The Academic Community-Hybrid Model in Medical Oncology - Dan Roberts
January 17, 2022
In a conversation with Alicia Morgans, Daniel Roberts discusses his innovative approach to oncology care through an academic-community hybrid model. Published in the Journal of Clinical Oncology, this model aims to bridge the gap between academic research and community-based care. Roberts, who is also based at Dana-Farber, explains that the model allows him to engage in clinical medicine while also participating in academic research and clinical trials. He emphasizes the importance of institutional support in making this model work, as it enables him to serve patients in both settings effectively. Dr. Roberts is particularly interested in expanding clinical trial enrollment in community settings, a move he sees as crucial for the future of oncology care. He believes that this model, although not one-size-fits-all, has the potential to be adapted across various institutions, enhancing patient care by integrating academic advancements into community practice.
Biographies:
Daniel A. Roberts, MD, Medical Oncologist, Dana-Farber Cancer Institute and Beth Israel Deaconess Medical Center, the Lank Center for Genitourinary Cancer, Boston, MA
Alicia Morgans, MD, MPH, Genitourinary Medical Oncologist, Medical Director of Survivorship Program at Dana-Farber Cancer Institute, Boston, MA
Biographies:
Daniel A. Roberts, MD, Medical Oncologist, Dana-Farber Cancer Institute and Beth Israel Deaconess Medical Center, the Lank Center for Genitourinary Cancer, Boston, MA
Alicia Morgans, MD, MPH, Genitourinary Medical Oncologist, Medical Director of Survivorship Program at Dana-Farber Cancer Institute, Boston, MA
Read the Full Video Transcript
Alicia Morgans: Hi, my name is Alicia Morgans, and I'm a GU Medical Oncologist at Dana-Farber Cancer Institute. I am so excited to talk today with a friend and colleague, Dr. Dan Roberts, who is a Medical Oncologist and Hematologist at Dana-Farber on the Longwood Campus, as well as the Dana-Farber Milford Satellite. Thank you so much for talking with me today, Dr. Roberts.
Daniel Roberts: Thanks, Alicia. It's a pleasure to be here.
Alicia Morgans: Great. Well, you wrote something so intriguing recently, and it was published in the Journal of Clinical Oncology. A really important paper, from an opinion perspective, about this concept of the academic community hybrid model and how medical oncologists may engage in ways that are different than we've traditionally discussed or thought about. Can you explain this model a little bit?
Daniel Roberts: Sure. Yeah, I'd be happy to. So this model has been around for a few years, and folks have been talking about this throughout different health systems throughout the country. What it really is, it's an idea that you can serve the community, and practice community oncology while also serving the academic mission. As I was going through the fellowship process, I realized I really wanted to do clinical medicine. That was my passion, but I loved academics. I loved being around all the experts and the research and the clinical trials, and I didn't want to give that up. I did want to work in the community, which is something I realized over time, but I also wanted to be part of the academic scene and involved in that. And so what I really was hoping for was a career that had both, and that's kind of the idea.
Alicia Morgans: Well, and I think that's so important and timely because I have to say I've mentored and worked with a lot of people over time who wanted something very much like that. But it can be really hard to find a community practice that is able to support the infrastructure for clinical trials, for example, and also can be difficult in an academic center to see more than one tumor type. So really you are walking a line or bringing a specialty back together that has been split for some period of time. How are you enacting this type of model or a similar approach in what you do on a day-to-day basis?
Daniel Roberts: Sure. So it is a tight line. It's a tight line to walk, but it's walkable. I think one thing that we need to acknowledge first and foremost, is the reason why I'm able to do this is that I've had support over the years. I had amazing support from my fellowship program, who allowed me to train in the community for a lot of my fellowship. I've had amazing support now with Dana-Farber, from both the GU Division leadership, as well as the network that runs the satellites. And that is just huge. Nothing can happen without institutional support.
So what I do, in terms of how my work breaks down is I'm downtown and doing mostly prostate cancer in the Longwood area. One day a week, I also see kidney and bladder, occasional testicular cancer as well. Then I spend the rest of my clinical time at the Dana-Farber Milford, where I do probably, a rough estimate, probably 60% genitourinary cancers, a smattering of other general oncology, and then some benign hematology.
I think it's very important that I have dedicated time where I physically go downtown, and I am part of the group. I go to all the meetings that all the other GU medical oncologists go to, the protocol development meetings, I have a vote there and all the seminars, et cetera. And so I have dedicated time to be part of that. Then I obviously have my time out in the satellite, so I'm very much given the support and infrastructure needed to do the job. Then what this results in and what I love about this is that I am able to really bring that academic care out into the community and vice versa actually, I can sometimes bring Milford patients downtown when I need to for trials. But that's kind of how it's worked out.
Alicia Morgans: I think that's so important because we know, I think in oncology, that the majority of our patients are actually treated in community settings. Especially as the population ages, cancer becomes more of a chronic problem, we will continue to see patients and need to see patients and meet them where they are. If nothing else, the pandemic has taught us that patients do not always want to come in, and sometimes it's not safe for them to come in. So, how do you bring the academics out into the community? In what ways, other than bringing those community patients downtown, can you really connect them with an academic mindset or even some of the academic approaches to medicine?
Daniel Roberts: The big thing is trials. Can we get trials out in the community? As is well documented, I think it's somewhere around 5% of all cancer care patients are on clinical trials. We are talking about a huge low-hanging fruit to try and improve clinical trial enrollment. This is where we really could do it, is getting the trials out in the community. That's much easier said than done. We have a smattering of GU-related trials in our satellites, and they've been more or less successful depending on the trial, but that's certainly the area that I am interested in and hope to kind of keep working on as the Dana-Farber network grows too, is to really try and improve clinical trial enrollment.
Then there are educational initiatives that I think a lot of our other colleagues have worked on too with making sure that as the rapidly evolving treatment landscape for all our cancers changes, that all of the satellites are in the loop. In the people that see and subspecialize in prostate cancer, for instance, they know quickly, hey, the PEACE-1 data came out, the new STAMPEDE data with high-risk abi.... These are important things that help for information dissemination and education.
The other area which would serve as a really nice link to satellites and community is this "Pathways". The Cancer Care Pathways, which has been implemented really around the country with different companies and venues serves as a really nice way to not only make sure that folks are up to date with the latest in treatment changes but also clinical trial availability. Pathways tends to have a built-in option for clinical trials. So these are some of the ways that kind of this hybrid model can facilitate that.
The other thing is that when you have someone at a satellite who is integrated with a downtown group, a disease subspecialty group, they serve as that academic representative, and people go to them with cases and end up kind of getting that care locally that way.
Alicia Morgans: So I think that is so important. I wonder Dan, what you would say to either critics or those who just don't necessarily feel like they have the resources that your academic institution has to help build these bridges and make these connections. What would your advice be to these folks?
Daniel Roberts: Yeah, I certainly think this is not a one-size-fits-all approach. Every institution is going to have its own set of resources and unique circumstances. Listen, I think part of this model is you don't have to physically be present downtown. I, for instance, may not be able to have a clinic in Boston if my satellite was three hours away. I think that this is still a scalable model in different resources. Many groups throughout the country, cooperative groups, and the National Community Oncology Research Project through the NCI, there is just so much room to grow here that I think this sort of model definitely can be implemented throughout the country, but it's going to be unique to each institution and system.
Alicia Morgans: Well, I think this is certainly the way that we need to go as an oncologic community in the future and that the separation between community care delivery and academic care delivery does not need to be so wide. I really commend you for bringing the groups together, maintaining that link, and ensuring that patients get the best care wherever they are in the system. I really hope that you continue this work and that this type of approach to delivering cancer care extends much beyond you. So thank you so much for your time and for your expertise.
Daniel Roberts: My pleasure. Thank you for having me.
Alicia Morgans: Hi, my name is Alicia Morgans, and I'm a GU Medical Oncologist at Dana-Farber Cancer Institute. I am so excited to talk today with a friend and colleague, Dr. Dan Roberts, who is a Medical Oncologist and Hematologist at Dana-Farber on the Longwood Campus, as well as the Dana-Farber Milford Satellite. Thank you so much for talking with me today, Dr. Roberts.
Daniel Roberts: Thanks, Alicia. It's a pleasure to be here.
Alicia Morgans: Great. Well, you wrote something so intriguing recently, and it was published in the Journal of Clinical Oncology. A really important paper, from an opinion perspective, about this concept of the academic community hybrid model and how medical oncologists may engage in ways that are different than we've traditionally discussed or thought about. Can you explain this model a little bit?
Daniel Roberts: Sure. Yeah, I'd be happy to. So this model has been around for a few years, and folks have been talking about this throughout different health systems throughout the country. What it really is, it's an idea that you can serve the community, and practice community oncology while also serving the academic mission. As I was going through the fellowship process, I realized I really wanted to do clinical medicine. That was my passion, but I loved academics. I loved being around all the experts and the research and the clinical trials, and I didn't want to give that up. I did want to work in the community, which is something I realized over time, but I also wanted to be part of the academic scene and involved in that. And so what I really was hoping for was a career that had both, and that's kind of the idea.
Alicia Morgans: Well, and I think that's so important and timely because I have to say I've mentored and worked with a lot of people over time who wanted something very much like that. But it can be really hard to find a community practice that is able to support the infrastructure for clinical trials, for example, and also can be difficult in an academic center to see more than one tumor type. So really you are walking a line or bringing a specialty back together that has been split for some period of time. How are you enacting this type of model or a similar approach in what you do on a day-to-day basis?
Daniel Roberts: Sure. So it is a tight line. It's a tight line to walk, but it's walkable. I think one thing that we need to acknowledge first and foremost, is the reason why I'm able to do this is that I've had support over the years. I had amazing support from my fellowship program, who allowed me to train in the community for a lot of my fellowship. I've had amazing support now with Dana-Farber, from both the GU Division leadership, as well as the network that runs the satellites. And that is just huge. Nothing can happen without institutional support.
So what I do, in terms of how my work breaks down is I'm downtown and doing mostly prostate cancer in the Longwood area. One day a week, I also see kidney and bladder, occasional testicular cancer as well. Then I spend the rest of my clinical time at the Dana-Farber Milford, where I do probably, a rough estimate, probably 60% genitourinary cancers, a smattering of other general oncology, and then some benign hematology.
I think it's very important that I have dedicated time where I physically go downtown, and I am part of the group. I go to all the meetings that all the other GU medical oncologists go to, the protocol development meetings, I have a vote there and all the seminars, et cetera. And so I have dedicated time to be part of that. Then I obviously have my time out in the satellite, so I'm very much given the support and infrastructure needed to do the job. Then what this results in and what I love about this is that I am able to really bring that academic care out into the community and vice versa actually, I can sometimes bring Milford patients downtown when I need to for trials. But that's kind of how it's worked out.
Alicia Morgans: I think that's so important because we know, I think in oncology, that the majority of our patients are actually treated in community settings. Especially as the population ages, cancer becomes more of a chronic problem, we will continue to see patients and need to see patients and meet them where they are. If nothing else, the pandemic has taught us that patients do not always want to come in, and sometimes it's not safe for them to come in. So, how do you bring the academics out into the community? In what ways, other than bringing those community patients downtown, can you really connect them with an academic mindset or even some of the academic approaches to medicine?
Daniel Roberts: The big thing is trials. Can we get trials out in the community? As is well documented, I think it's somewhere around 5% of all cancer care patients are on clinical trials. We are talking about a huge low-hanging fruit to try and improve clinical trial enrollment. This is where we really could do it, is getting the trials out in the community. That's much easier said than done. We have a smattering of GU-related trials in our satellites, and they've been more or less successful depending on the trial, but that's certainly the area that I am interested in and hope to kind of keep working on as the Dana-Farber network grows too, is to really try and improve clinical trial enrollment.
Then there are educational initiatives that I think a lot of our other colleagues have worked on too with making sure that as the rapidly evolving treatment landscape for all our cancers changes, that all of the satellites are in the loop. In the people that see and subspecialize in prostate cancer, for instance, they know quickly, hey, the PEACE-1 data came out, the new STAMPEDE data with high-risk abi.... These are important things that help for information dissemination and education.
The other area which would serve as a really nice link to satellites and community is this "Pathways". The Cancer Care Pathways, which has been implemented really around the country with different companies and venues serves as a really nice way to not only make sure that folks are up to date with the latest in treatment changes but also clinical trial availability. Pathways tends to have a built-in option for clinical trials. So these are some of the ways that kind of this hybrid model can facilitate that.
The other thing is that when you have someone at a satellite who is integrated with a downtown group, a disease subspecialty group, they serve as that academic representative, and people go to them with cases and end up kind of getting that care locally that way.
Alicia Morgans: So I think that is so important. I wonder Dan, what you would say to either critics or those who just don't necessarily feel like they have the resources that your academic institution has to help build these bridges and make these connections. What would your advice be to these folks?
Daniel Roberts: Yeah, I certainly think this is not a one-size-fits-all approach. Every institution is going to have its own set of resources and unique circumstances. Listen, I think part of this model is you don't have to physically be present downtown. I, for instance, may not be able to have a clinic in Boston if my satellite was three hours away. I think that this is still a scalable model in different resources. Many groups throughout the country, cooperative groups, and the National Community Oncology Research Project through the NCI, there is just so much room to grow here that I think this sort of model definitely can be implemented throughout the country, but it's going to be unique to each institution and system.
Alicia Morgans: Well, I think this is certainly the way that we need to go as an oncologic community in the future and that the separation between community care delivery and academic care delivery does not need to be so wide. I really commend you for bringing the groups together, maintaining that link, and ensuring that patients get the best care wherever they are in the system. I really hope that you continue this work and that this type of approach to delivering cancer care extends much beyond you. So thank you so much for your time and for your expertise.
Daniel Roberts: My pleasure. Thank you for having me.