MGH oncologist describes cutting edge Island collaboration
Photo by Nelson Sigelman
Beginning Friday, a team of Massachusetts General Hospital Cancer Center (MGHCC) clinicians will provide medical oncology and hematology services in a newly renovated suite of offices at Martha's Vineyard Hospital.
The goal is "world-class local care," said Dr. Richard T. Penson, MGHCC clinical director of Medical Gynecologic Oncology and medical director for the Coordinated Cancer Care Program, at a meeting of Martha's Vineyard Hospital staff members last week.
Dr. Penson and MGH nurse practitioner Jane Kelly, a native Nantucketer, visited the Island and the hospital for the first time on Friday to meet with doctors, nurses, and administrators to talk about the new program.
Ms. Kelly's responsibilities will include coordinating seamless care between Boston and the Vineyard. She will split her time between the Island and Nantucket Cottage Hospital, which will also participate in the coordinated care program.
She and Dr. Penson will work with five MGH cancer specialists, who will work here as generalists. One member of the team will travel to the Vineyard on a rotating basis to see Island patients, with visits scheduled twice a month. The team includes Dr. Gerry Azzoli (lung), Jeffrey Barnes (lymphoma), Marcia Browne (breast, GI, lymphoma), Donald Lawrence (melanoma, head, and neck), and Lydia Schapira (breast).
Martha's Vineyard Hospital and MGH will also share the same medical technology. Chemotherapy treatment records will be available as part of electronic medical record system that has helped to reduce errors.
At one of two meetings held Friday with hospital staff, Dr. Penson emphasized that the MGH team wants to work closely with their Island counterparts as part of a team. "If you say, that doesn't work here, we'll really listen," he said. "The way we are going to deliver excellent care is together."
Dr. Penson's presentation included a sobering overview of the incidence of cancer, a disease that will strike one in three women and one in two men over the course of their lifetimes, according to the American Cancer Society.
And it is an extremely expensive disease, Dr. Penson said, costing the nation $77 trillion in health care costs every year.
Two charts, one for men and another for women, charted cancer death rates from 1930 to 2008. A line that rose and fell beginning about 1990 illustrated a steep decline in deaths among men attributable to lung and bronchus cancer.
"What is the one thing that's made a difference to cancer care in the U.S.? It is smoking cessation," Dr. Penson said. "And this is the benefit from quitting cigarettes. There's been a massive decline in the death rate from lung cancer."
The graph also illustrated a slow drop in deaths for women with breast cancer. "That's a really hard-won battle, to drive down mortality from breast cancer," Dr. Penson said. "The whole package of care is better."
Future challenges are tied to an aging population, and diet. "The epidemic of obesity is, we think, going to really drive up the incidence of cancer," he said.
A map of the country provided a graphic illustration. In 1996, only five states, shown in red, had a population where more than 55 percent of the adult population was overweight. In 1998, almost half the country was overweight. The 2010 map is completely red.
Dr. Penson described a test in which rats were fed sugar. The rats got cancer. "But if you feed rats sugar and put them on a treadmill and they burn off calories they don't get cancer," he said.
Learned to hug
In 2012, there were 13.7 million cancer survivors in the U.S., he said.
Dr. Penson speaks in optimistic and cheery tones about his work and the field of cancer treatment. He also speaks honestly about the reality of treating people with a deadly disease. "A lot of people die of cancer," he said.
Pallative care is now a major component of cancer care at MGH, he said. Studies have shown that people who receive pallative care and treatment for depression live longer and have a better quality of life.
"Everybody's different and trying to respond to that is really important," he said.
Dr. Penson said he and his fellow doctors are wed to an older style of care in which they get to know their patients. He said none are "9 to 5" types of doctors.
A native of Great Britain with traditional British reserve, he told the group he had never hugged a single patient until he arrived in the United States. There was a subtle culture shock.
"Every patient I ask, are you a handshaker or a hugger," he said. "And I would say 96 percent of patients say, 'I'm a hugger.' So I hug a lot of patients now."
Asked how he maintains his cheery comportment, Dr. Penson told The Times that the field of oncology is demanding. "I think 52 percent of oncologists burn out," he said. "So, the sort of people you are going to meet have developed some defenses against burn-out. For a lot of us, it is realistic optimism."
Dr. Penson said many of the doctors use humor as a coping strategy. Though he is not the funniest, he said, "There is a lymphoma doctor who is howling funny."