A Message from AACI President Stanton Gerson, MD
Director, Case Comprehensive Cancer Center
December 2016

The AACI Cancer Center Network Care Initiative

Many cancer center hospital systems are expanding their services across large geographic regions, while cancer care is consolidating around ever enlarging groups. As I took on a leadership role within AACI, I thought that understanding these networks better might be a fruitful effort for the association. Thus, over the next two years as I serve as president of AACI, I look forward to the opportunity to describe these networks and to develop suggestions available to our centers to improve the quality of cancer care administered across individual cancer center networks, with better integration of treatment services, especially those now unique to our centers, into the community.

At the Case Comprehensive Cancer Center, our clinical partners, University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, face daily challenges in managing patient care across the entire Northeast Ohio region, covering some 4.3 million people and 16,000 (out of a total of 23,000) new cancer cases diagnosed annually. This has weighed heavily on my mind over the past year, spurring the idea for the "AACI Cancer Center Network Care Initiative."

One preliminary step in this process is to ensure that major academic cancer centers—NCI-designated as well as emerging centers that are also AACI members--are able to paint an accurate picture of the impact they have on cancer care across the regions they serve. When Vice President Joe Biden announced the Cancer Moonshot, he indicated only 15 percent of all cancer cases are seen by NCI-designated cancer centers, when in actuality this number is much higher. The discrepancy is due to NCI-designated cancer centers only reporting to the NCI the analytic cases seen at our main campuses, leaving out the amount of cases seen across our networks. I raised the issue at AACI’s annual meeting this year, suggesting that we all collect such data and add it to our descriptions in our core grants as this may become a reportable element to NCI. We can also remind our elected officials of our community impact when we describe our centers. That would be a big win for the initiative.

The challenge is that managing networks is a complex task, without a clear roadmap. Employment models, referral patterns, use and access to clinical trials, use and coordination of carepaths, and monitoring quality are just a few of the issues that we all address in our network management. AACI first commented on this in the AACI Cancer Center Network Care Initiative White Paper. This document was signed by many of the cancer center directors who participated in the Cancer Moonshot national summit in June and was submitted to the Vice President’s Cancer Moonshot Task Force. AACI aims to continue to pursue the goals of the Cancer Moonshot, which are of vital importance to the health of our patients. This paper outlines our readiness to collaborate with oncology practices across networks to improve the availability of high quality care, carepaths, innovation, proper referrals, and availability of clinical trials to a larger population of patients.

I am initiating an AACI review of network scope and activities as my presidential initiative. First, we will collect data (with assistance and participation from AACI cancer center directors), engage cancer center clinical leaders and then identify and discuss best practices and commercial support efforts to improve our coordination and care across networks. Key elements of the data we will collect from each center include:
- Quality of care across their network
- Multidisciplinary care across their network
- Access to local and national clinical trials, genomics tumor boards, and center tumor boards across their network
- Uniformity of care through implementation of carepaths across their network
- Integration of patient databases for aggregation of data for research and quality
- Improved screening and prevention strategies across their network
- Population education in cancer prevention, screening, treatment
- Linkages to safety net hospitals
- How patients can get expert opinions and care closer to home.

Next steps for the initiative are as follows:
1. AACI's Physician Clinical Leadership Initiative is tasked with developing a questionnaire about the current status of networks including topics about care coordination, employment models, availability of clinical trials and genomics, research pharmacies, use of carepaths, data sharing, end of life care, high risk assessments, and use of commercial products to facilitate program interactions across sites.

2. We will assemble and review results, aiming to both publish the survey results and identify best practices that will increase patient access and quality of care, while improving the efficiencies and consistency of care.

The AACI Cancer Center Network Care Initiative depends on the engagement during data gathering and discussion of all cancer centers. I am asking centers to respond to the survey when it is released, and to participate in review of their practices and approaches to managing networks.  Our aim is to improve the quality of cancer care administered across cancer center networks.

This initiative might sound bold – and it is. However, it is also necessary. Given the breadth of expertise within our organizations, I am confident we have the ability to develop a viable solution that will directly benefit patients.

My hope is that at the end of my tenure as president, we will have a concrete plan to assist centers across the country in developing high quality network-based cancer care that provides access to clinical trials and advanced diagnostics and interpretation, while reinforcing the value of the nation's academic cancer centers.