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Added cancer centers mean patient options, provider challenges

Cancer: The word itself generates anxiety. A diagnosis can be devastating and treatment even scarier. And for many patients, the ordeal gets worse.

The Patricia D. and M. Scot Kaufman Cancer Center in Bel Air and Aquilino Cancer Center in Rockville, two comprehensive facilities, mean cancer patients in those areas don’t need to travel to Baltimore or Washington for treatment.

Physicians say too many patients spend hours driving to and from major hospitals so they can receive comprehensive treatment at a single site. Others stay closer to home, but end up bouncing from hospital building to clinic to another hospital.

To address that issue and to prepare for an expected increase in the number of people who will be diagnosed with cancer in the coming years, several community hospitals in Maryland are unveiling new cancer-care facilities on or near their campuses.

The goal is to give residents in those communities an alternative to traveling long distances for each appointment, each chemotherapy infusion, each support group meeting. The new buildings will bring those services under one roof, and hospital executives say they’ll be on par with the offerings at major hospitals in Baltimore and Washington, which have long attracted sizeable numbers of patients from across the state.

Two centers are opening to patients within days — the Patricia D. and M. Scot Kaufman Cancer Center at Upper Chesapeake Medical Center in Bel Air will open Oct. 7, while the Aquilino Cancer Center, adjacent to Shady Grove Adventist Hospital in Rockville, will start seeing patients next week. Additionally, Carroll Hospital Center is scheduled to unveil the new William E. Kahlert Regional Cancer Center on its Westminster campus in about a year.

“About 95 percent of cancer care can be delivered on an outpatient basis, and it’s not unusual for a cancer patient in their first year after diagnosis to have 100 visits,” said Lyle Sheldon, president and CEO of Upper Chesapeake Health System. “Some of those services were [in Harford County], but they weren’t coordinated in a single, centralized place. If you have to drive down to Baltimore for care, that’s just an exorbitant amount of time you’re spending, and it certainly doesn’t help the healing process.”

In most industries, businesses wouldn’t be happy about new competitors coming online at the same time. When it comes to cancer care, however, reactions are mixed. Some providers welcome the additional centers, while others are contemplating how they will keep going.

At 21st Century Oncology of Maryland, a private practice with two Harford County locations, volume will “definitely, definitely” decline, said Medical Director Dr. Vladimir Ioffe.

“I’m not even sure we’re going to be able to keep these centers open,” Ioffe said. “I’m thinking how we can possibly — we may have to consolidate the Belcamp and Bel Air locations into one, or we may reduce staff or reduce hours. There’s only a certain number of patients, and when you add a large cancer center like [Kaufman at Upper Chesapeake], it’s going to shift the volume away from us and toward them. That’s the reality.”

But several hospital officials — even those who see cancer patients from areas that will now be served by new centers — say they’re not worried about losing market share to the new facilities. There’s enough demand in Maryland to fill the new centers, as well as sustain the necessary volume at existing ones, several people said.

“Over the past five to 10 years, hospitals in this region have been investing in multidisciplinary cancer programs,” said Terry Langbaum, chief administrative officer of cancer services at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center. “Most of them have plenty of patients to take care of locally, and they do well, and we all sort of live in symbiosis.”

Although most hospitals have little risk of losing market share, academic medical centers are particularly protected against that possibility, Langbaum said.

Institutions like Hopkins and the University of Maryland Marlene and Stewart Greenebaum Cancer Center, both in Baltimore, serve a niche: They’re equipped to take on patients with highly complex or rare medical conditions that community hospitals either can’t or don’t want to accept.

Additionally, a certain percentage of patients will always want to be seen at an academic hospital, regardless of the severity of their diagnosis, because it gives them peace of mind, Langbaum said. For those reasons, these hospitals don’t expect a shortage of patients any time soon.

Further, if community hospitals weren’t building new facilities, existing centers might not be able to accommodate all the patients who need care, officials said. That’s because cancer becomes more prevalent with age, and the U.S. has a graying population. Over the next 15 years, as baby boomers enter their later years, the number of cancer diagnoses is expected to increase significantly, Langbaum said.

“We [at Hopkins] couldn’t possibly be providing all of the care that’s necessary in this region,” she said. “And there are times when it’s preferable, and just as clinically appropriate, to be in your community getting care as it would be to get care at Hopkins.”

Dr. Kevin J. Cullen, director of the Greenebaum Cancer Center, agreed. Patient volume at the center has doubled over the past eight years, he said. To address the challenge of increased demand, the center is helping other hospitals develop their own cancer programs, including the one at Upper Chesapeake, which is owned by the University of Maryland Medical System.

The affiliation with Greenebaum is invaluable, Sheldon said. Physicians will get access to the university’s vast resources, for example, and patients can participate in the university’s clinical drug trials.

A changing landscape

Not everyone sees those affiliations in such a positive light. Over the past several years, the number of private radiation-therapy and chemotherapy practices in Maryland has dwindled as hospitals have moved to operate those services themselves, said Ioffe, with 21st Century Oncology.

“For the most part, only a few service lines are profitable for hospitals, and radiation therapy is one of them,” Ioffe said. “Hospitals always want control of those service lines. That’s why all the hospitals are opening up their own radiation-therapy centers. Unfortunately, this whole thing has nothing to do with quality of care. It’s all about profit, profit motive.”

There are also fewer medical oncology (chemotherapy) practices than five years ago, hospital executives said. Several years ago, reimbursement rates for chemotherapy declined, so infusions became too expensive for private physicians to manage on their own, according to Cullen.

“The hospitals are in a better position to run these complex services for patients,” Langbaum said. “That’s the reason we’re seeing fewer private practices and more and more hospital-based physicians.”

That trend is evident at Carroll Hospital Center. In 2011, the hospital bought a local private practice, Carroll Hematology Oncology, and renamed it the Carroll Regional Cancer Center to provide outpatient care in a facility adjacent to the main hospital. Most of the practice’s doctors became hospital employees.

Since then, Carroll has provided some services in the main hospital and some in the outpatient center, but it reached capacity, said Chief Nursing Officer Stephanie Reid, who oversees the cancer program. The new Kahlert Regional Cancer Center will provide more space and will bring the program under one roof, Reid said.

The Shady Grove Adventist Aquilino Cancer Center is also a good example of that changing landscape. About half of the center’s space will be filled by private physicians who are partnering with the health system; the other half is for hospital-based services, said Jane Peck, executive director of cancer care services for Adventist.

Because cancer care is complex, with treatment plans involving different combinations of specialists, the top advantage of a comprehensive cancer center is having all those departments — medical oncology, surgical oncology, radiology, rehabilitation, diagnostic imaging, psychiatry and others — in one place.

That’s rarely feasible for a private practice. Most specialize in one or two areas, such as radiology. Patients are sometimes referred to private practice by the local hospital, but as more hospitals build up their cancer units, those referrals become less frequent.

The Aquilino Cancer Center is billed as Montgomery County’s first freestanding comprehensive outpatient facility for cancer treatment, meaning it offers chemotherapy, radiation and support services.

However, Dr. Kashif Firozvi, a private physician with Maryland Oncology Hematology, which has several locations in the state, disputes that claim. Firozvi said his practice offers the same range of services at its Silver Spring office, where is medical director.

“We’re already offering comprehensive care,” he said. “We have radiology imaging, medical oncology [for chemotherapy infusion], relationships with surgeons. … In fact, many patients say they won’t go to Hopkins or wherever because it’s more efficient and easier to navigate the system in our environment. I don’t think our patients will leave us for a new cancer center when we have the same environment here.”