Dr Nadeem provides community and clinical strategies to treat patients with MM.
Ryan Haumschild, PharmD, MS, MBA: Continuing to build that bridge between community and academic sites is going to be something that benefits not just our own patients but patients across the country, and I truly feel that way. How do we leverage the expertise of the people around the table here today with me and other leading researchers to make sure we’re impacting that and setting our community providers up for success while also making it easier for the patient? Dr Nadeem, I’ve got a question for you because with your organization being an NCI [National Cancer Institute]-designated comprehensive cancer center, you have that opportunity for influence. You have those experts who help developed treatment pathways. How do you work on relationships between the academic and community setting? Do you find that a lot of community oncology clinics look to you all for guidance? Lastly, how do you take your pathways, and do you sell them to the other clinics so that they have the chance to utilize them as well?
Omar Nadeem, MD: The myeloma physician community may be a smaller community, but we’re all treating the same disease. Whether it’s a community physician or an academic physician, we all have the same tools, and we can only use them in certain settings in some circumstances. But generally speaking, we’re all on the same mission. We have a huge collaboration with so many of our colleagues across the region that builds over time as you treat more and more patients together. We have our initial affiliates, and those affiliates are an extension of our center essentially, so they have access to our pathways and the same exact data that we’re sharing as part of some regular meetings among the affiliate sites. But then there’s the larger community beyond that, who don’t always have access to our pathways, and are more on the phone, or through an email, or through a text message, or whatever it may be to discuss a patient case and coordinate that referral if that’s what we need. And that happens every day. That’s why we do what we do, and that’s why we love what we do, to be able to help and have that kind of outreach. It happens in many different layers, and there is definitely a big educational component. We do a lot of tumor boards with some of our partner sites that may be a bit further away that have an affiliation with us. That’s how it happens on a regular basis where cases can be discussed. But a lot of it is also informal, and frankly, I think that’s great, to be able to have those conversations with the physicians who may be treating a tough patient who’s quite far away.
Ryan Haumschild, PharmD, MS, MBA: Excellent. I think that communication is huge. Dr Lipe, you talked about that a bit, those monthly meetings, meeting with your colleagues. Are there any other ways you communicate with the community setting at your organization to make sure you’re in step with them? Is it through the electronic medical record [EMR], do you see order sets and treatment pathways? Do you see in-person meetings being the best way? What are the ways that you best communicate with your community colleagues on an ongoing basis?
Brea Lipe, MD: I think the most common way we communicate is just by informal texts and emails and, “Hey, what do you think of this?”I think that is what you want to be as an academic center. I want to be approachable, I want to be reachable, and I want people to feel comfortable reaching out to me. So trying to establish personal connections in whatever way works I think is really important. I think that’s often accomplished better outside of the formal settings, just being available and knowing that I’m going to respond. It’s hard sometimes because I’m sitting here thinking about this all the time, and they’ve got a clinic full of patients, and they’re treating lung cancer and breast cancer, and then this patient with myeloma comes up. So, I like to be respectful of their time and not necessarily call them, but be available and really approachable. Any question is fine, and if they want to see me, fine, and if they don’t want to see me, that’s fine. But this is my phone number, call me. This is where I live, find me. This is where my kids go to school, drive by; I’m just kidding. But approachability I think is important.
Raymond Thertulien, MD, PhD: I think that’s very important in myeloma. It’s a small community as you said, and I have a very good perspective on this because before I took over the directorship for multiple myeloma for the Novant Health Cancer Institute, I was in private practice. Even though I had a healthy myeloma practice because that’s what I did in my former life in academia, I was seeing lung cancer and breast cancer and pancreatic cancer. And it is challenging for a provider in the community to practice general oncology and be aware of all the latest regimens and approvals in multiple myeloma, and we’ve had a lot of them lately. Again, being available informally [is important]. In our system, they actually send me a name and chart of patients because we use the same system throughout the network. So, it’s easy for them to send me a patient’s medical record number and chart. I can press on the message and open the chart and look at the records for the patient, and then through the EMR, communicate with them in addition to the informal texts and phone calls. I think it works really well within our network, and myeloma physicians usually make themselves very much available so that we can improve the care for patients with myeloma within the communities.
Brea Lipe, MD: Another thing I didn’t mention before is there’s talking about the regimens and then the practical utilization of them. So, how it was designed in the trial, and what do I actually do, when do I stop the dex [dexamethasone], do you need the premedications still, and what dose of Revlimid [lenalidomide] do I start with? I think that is something that is nuanced and can be really challenging because you can read a paper, and this is what they did, but now none of us do that anymore. I think one of the benefits of the electronic medical record is, at least at our institution, we’ll create a “how to” on a regimen. So, this is our RVd [lenalidomide, bortezomib, dexamethasone] regimen or our D-RVd [daratumumab plus lenalidomide, bortezomib, dexamethasone] regimen, and this is how we standardly give it. There can be nuances for different reasons. But then when a provider calls and says, “I’ve never done that before, how do you actually do it?” And there are practical questions like, what comes first, the daratumumab or the bortazumib? Things like that can be challenging. With the EMR, you can print out, this is how we do it, this is how it’s built, this is when we give this, and this how we say that. And this is when we stop the dexamethasone or whatever it is we’re giving. I think that’s been another mechanism for communication that has been really helpful.
Ryan Haumschild, PharmD, MS, MBA: Excellent points.
Transcript edited for clarity.