“Democratizing” cancer care: City of Hope’s national enterprise model for delivering cancer care.
Authors: Schriber Jeffrey , Artz Andrew S. , Purvis Amy , Slack James L. , Larsen Jeremy Todd , Park Soyoung , Tulipana Kevin Frank , Majkowski Gemini , Nakamura Ryotaro , Popplewell Leslie , Herrera Alex Francisco , Budde Lihua Elizabeth , Koller Paul B. , Janakiram Murali , Ball Brian , Phillips Tycel Jovelle , Rosenzweig Michael Alan , Marcucci Guido , Smith Eileen P. , Stewart Forrest 
Published: August 2023

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Background: Despite progress in cancer care, many patients do not have access to innovative care including participation in clinical trials. In 2021, City of Hope (COH), as part of a national expansion of its established cancer services, acquired Cancer Treatment Centers of America in the Chicago, Atlanta, and Phoenix regions to offer a standardized system of care to patients in those regions. The goal is to integrate academic and community-based practices into a single enterprise focused on improving access to care. Physicians collaborate to enhance patient care and connect patients and families to innovative treatments. Initial priorities included integrating patient conferences, developing common quality programs and metrics, new physician recruitment, integrating clinical pathways, developing new specialty programs, integrating EHRs, contracting, branding/marketing, operating as non-profit organizations and other organizational structures. Methods: We describe changes made at a single site as a model to improve local cancer care. Phoenix (PHX), Arizona is the 5th largest city in the United States. Most patients with hematologic malignancies currently receive care in the community setting and lack access to clinical trials. Results: In collaboration with our parent center in Duarte, we have instituted a variety of changes designed to enhance patient care. The hiring process for physicians (who become COH faculty). in the hematologic malignancy program includes stakeholders from Duarte and Phoenix. All potential transplant, cellular therapy and complex patients are presented and discussed with related COH faculty at regularly scheduled interdisciplinary rounds. To date, over 50 have been presented, 20 have proceeded to autologous transplant. Quality programs are integrated with active participation in QA conferences at each facility. Second opinions are returned to their primary oncologist with recommendations. Patients who would benefit from a trial or innovative therapy not available at the Phoenix site are referred to the Duarte campus and return to Phoenix following that intervention. The first shared allogeneic transplant patient performed in Phoenix is pending. In the next phase of integration, trials will be offered at COH PHX. An integrated approach to determine eligibility for older myeloma transplant candidates piloted by COH PHX is under development. Conclusions: The ability to remain in their local community while obtaining an opinion from an NCI designated cancer center, democratizes care for hematologic malignancy patients. Ongoing discussions throughout their treatment determine the best options including clinical trials if appropriate. The majority of patients will receive therapy locally, especially as the number of clinical trials grows. This model once fully integrated, improves access to care and can be easily replicated at other sites.