Blue ribbon panel urges outpatient cancer center
By Alice Keesing
Advertiser Health Writer
The number of people diagnosed with cancer every year in Hawai'i is expected to double in the next three decades, sparking a debate about the best way to deal with the resulting social and economic costs.
Every year, as many as 6,000 people in Hawai'i learn they have cancer — a number that is expected to double by 2030, according to the draft report of a blue ribbon panel on cancer. At the root of Hawai'i's escalating number of cancer patients is the state's aging population.
The report finds that survival rates for Hawai'i residents with cancer are at or above the national average. However, it also finds "many problems" with current cancer care in Hawai'i that in some cases can leave patients waiting as long as three weeks between diagnosis and treatment, adding to the stress on those who are told they have the disease.
The draft report proposes an outpatient cancer center that would bring more cutting-edge treatments and better coordination for Hawai'i patients. But even as the panel is reaching the end of its study, there is disagreement among panelists and in the wider medical community — where cancer care is a substantial portion of the market — about the form such a center should take.
The risk of cancer is 10 times higher in people older than 65. It is predicted that one in five Americans will be older than 65 in the next 30 years, and Hawai'i is expected to surpass the national average.
"It's a phenomenon that's happening all around the country," said University of Hawai'i Medical School Dean Dr. Edwin Cadman. "It will be a financial burden on the healthcare industry, on insurance, so that's why it's important to consider how to offer curative treatments to people."
In 1999, Gov. Ben Cayetano appointed a group of experts from all areas of the healthcare industry to a panel and charged them with finding ways to reduce that burden. Cayetano has expressed the wish that Hawai'i be "at the forefront of cancer-related care and treatment."
The panel recently completed its draft report. It is now being discussed with those involved in the cancer field and a final report is expected early next year.
According to the draft, Hawai'i residents have a higher rate of cancer than the world average, although that may be a result of the state's strong reporting system, according to Dr. Scott Hundahl, who heads The Queen's Medical Center Cancer Institute. Certain ethnic populations also suffer more — Filipino women in Hawai'i, for example, have far higher rates of thyroid cancer than the national average.
At the same time, overall cancer survival in Hawai'i is substantially better in Hawai'i than the Mainland.
Nonetheless, the panel identified several problems with the care of cancer patients in Hawai'i, including low screening rates for Filipinos and Hawaiians and the lack of radiation treatment units in some areas, including Moloka'i, Lana'i, Kaua'i and Kona.
But the most overarching problem is a fragmentation of services that can lead to delays in service and a lack of support for newly diagnosed cancer patients.
"For many, delay between diagnosis and the beginning of treatment extends to three weeks or more," according to the draft report. "This is a period of intense anxiety for patients and their families."
Blue ribbon panel member Jonathan Brookfield, whose wife, Stacy, died of breast cancer four years ago, said the industry needs to focus on the "human side" of cancer care.
"The small things that add up and take a tremendous amount of time were the appointments, going between several different doctors — I think at one time we had 14 different doctors — so it's crazy," Brookfield said.
The report also notes a dearth of clinical trials in Hawai'i, which means Hawai'i patients are missing out on the newest drugs and treatments. While experimental, the trials often represent a patient's only hope. As many as 50 percent of people will not be cured by today's standard treatments.
But the solution to those problems is proving to be a source of controversy in an industry in which cancer diagnosis and treatment represents a large chunk of business. The report recommends the medical community collaborate on an outpatient cancer center to provide convenient access and coordination under one roof. It also would be a site for clinical trials.
Such a center already is being proposed by Dr. Carl-Wilhelm Vogel, director of the University of Hawai'i Cancer Research Center. The center will become part of the medical school development at Kaka'ako, and Vogel is proposing a state-of-the-art outpatient clinic at that site.
As one of 59 cancer centers recognized by the National Cancer Institute, the center is in the forefront of cancer research. Along with prestige, the center brings in millions in research money — 10 federal dollars for every state dollar spent, according to Vogel.
The NCI recently singled out Hawai'i's lack of a clinical trial facility, and Vogel said the collaboration of the medical community at such a facility would bring the best care to Hawai'i's patients.
"We have an NCI-designated cancer center and we have excellent medical facilities in the state but we have to basically join forces to build a state-of-the-art outpatient cancer facility in order to bring cancer care and cancer research ... to an ultimate level in our state," he said.
But Vogel's proposal is being greeted with caution.
"The hospital industry is suffering financially and one of the few areas that they do continue to have a positive margin is diagnostic cancer services and therapy, so when you are talking about coordinated services that's a little bit different than talking about setting up a freestanding cancer therapy diagnostic unit," said the medical school's Cadman.
The cancer center also would have to prove to state officials that it would not provide services that already exist.
"It just doesn't make sense to duplicate activities that already exist here; to put in expensive equipment, parking facilities, pharmacy activities and things that you would need to support such an outpatient activity," said Rich Meiers, president of the Healthcare Association of Hawai'i, which represents all the state hospitals. "We're already trying our best to control healthcare costs that are spiralling out of control because of pharmaceutical costs etc., and now to do something that's going to exacerbate that problem, it just does not seem the best management of healthcare dollars."
Vogel argues that his proposed center would bring new services to Hawai'i's patients. And rather than taking money away from hospitals and oncologists, a research clinic would bring more money into the state, he said.
A clinical center in Hawai'i would stem the tide of Hawai'i patients who take their business and their money to Mainland facilities. The addition of clinical trials would bring in millions of research dollars. And it could tap into the "medical tourism" market by attracting patients from Asia.
But there also is disagreement even within the university about whether Kaka'ako would be the best site for such a facility.
"It's not a good idea at Kaka'ako for a lot of reasons," Cadman said. "One is that we don't necessarily need to reduplicate capacity that's here in the state, and it needs to be near a hospital. What we need first is to attempt to coordinate (existing) cancer services."
Others argue that instead of building a multimillion dollar facility, hospitals and individual doctors could collaborate through a "center without walls."
At Queen's, which serves one-third of the state's newly diagnosed cancer patients, officials already are planning an extension of their cancer institute to provide a one-stop-shop model of care.
"You don't have to construct a specific facility at the Cancer Research Center ... to provide that service," said president and chief executive Art Ushijima.
Vogel argues the blue ribbon panel report proves that the current system of collaboration isn't working. Only by coming together at one site will Hawai'i move to the forefront of cancer care, he said.
"What it really boils down to is, is the financial consideration and history of competition of our hospitals more important than the quality of care for our citizens?" he said.
The blue ribbon panel is expected to recommend the state hire an independent consultant to examine the different options and crunch the numbers to see what effect the facility would have on Hawai'i hospitals and physicians.
Reach Alice Keesing at akeesing@honoluluadvertiser.com or 525-8014.
