Daniel A. Roberts, MD, is a medical oncologist and hematologist based out of Dana-Farber/Brigham and Women's Cancer Center at Milford Regional Medical Center, as well as the Lank Center for Genitourinary Cancer at the Dana-Farber Cancer Institute (DFCI) Boston campus. He practices one day per week as a subspecialist in genitourinary oncology in an urban setting (on DFCI's Boston campus), and spends the majority of the rest of his clinical time practicing both genitourinary oncology and general hematology and oncology in a DFCI satellite cancer center (in Milford, Mass., about 40 miles outside of Boston), which serves a more suburban and even rural population.
In a recent "Art of Oncology" article in the Journal of Clinical Oncology, he explained how oncology could benefit from the more widespread use of an academic-community hybrid model of care, as well as why more students and trainees should have access to opportunities in this type of work (2021; doi: 10.1200/JCO.21.01413). In an interview with Oncology Times, Roberts shared thoughts about his work and why he thinks the care model should be more widely utilized.
1 In the article, you talk about the academic-community hybrid model of care. How is it different from traditional care models and why did you decide to write about it now?
"I would say that the key feature is a community-based practice that is fully integrated with an academic medical center with the goal of bringing cancer care to communities typically underserved by these academic hubs via clinical trials, research, and novel care processes through true collaboration.
"Collaboration is really the key. Posting the name of a well-known academic cancer center on a satellite is not enough. The academic sites need to see the satellites as an extension of themselves and vice versa. Satellite staff need to be included in meetings, projects, tumor boards, and other activities that occur at the academic hub. Ideally, there are providers or staff who are physically present at both sites, like myself.
"Of course, this is not a one-size-fits-all; but the deeper integration between the satellite with the academic hub, I believe the more successful the care delivery.
"As I moved through my fellowship and learned more about oncology care delivery, I became convinced and felt strongly that the 'academic-community hybrid' was not only a necessary niche that needed to be filled to bridge two co-existing models of care (academics and community-based practice), but also that there were so many fellows like me who are interested in a similar career."
2 Are these models of care feasible everywhere (including in rural areas not geographically near major oncology centers or metropolitan areas) and what needs to happen to encourage their growth?
"I believe [they are feasible]. The disruptive innovation of virtual collaboration paved by the pandemic that led to telemedicine and Zoom meetings has eased communication between groups from afar. For instance, our team at the DFCI Milford satellite site can now attend any tumor board happening in Boston, which was not the case before COVID. Certainly, for sites that are located geographically far away from the main academic hub, there is still a barrier for staff to move between the locations. But there is still a lot of collaboration that can be done virtually.
"[To encourage these collaborations], I think first and foremost hematology/oncology fellowship programs need to not only recognize this as a viable career path, but start to offer formal community-based or academic-community hybrid tracks. Funding for these fellowship positions, which of course tends to be a barrier for expanding or reallocating trainee resources, will need to be prioritized.
"We also already know the majority of cancer care is delivered in the community, and issues regarding health disparities and low clinical trial enrollment nationally have been documented ad nauseum. This could be a lucrative way to address these major issues facing our field.
"We also need to call much more attention to existing programs, like the NCI Community Oncology Research Program (NCORP), for example, earlier in a trainee's career."
3 What advice do you have for other fellows/oncology students who want to get to where you are?
"My main piece of advice for like-minded fellows is you do not have to choose between academics or the community-you can have your cake and eat it too. We are now living in an era where an academic environment can successfully co-exist in a community-based practice. It's more important to follow a path for which one is passionate than be forced into a construct of oncology care delivery that does not fit one's career goals.
"I would also note that I had amazing support from my fellowship program directors at Beth Israel Deaconess who embraced the path I chose. They also had worked with DFCI leadership so I could rotate there clinically while still a fellow [and then] help with a smooth transition to my new position."