key: cord-0818119-5ja6a8n0
authors: Garg, Amit K.
title: Community-based Cancer Care Quality and Expertise in a COVID-19 Era and Beyond
date: 2020-07-24
journal: Am J Clin Oncol
DOI: 10.1097/coc.0000000000000725
sha: 0ab2cff28f31c29cac62ed314a3735cb8a80b1e3
doc_id: 818119
cord_uid: 5ja6a8n0

nan

demonstrated superior outcomes for patients who undergo complex cancer surgery under the skilled hands of prolific academic surgeons. 6 However, in an era of major advancements in radiotherapy, systemic treatment options, and emerging technologies, cancer-related outcomes and patient experiences in community settings may be hypothesized to be on par if not better than large reputable academic centers for the large majority of cancer cases. 2 This translates to the idea that community-based cancer expertise, born out of clinical experience and acumen, is important to recognize and support in large tertiary-care community-based cancer programs that seek to reassure patients that their care will be of the highest quality.

The difference between academic expertise and clinical expertise is often overlooked. In many instances, the academic infrastructure largely separates cancer experts on a disease sitespecific basis whereby specialists primarily treat patients with 1 or 2 disease sites (ie, breast cancer or prostate cancer) and have little to no experience with cancers elsewhere in the body. For those clinicians who are community based and see a wide variety of cancer cases-a gestalt develops through experience such that the natural history of many cancers rather than just one is taken into account when making complex multidisciplinary treatment decisions. This provides a valuable perspective to the cancer patient who may be seeking a broad perspective on their disease and how treatments, outcomes, and side effects compare among cancers that arise in different parts of the body. Community-based cancer doctors may also see a higher volume of patients since their priorities are centered on their patients rather than divided among research-related activities that often monopolize a busy academic schedule. Furthermore, a cancer patient who is followed by a communitybased physician will maintain a continuity of care throughout their disease process rather than being referred to different specialists within an academic setting depending on what organ their disease affects. This experience, which engenders a more wholesome understanding of cancer as a heterogenous group of diseases that differentially affects organ systems in diverse ways, may lead to more rounded treatment plans-inclusive of quality of life considerations-and inherently quite balanced and individualized to a growingly inquisitive and insightful patient population.

Perhaps the undeniable value of large academic medical centers lies in their promise for the development of innovative and promising clinical trials, especially for those patients with advanced cancers that may not benefit from standard therapies or for those with complex surgical needs. But for most newly diagnosed cancer cases, patients are safely, effectively, and more conveniently treated with expertise in the community setting. Considering the cost, comfort, and value of traveling long distances for care, especially in this COVID-19 era, community-based cancer expertise will be an important focus for patients and families.

Just about every cancer program in the country, if not the world, may be asking the important question "Is cancer care going to change forever as a result of COVID-19?" If cancerspecific quality measures can be maintained while improving efficiency and value the answer is probably yes. Innovation in workflow and operations have already been implemented and community-based cancer programs living at the intersection of social, economic, and health care reform may be uniquely positioned to lead this effort.

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