Dr Paul Thurmes Addresses Gaps in Cancer Care

Paul Thurmes, MD, medical oncologist and hematologist, Minnesota Oncology, spoke on key responsibilities and approaches that are often lacking in cancer care.

Taking the time to speak with patients to help them understand their options and make the right choices for themselves is essential to cancer care, said Paul Thurmes, MD, medical oncologist and hemtaologist at Minnesota Oncology.


What gaps in cancer care do you typically see with patients and how is Minnesota Oncology helping to address these gaps?

Gosh, gaps in cancer care, there's lots. I think kind of right out of the starting gate, as far as cancer diagnosis, is that the traditional model, even for seeing patients with cancer has been that the person has some symptoms or some scan for something that's concerning. And then they go through this very long process of delays and maybe getting a biopsy, maybe seeing a surgeon, maybe not, and their primary doctor trying to sort this out. I think just the delays in people being able to get the answers that they need, and the information that they need about what's going on, has really been a challenge in cancer care.

And frankly, particularly with the rapid access to information and medical care these days, for instance, the technology that's available so patients can instantly get their CT results online, and if there's a concerning finding, that can be very alarming for them. Pretty much anyone who shows up in an emergency room very frequently will get a CT scan, that can be anxiety provoking, etc. There's this whole bunch of initial information, but then this lag time between how it's really dealt with for the patients frankly, in a not very patient-friendly manner.

Minnesota Oncology has taken the approach in the past year or so that we will see anyone who really needs our care very early on, even if it's just a suspicion of cancer. A concerning symptom or concerning CT scan, we have sort of guaranteed that we'll get these patients into our clinic and be seen by one of our oncologists within 24 to 48 hours. And they don't have to have gone through that whole biopsy. And in the past, it's been oh, before you see the oncologist, somebody else has to work you up and prove that you have cancer. We'll see the patient; we will work them up, they're just super hungry for information on what's going on. “Doc, what's the next step? What are the possibilities here?” And I, as an oncologist, I can outline for them, and my other colleagues can do that as well: outline for the patient, really, what we're seeing, what the possibilities are here, how we're going to deal with it, how we're going to work that up; if it is cancer, what would be the next steps for that, etc. So, really get them in early to have those conversations and to have that workup, and that gives them reassurance.

It also really helps, when they get those answers early, it reduces their anxiety, it reduces their use of subsequent medical care because somebody who's waiting, waiting, waiting, waiting, for that appointment, for that biopsy for, that next appointment, etc., they're bound to need more medical care. The next time they have a headache, and they're like, oh my gosh, I'm sure it's cancer. They show up in the emergency room, what happens in the emergency room? Maybe they have cancer, we should do an MRI. And it's just test after test. It just isn't really sequenced properly or really thought through because everybody's just kind of in a panic during this month.

The patient really should have been worked up kind of more thoughtfully, so we can get them in and do that thoughtful, thorough workup and care that they really need and deserve. Give them the information and communicate with their care team, sort of what the next steps are and how we're going to go about this. I think that certainly has been a gap in cancer care and one that we're trying to address.

I think one of the other gaps has been helping patients understand their diagnosis early on and giving them the tools and the information that they need to really get through this cancer diagnosis, which really, as all of us know, a cancer diagnosis can just turn someone's world upside down.

In addition to getting these patients in very early, within 24 to 48 hours, we've also been assigning them to a nurse navigator. And the nurse navigator’s kind of this patient's touch point, really for those first couple of visits, and then ongoing through their care, because they're going to be part of the care team.

Those nurse navigators will really be part of their care team throughout their whole treatment course and follow-up course. But during those first couple of visits in that first week, week and a half, 2 weeks, 3 weeks, whatever it is; during that week, during that first initial phase of workup and subsequently getting patients started on treatment. Again, these are super high anxiety times for patients, when they they're trying to figure out, what do I do with work? What do I do with my family? What is this going to look like? What is chemo going to be like? What is surgery going to be like? What is radiation going to be like? Well, it’s just a super heavy burden and getting them in with our nurse navigators and connecting them very early on with that process, we have found to be really helpful for them and patients have really, really appreciated that.

Again, great patient care, I think, allows for better sequencing and thoughtfulness and workup and treatment. And it also gives patients the tools they need to understand what's going on and how they can manage their lives around this.

In addition to that, getting them connected to really essential services like social workers, or mental health experts, or palliative care. I think the those are things that have been implemented.

I would also say end-of-life care, kind of on the other end of the spectrum. I've mentioned the sort of initial phases of a cancer diagnosis. And hopefully through treatment, most of our patients, and many of our patients absolutely do great, and they graduate, and 5 years later, we say congratulations, wonderful. But certainly, in this field, there are patients who will have their cancer advance and will succumb to their disease at some point. And, I think what has been lacking in this field is giving patients the opportunity to make the life choices that are really what they want and that are really important to them. Giving them the time and space to ask those questions.

As a cancer physician, sometimes the easiest thing to do is really just to say to the patient, “OK, your next chemotherapy is this.” That takes 5 minutes for me, as a physician, to do, but that might not be the right thing. Those conversations around, is it really the right thing? Is it not? Here are your treatment options. “Hey, doc, what’s this going to be like?” And spending the 20, 30, 40 minutes with the patient to really help them understand, really help them make choices for themselves that are really right. And frequently that will be hospice care at some point in their journey.

We've really moved those discussions earlier in the treatment course so that whether or not somebody has a really excellent prognosis, or just not a very good prognosis at all, we've kind of moved the discussions earlier so that patients can do advance care planning, they can outline really what they want, really what their wishes are.

And that can then be applicable for a long time. Again, whether there's a good outcome or a more difficult outcome from their cancer diagnosis. And also getting them in with our palliative care team very early on in their diagnosis, particularly if there's symptoms that need to be managed early on, rather than waiting for somebody to really be in dire straits, getting them in with our palliative care team to have those discussions. So, when those life transitions come about, they can be done without me as a physician just clicking the next box for chemotherapy, because lots of times that just is not the right thing for our patients. And sometimes that is the right option. I mean, we have so many new treatment options, and sometimes patients are surprised and we’re surprised about like, “Oh, you know, here's something else that we can do.” And it's a really good option, but we want it to be on the patient's terms. Having those discussions early and often has served the patients well.

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