is we're able to partner with that local clinic and say, well, yeah, and now, could you help us get the blood test. So again, you don't have to drive all the way down to the Ann Arbor, the main hospital, for example. You could stay up at the clinic, but, and we'll partner with you to make sure you get your blood work done. If there's imaging, then let's partner with the local institutions to get that imaging done. Um, so I do think the post- kind of COVID world has really opened up virtual care delivery, um, and leveraging kind of these academic sites or kind of the main hospital sites with, um, and being able to provide care to more of the satellite clinics has been this lovely, um, uh, positive kind of benefit that's come out of it. So going along with that, um, one of the things that, that we as academic institutions, right? We were actually responsible for setting up silos. For example, partnering, you know, you said it beautifully, partnering up with additional providers that's outside. So, I think putting that into the practice, you know, when we particularly historically have complex, for example, oncologic care, we want uh the patient's care to be completely transferred over, right? But in this setting where we have actually tools, we could actually open up that communication. As well as collaborative care to, you know, local providers. And one of the examples that I could give you is, is, you know, we have a partnered up and a program that we established from our division called the Surgical Oncology Outreach Network down in, uh, Texas, where we have done outreach throughout all the surrounding, uh, hospitals and regional centers. And through there, we got buy-ins to say, you know, not necessarily all the care has to be done in Dallas. And Texas is the size of the state, it's just not feasibly possible. So we trust the care that our partners are providing in our regional centers, but also provide inputs as well as them providing us feedbacks in terms of what works and what works not. And one of the things that we're piloting currently is like virtual tumor board within, you know, within our network and within our state. Uh, someone in our audience asked, thank you all for those insights. And, and this is sort of on the same theme. I mean, on the, on the general theme, but, um, someone in the audience asked, how do you address the challenges of collaboration across institutions? And I think you've already given some good insights and examples. I don't know if anything else comes to mind. Um, you know, I think, I think tapping into the best of sort of virtual connectivity is certainly one answer, but, um, Doctor Kim, or any thoughts on that, or I was just, I, I mean, I think you can tell we are, it, it that these communities are actually smaller than you might think, um, and people know each other very well. And so, for example, Doctor Kim was a fellow at Pitt when I was a resident, and so. I think across institutions, picking up the phone and, and calling a colleague is, in my experience is welcome and, and I think really contributes to better patient care. And some of these national communities where you can meet and network with colleagues across institutions are becoming increasingly important for that reason. But we have to get out of the mindset that we are taking care of patients at our single place and that we're taking care of patients for the patients, right? Yeah, and going along with that, you know, in terms of how do we break, uh, you know, the barriers to do in cross-institutional collaboration, I think it's exactly that. I think in our current era in academic medicine, one of the things, uh, the, the critique that I would like to provide is that, you know, we're so caught up on the academics, right? The academic currency, which are the grants that The prestige, the innovation, and, you know, getting that high-impact paper out. But at the end of the day, I think we all have to remember, we do this for patient care. And I think if we could establish that understanding across, uh, you know, our national level and putting our egos aside and saying we could actually do something more innovative by partnering up with it, you know, with a goal. Of optimization patient care. I think that's the key. And I think, you know, sometimes when you look at the Twitter world or, you know, within the, uh, you know, the, the social media world, sometimes that just gets taken out, right? And, you know, I think going back to truly when we apply for medical school, what do we write on our first essay, right? It's to take good care of patients, right? Like they're our family members. I think once we remember that, that could potentially break down barriers. Yeah, and I just would just echo what both Dr. Myers and Kim said, I can't agree with it even more. And I think truly, we are moving towards like, it's team science. And we were thinking about team science and like within the institution, but it's not, it's not team science within an institution, it's just team science in general, right? Whether that means, uh, you know, what within the institution, outside the institution, Both community partners, academic partners, partnering with patients and patient organizations, truly, I think the team has evolved to include all players who are just at the table for the same reason, like Dr. Kim said, to help take care of a patient and just provide the best care we can. And I think that's really hopefully where the field is moving forward. Yeah, I just wanna, wanna say one thing because it reminded me, we were, um, I was at a, uh, robotic surgery training conference and um GYN surgeon from Boston was telling me about one of the recent Harvard graduations, and she said, That this person had talked about listening like you might be wrong. And I think in the setting of a multidisciplinary collaboration, when a certain institution may have different resources than a collaborating or partnering institution, it's really important for me to be able to listen to a different perspective and say, oh, how, how do you do things? How would it work to do this at your institution? How can I help you? For that same common goal. So I just thought I'd share that because it's so front of mind for me. I think that's a great mantra and, and perspective way to approach a lot of things. But, um, we have a few more minutes. I, I want to see if I can incorporate a couple more questions. Um, lifelong care. Um, Doctor Radhakrishna, maybe you could start with this one. You know, in your work focused on survivorship, you know, more and more people are surviving and thriving. Um, and, and, you know, as think about, you all think about, you know, a lifetime of management in certain cases and the long-term impacts of maybe a particular intervention or treatment that someone received when they were young. Um, any thoughts or insights there in terms of, again, kind of collaboration and, you know, working with folks, you know, throughout that entire survivorship, uh, uh, Journey. Yeah, um, I, I think that's so, it's so paramount these days cause, there are a lot of people surviving, which is great, right? Um, and so I think we are, we've been so focused on, you know, the, the cancer treatment at that time and um less so on what happens after. And so, um, I think, you know, um, the more we get the collaboration happening from the beginning, which is that there's still the other part of you that still needs to be taken care of even though you have your cancer diagnosis, which obviously is first and foremost. To get done, um, allows us to kind of return to that after the cancer treatment, right? And recognizes that we need to treat the whole person. Um, and so, understanding that, of course, you had your cancer, you had the treatment, and you're dealing with the, the effects of that, whether it's from the cancer itself or from the treatment itself, but then contextualizing it in kind of the whole health, um, and thinking about the whole person, I think is really where, um, we're all moving towards and, um, and Focusing on, you know, we were just talking yesterday to a group of primary care providers saying we understand that, you know, cancer and the treatments are just accelerating aging, for example, and so many of our patients are falling within that group, right? 2/3 of cancer survivors are over the age of 65. And so how do we think about that and how do we try to be more proactive when it comes to prevention? And so what can we encourage to make sure that you, we are doing like Whole body, whole health. So what's the role of nutrition? What is the role of physical activity, and so on and so forth. And so I think preventive health and thinking about that becomes so much more important. But I think it starts from the beginning, which is to say, hey, yes, of course you have this disease. Yes, of course, we want to treat the disease, but there's still, you're still a whole person. And so making sure that that tie is there from the beginning so that when the treatment is completed, um, we can hop back to thinking about it in the context of the whole body, I think is important. Um, Another thought again, sort of lightning round, a final question or two, you know, patient and, and family experience, you know, that's something too that we've talked a little bit about, you know, making sure to involve perhaps family members, partners, others in, in the process, you know, as part of that team and then, you know, as equal collaborators in, in this entire process. I wonder if there are any other sort of effective approaches on this front or if there's anything in terms of how you engage with. Individuals, family members, or sort of the broader kind of community of care that that comes to mind to, you know, share with our audience. I think the goal is to establish family members as a part of the team, team members, right? So, you got to set that expectation, um, uh, from, you know, the beginning, right? And in terms of expectation is also preventative medicine, right? Once you know what you're getting into and what the whole process of cancer care and. Survivorship is gonna entail, that actually alleviates a lot of the anxiety as well as um some of the, um, you know, the wrong expectations that the family members may have and, and curtail some of the, the, the, uh, the, the myths behind, you know, treatment and symptoms and so on and so forth. Um, but, you know, a lot of these patients, especially, you know, for, uh, patients that, uh, Doctor Myers takes care of early onset, right? And I'm seeing a, a cohort of that, uh, which has completely changed my practice in the last five years also to a point where we're actually, you know, like the model that the bridge has. Over at Ohio State, we're in, uh, you know, we're about to initiate an early onset program. It's not just about an individual, but the whole family, right? And they all go through it together. Whether it be the anxiety prior to the CT scan or anxiety about getting the diagnosis of recurrent disease, right? And, and how do we go about, how do we navigate financially, right? Because more, it, the, the, the treatments that we have, despite the fact that they're innovative, they're getting more and more expensive, right? And how do we help them as an institution, but as a community and as a state and a federal level, right? Um, so, I think engaging family members, not just as a patient family, but as a team member of the whole, uh, spectrum of care team, I think that's important. We've only got a, a couple of minutes left, so I, I want to sort of ask a final question. And, and, you know, in, in a sense, you know, if, if there's anything we haven't talked about or that we have talked about that you really want to underscore, um, I'd love to just sort of go around the horn and hear from each of you any sort of final takeaways or, or calls to action. Again, you all have shared a lot of great insights around technology, around collaboration, you know, around some of the kind of core themes that we've been exploring. But is there anything else that comes to mind or, or anything that again, you want to kind of double down on, uh, from what we've talked about, um, maybe Doctor Myers, we could start with you and, and hear from the others as well. I, I really, one of the things that we see a lot, again, most of my work is an early onset, so I use that as a platform, but I believe that the core oncology specialists, the medical oncologist, the surgeon, the radiation oncologist, We have a more traditional infrastructure for collaboration than some of the cancer supportive care services or the primary care teams do. And so, I, I, if I had to have a call to action, it would be just that is to have individuals think more broadly about the collaborative team and try very hard to engage with that team as early as possible because to Dr. Radhakrishnan's point, The expectations of who cares for what need to evolve. It is no longer possible for one or two providers or clinicians to, to really be responsible in order to optimize outcomes. And I would just add to that, I completely agree. And I think um what even this webinar shows is that I think my call is we just, all of us just have to be very intentional, right? This just isn't going to happen because we want it to. Um, we've kind of just went along because we all think our, you know, we're all motivated by what Dr. Kim said when we wrote our medical school application is we want to take the best care we can of our patients. So we just, we do stuff, right? We, we make sure our patient gets. Thing that we need, we try to reach out to whomever we need to make that happen, um, but it's has been on an individual level, and I don't think it has to be, right? Um, so I just think we have to be intentional on a larger level, whether that's the clinic system, hopefully the healthcare system, hopefully the regional, national system to say that collaboration matters and is the pathway to, to make sure that we provide the best care possible. And in a world where things are Complicated in healthcare where it's not just one person, um, where, you know, it's not back in the day where the PCP used to go to the patient's house and provide that kind of care. That's just not the world we live in anymore. And so, we're just the complexity in healthcare. I just think we have to be really, really intentional in how we wanna do that, and collaboration is the key, and we, um, we need to all say, yeah, it's important to do it. Doctor, I want, I want to stress what Dr. Ronna Christian said, you know, our healthcare system is evolving, right? We're going into systems-based practice, but also our disease processes are evolving. We're seeing much more early onset cancers and, you know, in various different sites. And also our migratory patterns are changing too. So it's the patients are not going to stay in one system, right? So I think I want to stress the point that we have to be intentional, just like what Dr. Radha Krishnan and Dr. Myers were saying. that we have to break down the silos and have that collaborative approach. And I think what needs to happen at a, a, you know, in terms of policy is maybe, you know, at a federal level or state level that we have to be intentional from insurance standpoint or from a health system standpoint to say, you know, you can, you know, if there are other available options for patients, that we should do any, anything possible for that to happen. And I think intentionally creating that is gonna be very important. Well, I think that's a great note to, to close out on. I want to thank, uh, say thanks so much to Doctor Kim, Doctor Myers, Doctor Radhakrishnan for your great insights for joining us, uh, today. You know, a World Health Organization report released just the other day noted that annual cancer cases are projected to rise. Considerably over the next 25 years, and that 1 in 5 people will develop cancer in their lifetime. So, the stakes are high. And, and, but I am really grateful for the work that you all on our panel and that so many of you in our audience are doing to improve care and the experience for those who are affected by this. Look out for a follow-up email from our team with a link to the recording of today's session, and I do hope you visit usnews.com/events to see some of the other programming we've hosted lately, including videos and coverage of our recent Healthcare of Tomorrow conference, which we hosted in Washington DC in June. Thank you all again for joining us and looking forward to seeing you another time. Appreciate the opportunity. Thank you, everyone. Thank you.
