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Dennis Bruens calls it a journey, the challenging navigation from cancer diagnosis through happy or heartbreaking conclusion. That journey is personal, but one not made in solitude as teams of professionals assist in guiding patients through the complex network of treatments.
That journey is being taken by more victims of cancer as a greater number are diagnosed. Meanwhile, survival rates have risen, as have costs of treatment, forcing local care providers to develop strategies to meet the increasing need and compete with larger cancer centers balanced against rising costs of care.
Care provider collaborations and regional cancer centers are the trending solution, providing a one-stop shop of sorts in providing a comprehensive menu of services in a more spa-like environment. The recently completed, 24,000-square-foot expansion of the Lee Health Regional Cancer Center in Fort Myers is among the latest examples of the effort to streamline fragmented care while providing a more comfortable patient experience.
“What you see in the design here is a focus on life,” says Bruens, vice president of oncology services at Lee Health Regional Cancer Center. “When you walk in you see through glass into the rehabilitation area, and the intent is to show people getting better. The pictures here are colorful and connecting with nature, and it’s all about creating hope and a healing enviroment.
“That is what this is all about: life and surviving.”
Lee Heath is joined in this trend on Florida’s west coast by Sarasota Memorial Hospital, which recently announced plans for a $220 million cancer treatment facility. Likewise, the H. Lee Moffitt Cancer Center & Research Institute in Tampa has grown its campus and research facility significantly over the last decade.
The increase in demand for services is in part the result of the region’s demographics and in part unprecedented survival rates which can keep more patients in cancer for longer periods.
“Even though cancer can affect people of all ages and backgrounds, in general it's an older person's disease,” says Bruens. “The population here is growing and it's aging at the same time, so that is the formula that will continue to result in growth. As we look at cancer care going forward, between population growth, aging of the population and treatments we have available versus 10 years ago, over the next five to 10 years 40% growth in the number of people who need the services is not out of the question.”
According the Centers for Disease Control and Prevention and the National Cancer Institute, Florida is second only to California in the most cancer diagnoses, with age demographics as the primary contributing factor. The projected number of new cancer cases in Florida by the end of 2018 is 135,170, or 7.8% of the anticipated national total of 1.7 million.
“In 1975, about one-third of cancer patients survived 10 years or more,” Bruens says. “For patients diagnosed in 2005, which is the last data we have of patients who have survived 10 years or more, that number is two-thirds, so in that intervening period we have doubled the survival rates for cancer. A lot of that is do to with early diagnosis and better treatment, so our mindset has gone from just treating the patients to healing them.”
With Lee Health's recent expansion, the center is now a 90,000 square feet facility. It includes palliative care, physician practices, a multi-disciplinary clinic, oncology rehabilitation services, a healing garden and speech pathology services. It is the fourth largest community cancer treatment center in Florida, with more than 15,000 patient visits each year and growing prior to expansion.
The expanded Regional Cancer Center allows Lee Health and its collaborative partners to consolidate nearly all non-surgical oncology services in one location. The facility is the latest example of a national trend toward health care systems broadening cancer treatment options in an effort to offer locally the same level of care as nationally known centers.
The mission of Lee Health's RCC — a collaboration between Lee Health, 21st Century Oncology, Florida Cancer Specialists and Florida Gynecologic Oncology — is more for the benefit of the patient rather than the bottom line, says Medical Director Dr. James Orr of 21st Century Oncology.
The partnership, in terms of branding, at least, comes with a risk in that both 21st Century and FCS have faced some non-treatment centric difficulties.
A global company, 21st Century, for example, recently emerged from Chapter 11 proceedings. It and Florida Cancer Specialists, with offices throughout Florida, have been named in a federal class action lawsuit accusing them of colluding to monopolize cancer treatment in Southwest Florida and inflating prices.
Both Fort Myers-based companies, which are among the nation’s largest cancer care providers, have dismissed the claims as baseless. 21st Century Oncology also faces a lawsuit related to a breach of 2.2 million patient records in 2015.
Lee Health President and CEO Dr. Larry Antonucci, says the focus of the partnership, pragmatically, is based on results. “We have the same great outcomes as many of more prominent cancer centers in the country,” he says. “This is possible due to the strong collaborative effort of Lee Health, 21st Century Oncology and Florida Cancer Specialists. It is one of the most significant and impactful health care collaborations in our community.”
Also officials note collaboration for the RCC occurred prior to the two companies’ legal issues, and it developed organically, says Orr, when disparate cancer providers in the community recognized the fragmented nature of care and the inefficiencies that resulted. It goes back two decades, to 1998, when cancer care industry veteran Sharon McDonald joined Lee Health after developing cancer programs on the East Coast and in the Northeast. McDonald is now chief administrative officer of oncology and home health services for Lee Health.
“Lee’s intent was to develop a program here," says Orr. "There was no program at all, so as part of 21st Century Oncology, I teamed up with Sharon and started thinking about how to develop a programmatic approach to cancer care.”
The impetus for the program that would become the Regional Cancer Center was gynecological oncology treatment, in which surgeons are also trained and certified in chemotherapy and radiation therapy. Lee Memorial had committed $5 million to develop six chemotherapy chairs on the sixth floor of the old hospital, the foundation of the comprehensive cancer care model there.
“Over the next two to three years, everyone came to the table because we had excellent services in the community and had good surgical care, and over the years providers got together to ask what we could do to improve the quality of care for cancer patients in the community,” says Orr. “One of the things that resounded the loudest was a need to at least house various providers in close proximity."
When the first cancer building opened in 2008, Lee Health owned it and Century 21st Century tool some space, adds Orr. Eventually Florida Cancer Specialists wanted in, too. Next the center, says Orr, began to add services, including surgical oncology, neurologic oncology and more.
Bruens says the Regional Cancer Center has seen double-digit growth since it opened in 2008. Orr says in 2013, all parties recognized the need to expand the center as additional services were added.
“Our multidisciplinary team offers a comprehensive approach to care and having these services provided all under the same roof makes a world of difference,” says Bruens.
Dr. Arie Dosoretz, radiation oncologist and RCC director of clinical operations and quality, says practitioners have embraced the regional cancer center model.
“Cancer care is changing. Unfortunately the need has gone up, and here we continue to see a tremendous need for our services,” says Dosoretz. “Over the last few decades, the patient has begun to demand a multi-disciplinary model where you are not just seeing a doctor by himself or herself making decisions, but rather all the oncology disciplines. And physicians want to be a part of being involved in the beginning so as a team they can plan and coordinate care.”
The Regional Cancer Center’s wholistic approach to cancer care is not alone in Southwest Florida. Sarasota Memorial Hospital recently announced a $220 million cancer treatment facility it plans to build at its midtown campus by 2020. The hospital cited a 20% increase in cancer patients between 2014 and 2016 and its effort to respond to the need.
“People are living longer, with their cancer either cured completely or managed like other chronic diseases,” James Fiorica, the hospital’s chief medical officer, previously told the Business Observer about the expansion.
The initial phases of the SMH project include a new cancer inpatient and surgical tower on SMH's main campus, expected to be completed in 2021, and an outpatient radiation treatment center on its University Parkway campus, expected to be finished in 2020. The third phase involves building a new cancer pavilion with outpatient services across from the main hospital.
Data suggests that such “high-volume” focal points on cancer care benefit outcomes for patients, leading to the trend of concentrating care in centralized locations.
“Annually, more than 7,000 men and women in Southwest Florida are given a cancer diagnosis,” says Orr. “All science suggests that the best clinical outcome and survival occurs when high-volume physicians care for their patients in a high-volume clinical setting. The Regional Cancer Center has facilitated the recruitment of world-class physicians who are intimately involved in the entire spectrum of care, from diagnosis to treatment and survivorship.”
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