Lung cancer network in the east of the country is steadily expanding. There is already structural cooperation between six hospitals, and a few others will soon join. Major advantages are speed of diagnosis, optimal patient care and short lines between practitioners. The collaboration gives all involved pleasure and energy, say Prof. Michel van den Heuvel (Radboudumc) and Roy Dambacher (Elkerliek, Helmond).
When immunotherapy was rolled out across various centers a few years ago, regional cooperation was already being discussed. According to the NVALT criteria for the application of immunotherapy, only Radboudumc was allowed to provide the new treatments, says Van den Heuvel. “We didn’t think that was ideal, because it meant that we couldn’t offer many patients care close to home. We did not want to centralize care for immunotherapy, but we did want to take control of that care.”
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 the care surrounding immunotherapy and to discuss patients with each other. At the beginning of 2019, a cooperation agreement was drawn up with hospital boards, health insurers and a number of other parties involved. “We were going to share information about quality characteristics of care in hospitals, among other things,” says Van den Heuvel. “We have also started a new, joint MDO that now takes place every week. There we discuss all lung cancer patients who are eligible for immunotherapy or targeted therapy. We have set up an educational program and have started to introduce immunotherapy in phases: first immunotherapy with single agents and then chemo-immunotherapy.”
Bernhoven (Uden) and Jeroen Bosch Hospital (Den Bosch) are now also affiliated with Lung Cancer Net.
Dynamic
Van den Heuvel sees the network as a dynamic collaboration, in which protocols and agreements can be adjusted gradually. There is a common care path for all lung cancer care and also a working group for medical consultation about treatments and check-ups. The MDO now has three branches: consultation on systemic therapy, a molecular tumor board for a small number of patients, and the central introduction of new treatments. “If there is a new indication, we immediately discuss it with each other. A new treatment can take place centrally or decentrally. For example, with regard to the new dual immunotherapy, we have agreed that we will roll it out from central to decentralized, depending on the numbers of patients and the indication. And when new medication becomes available, for example in an early-access program, we also have it available to all patients.”
An innovation agenda was already put together within Lung Cancernet in 2019. A topic that is currently being worked on is patient participation: how can patients make a good decision about a treatment with the doctor? “This is mainly about informing the patient: who does that and at what time?”, says Van den Heuvel. “There are already many initiatives in this area nationally, and we are also working on this 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, the greatest added value of Lung Cancer Net is the quality of care. This is created by continuously discussing and addressing each other. “The network is not a Radboudumc project, but something that we do together, including nurse specialists and an increasing number of surgeons. The network is therefore becoming increasingly concrete and multidisciplinary.”
Lung cancer networks also exist in the south-west 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 and with each other. We don’t want a single network in the Netherlands, but we do want to get better together. Regionalizing care and centralizing complex care, that brings progress. And apart from the ‘hard’ gains of the network, I see everyone enjoys providing care together. That gives confidence for future cooperation in other areas. That is also great added value of the collaboration.”
Colleagues in the region
Roy Dambacher (Elkerliek) agrees with the latter. “It is fun and educational to sit together regularly. I myself was educated at the CWZ and I thought it was nice to work together again with my trainer and former colleagues from 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 collaboration between Elkerliek and Radboudumc, especially for more complex lung cancer care. “There was already an MDO structure for lung cancer surgery, because it is centralized in Radboud. Lung Cancer Net was the next step in that collaboration. And that goes smoothly and to great satisfaction, for both practitioners and patients. The added value for patients is that they receive the best lung cancer care through our hospital. We can provide care locally, or refer as needed. All lung cancer patients are discussed in the network, so that each case is viewed from a larger perspective. This results in an optimal treatment plan.”
Short lines
A plus for the practitioners involved is that the lines are short and quick consultation is possible. Dambacher: “Between the regular MDOs, I can always call to discuss things. And we can easily refer patients back and forth. If an investigation has to be done quickly, it is easy to arrange. This way there is no delay in the diagnosis. That is also added value for the patient.”
With the advent of targeted therapies and immunotherapies, treatments are becoming increasingly complex. This increases the need for broader consultation. And that pays off, Dambacher notes. “Because we can rely on Radboudumc’s experience, specific treatment options are more quickly accessible to us. We used to refer patients for immunotherapy, but we have been offering this ourselves in our hospital for some time now.”
According to Dambacher, the collaboration gives everyone energy. The lung care nurses in the various hospitals, for example, also have contact with each other. “We all want the best care for the patient. In terms of care, speed and job satisfaction, the network delivers an enormous amount. It initially takes time and effort to set up a network, but that pays for itself.”
Analyses
Immunotherapy was the driving force behind the collaboration within Lung Cancer Net. Initially, these treatments took place at Radboudumc, but now all immunotherapy is divided among the participating hospitals. “We have already performed analyzes of the quality of care,” says Prof. Michel van den Heuvel. “Initially this was about numbers of practitioners, nurses and facilities. But an analysis has already been done on the numbers of patients discussed in Lung Cancer Net and which treatment they have received. The next analysis is scheduled for September. We then look in more detail at numbers of patients presenting with lung cancer and how many of them are treated. We also check whether all patients are indeed discussed in the MDT and what the causes are if this does not happen.”
This interview appeared in MedNet Oncology – Special Lung Cancer. These articles also appeared in the Special Lung Cancer: