The lung cancer network in the east of the country is constantly expanding. There is already structural cooperation between six hospitals and a few others will join soon. The main benefits are speed of diagnosis, optimal patient care, and short lines between doctors. The collaboration gives pleasure and energy to all involved, say Prof. Michel van den Heuvel (Radboudumc) and Roy Dambacher (Elkerliek, Helmond).
When immunotherapy was implemented in various centers a few years ago, regional cooperation was already under discussion. Under the NVALT criteria for applying immunotherapy, only Radboudumc was authorized to provide the new treatments, says Van den Heuvel. “We didn’t think it was ideal, because it meant we couldn’t offer care to many patients close to home. We didn’t want to centralize immunotherapy treatments, but we wanted to take control of those treatments. “
Discuss patients with each other
A meeting was held with pulmonologists and managers from Radboudumc and three surrounding hospitals: Elkerliek (Helmond), CWZ (Nijmegen) and Maasziekenhuis Pantein (Beugen). There it was decided to form a network for care surrounding immunotherapy and to discuss patients with each other. At the beginning of 2019, a cooperation agreement was entered into with hospitals, health insurers and several other parties involved. “We were about to share information on the quality characteristics of care in hospitals, among other things,” says Van den Heuvel. “We have also started a new joint MDO which now takes place every week. There we discuss all lung cancer patients who are eligible for immunotherapy or targeted therapy. We set up an educational program and started introducing phased immunotherapy: first single agent immunotherapy and then chemo-immunotherapy.
Bernhoven (Uden) and Jeroen Bosch Hospital (Den Bosch) are also now affiliated with Lung Cancer Net.
Dynamic
Van den Heuvel sees the network as a dynamic collaboration, in which protocols and agreements can be gradually adapted. There is a common care pathway for all lung cancer treatments and also a working group for medical advice on treatments and check-ups. MDO now has three branches: systemic therapy advice, molecular cancer advice for a small number of patients, and the central introduction of new treatments. “If there is a new indication, we immediately discuss it among ourselves. A new treatment can take place centrally or decentralized. For example, regarding the new dual immunotherapy, we have agreed to extend it from central to decentralized, depending on the number of patients and the indication. And when new drugs become available, for example in an early access program, we also have them available to all patients. “
An innovation program had already been put together within Lung Cancernet in 2019. One topic that is being worked on is patient participation: how can patients make a good treatment decision with their doctor? “It is mainly about informing the patient: who does it and at what time?”, Says Van den Heuvel. “There are already many initiatives in this area at national level and we are working on this too now. For example, there will be a new website with, among other things, patient information, protocols and scientific information ”.
No Radboudumc project
According to Van den Heuvel, Lung Cancer Net’s greatest added value is the quality of care. This is created by continually arguing and addressing each other. “The network is not a Radboudumc project, but something we do together, including specialist nurses and a growing number of surgeons. The network therefore becomes more and more concrete and multidisciplinary “.
Lung cancer networks also exist in the southwest and north of the Netherlands. Van den Heuvel wants to compare these networks with each other. “Not to compete with each other, but to learn from each other. We don’t want a single network in the Netherlands, but we want to improve together. Regionalize care and centralize complex care that drives progress. And aside from the “hard” earnings of the network, I see that everyone likes to provide assistance together. This gives confidence for future cooperation in other areas. This is also a great added value of the collaboration ”.
Colleagues from the region
Roy Dambacher (Elkerliek) agrees with the latter. “It is fun and educational to sit together on a regular basis. I studied at the CWZ myself and thought it was great to work together with my coach and my former colleagues back then. It is special and instructive to have contact with colleagues in the region. We will therefore also focus on more education and further training from the network ”.
Even before Lung Cancer Net there was a collaboration between Elkerliek and Radboudumc, particularly for the more complex lung cancer treatment. “There was already an MDO facility for lung cancer surgery, because it is centralized in Radboud. Lung Cancer Net was the next step in that collaboration. And this goes smoothly and with great satisfaction, both for professionals and for patients. The added value for patients is that they receive the best lung cancer care through our hospital. We can provide assistance locally or refer if needed. All lung cancer patients are discussed in the network, so that each case is seen from a broader perspective. This translates into an optimal treatment plan ”.
Short lines
An advantage for the professionals involved is that the lines are short and quick reference is possible. Dambacher: “Among normal MDOs, I can always call to discuss things. And we can easily direct patients back and forth. If a survey needs to be done quickly, it’s easy to organize. This way there is no delay in diagnosis. This too is an added value for the patient “.
With the advent of targeted therapies and immunotherapies, treatments are becoming more and more complex. This increases the need for wider consultation. And that pays off, Dambacher observes. “Because we can rely on Radboudumc’s experience, specific treatment options are more quickly accessible to us. In the past we sent patients for immunotherapy, but we have been offering it ourselves in our hospital for some time. “
According to Dambacher, collaboration energizes everyone. Lung nurses in various hospitals, for example, also have contacts with each other. “We all want the best patient care. In terms of assistance, speed and job satisfaction, the network offers a huge amount. Initially it takes time and effort to create a network, but this pays for itself. “
Analyses
Immunotherapy was the driving force behind the collaboration within Lung Cancer Net. Initially, these treatments took place in Radboudumc, but now all immunotherapy is split between participating hospitals. “We have already performed analyzes on the quality of care”, says prof. Michel van den Heuvel. “Initially it was about the number of practitioners, nurses and facilities. But an analysis has already been done on the number of patients discussed on Lung Cancer Net and the treatment they received. The next analysis is scheduled for September. So let’s look in more detail at the number of patients presenting with lung cancer and how many of them are being treated. We also check if all patients are actually discussed in the MDT and what are the causes if this does not happen. “
This interview appeared in MedNet Oncology – Lung Cancer Special. These articles also appeared in the Special Lung Cancer:
