Transcription:
Comprehensive Cancer Care in Merced

Bill Klaproth (Host): A cancer diagnosis can be scary not only for you as the patient, but also for your family and friends. At the Mercy UC Davis Cancer Center, you'll receive comprehensive, compassionate care in one convenient setting. Let's learn more about comprehensive cancer care in Merced with Dr. Parminder Sidhu, a Medical Oncologist with Dignity Health. Dr. Sidhu, thank you so much for your time today. The Mercy UC Davis Cancer Center has obtained the ACOS Accreditation. What does that mean?

Dr. Parminder Sidhu (Guest): It's a national organization which certifies different cancer centers according to their capabilities. As such, we are a community program, so it is the community comprehensive cancer center. What it really means is that this organization takes the data from our cancer center and compares it to the national data so that we have to follow all of the rules to ensure that we are providing timely and effective care for all cancer patients. And then our data gets compared to everybody in the US, and we can see where we are lacking and where we are doing better.

Host: Timely, effective care, that's what you're judged on, and that's why you receive this accreditation. That's wonderful. Can you also tell us about the supportive programs offered such as massage therapy, support groups, the wig bank, transportation assistance, smoking cessation? There are a lot of great programs as well. Can you tell us about those?

Dr. Sidhu: We try to provide every possible assistance to the patients. After the chemotherapy, how can we put these patients back to life? Many of them have got neuropathies and residual side effects from the chemotherapy. Massages are a good way — so we have a free massage for every cancer patient, so they can get the massage to recover from the side effects of the chemotherapy. We've also got a pathway to recovery — how to maintain and even improve your balance after you got the chemotherapy.

Then we also got more requests that wigs are not readily available in this area, so we have a program — we partnered with the American Cancer Society to have a wig bank here. We have the wig bank, and they can help our patients maintain their outlook. Then we have a program for patients — for example, I have a patient that does not have the means to travel to Stanford, but they need a special surgery that only can be done at Stanford — or this expertise is not available in our area, so they have to travel to Stanford. Or, somebody is living 30, 40, 50 miles from the cancer center, but they need radiation therapy, which is every day for one month, so they don't have the means to pay for their taxi, or they don't have the means to travel here, so we provide them a gas card so they can travel to get their treatment.

And then somebody going to Stanford, my social worker helps them get a very cheap night stay close to Stanford, or UCSF, or UC Davis if the patient needs to go to cancer care over there. In a nutshell, these programs are designed to help our patients not only emotionally, but also financially, and also socially to recover and get back to their real life.

Host: Those support programs are so important. As you say, giving patients back their life. Dr. Sidhu, can you also talk about Hospice Care? I know that's an important element of this too.

Dr. Sidhu: I did my Hospice/Palliative Care Fellowship before I did my Oncology Fellowship. Hospice is very close to my heart. I feel that there are patients, especially in Oncology, where we know that we do not have any cure. Most of these patients, especially with the Stage IV cancers, eventually get to the point where there is no more chemotherapy available. That's the time where hospice is very, very important.

Any patient who has Stage IV cancer, we start palliative care on day one of their diagnosis. We continue to work with them to make sure that they have an optimal balance of treatment and life. I don't want to make anybody so miserable that their life becomes so miserable that they don't want to live anymore. We always talk about what is the role of chemotherapy while they are getting treatment. Once they get to that point where treatment is not an option because the can't tolerate the treatment or treatment is not effective, and it's not killing the cancer anymore at that time to make sure that they are transitioned from this world to the next world is as peaceful as possible. That's where the hospice comes in the picture. I work with all hospices in the area, and I personally work with the hospice and the medical director. Most of the hospices are non-profit, charity based hospices in the area.

Host: Well, that's good to know you offer those services. Can you tell us about the Tumor Board? What is the Tumor Board?

Dr. Sidhu: Tumor Board — we have two types of Tumor Boards. Tumor Boards are important. Most of the cancer care — I would say 50% of the time, the cancer care is very straight forward. Somebody's got Stage III Colon Cancer, let's give them adjuvant chemotherapy. That's straight forward. These cases are black and white decisions. There are other times where you really need to apply the art of medicine where you can go this way or that way.

We have two types of Tumor Boards. One is a local Tumor Board, which we do once a month with our surgeons, with our pathologists, and with our radiologists and the radiation oncologists. All of the local doctors participate and review complicated cases where we want to make sure that everybody is on board. The surgeon is on board so that once we finish the chemotherapy, they do the surgery. Or the other way around. Once they've done the surgery to do the chemotherapy. Or if they need a chemo port, that's already discussed on the Tumor Board just to make our care more efficient. All of the doctors are collaborating and working on the same patients. All are at the same table, and they are talking to each other, not through their notes or not their phone calls.

The second is that — for example, especially from the radiation oncology side, we have a UC Davis Tumor Board. That is a specialized Tumor Board for several areas. Every single patient who comes to the radiation oncology department, their case and cure get discussed at the UC Davis Tumor Board. For example, somebody got breast cancer, we'd review their plan and everything at UC Davis. In other words, they are very, very similar. They are going to get the same care at UC Davis, but now they can get closer to their home because the machine is here. All of their planning happens together with the UC Davis doctors, which are specializing in that area — for breasts, for lung, for the brain. All of the planning happens there. If I have a complicated — instead of sending the patient to Stanford or UCSF or UC Davis for a specialized opinion, I can ask these question on the Tumor Board, and then we can decide.

The other important point on this is that sometimes we do not have a clinical trial, and there are certain new medicines available at a tertiary care center, like UC Davis, so they will let me know that there is a clinical trial for this complicated patient which can be enrolled. We can send them for clinical trials to the place wherever the clinical trial is.

Host: That's really good to know. You mentioned a lot of collaboration with both of the Tumor Boards. It's good to get all of the minds thinking about the same thing. I would imagine collaboration is part of the Patient Care Navigator as well. Tell us about the Patient Care Navigator. What should we know about that?

Dr. Sidhu: Let me give you a common example like breast cancer. If somebody found a breast mass, where are they going to go? They're going to go to their primary care. Primary care doesn't know many times. What they will do is they will send them to the surgeon. From the surgeon, they will go to the radiology place, and the radiology place will do an ultrasound or mammogram, and they'll say, "Oh, we saw it." Then they go back home. Then after a few weeks, they go to biopsy. Then after a few weeks, they go back to their surgeon. After a few weeks, the surgeon will discuss these results and send them to oncology. After oncology, they will go back to the surgery. There is a lot of pieces that need to be put together. We see that many patients when they know that there is something wrong with them, but it's just taking too long because just for any cancer, there are so many doctors that need to be involved. There are so many different pieces of the puzzle that need to be put together before we can do surgery, or start chemotherapy, or do any treatment.

In order to make it more efficient, we have a Care Navigator. For example, somebody got breast mass, the primary care can give us a call that we are referring this patient to the breast cancer navigator. The Navigator knows everything. We see the patient, and then we put all of the pieces together. Instead of taking two months, we can finish everything within a week. That's the goal of Navigation.

Host: I can see where that would be a huge help. Nobody likes to waste time, and people like to get going on their treatment.

Dr. Sidhu: Yes, absolutely.

Host: Yeah, so the Care Navigator really makes this more efficient?

Dr. Sidhu: More efficient. Because everybody is so busy everywhere, the Navigator — the patient has the phone number directly to the Navigator, and then they can ask when is my appointment with this doctor. Normally, when you go to the surgeon, he will explain what he thinks, but he is not going to explain what oncology is going to think, what radiation oncology thinks, what type of chemotherapy she's going to get. With the Navigator, she can ask — the patient can ask any question relevant to her disease from one person, and anything can be arranged through the Navigator quickly and efficiently.

Host: Not only do you offer a Care Navigator, but you also offer full Social Worker support. Tell us about that.

Dr. Sidhu: Social Worker support is very important because especially in our town, many patients need a lot of social services. They need disability. Sometimes they don't have insurance. Sometimes they need medication assistance programs. The Social Worker is the person who runs a lot of our supportive programs, or overseas a lot of our supportive programs. It's very key. I can give you an example from recent — where I got a thank you letter from one of my patients. We lost a patient, and the cost of the funeral was almost like $47,000.

Host: Wow.

Dr. Sidhu: That was very, very expensive for the family, and they could not afford it. They even tried to raise the money. My Social Worker, who does these things all of the time, together with the family and the patients. They came to the cancer center. My Social Worker worked with them. She made several phone calls, and we were able to bring the cost down to $13,000.

Host: That's amazing.

Dr. Sidhu: And then the family was very, very thankful. They got what the patient wished at a much lower cost. They were all at the end, not happy, but they were satisfied with how much the Social Worker made a difference in their feelings.

Host: That is really, really important, and a great service that you offer. If you could wrap this up for us, Dr. Sidhu, can you also tell us about chemo certified nurses, also your patient-to-nurse ratio, and you even have an on-site pharmacy and ER too?

Dr. Sidhu: This is kind of one big package that usually most community doctors or private oncology places will not have. First of all, we are very close to the hospital. It's not uncommon that the patient gets an allergic reaction to the chemotherapy. At average, we get one code or one emergency at the cancer center a month. Somebody got reactive. So far, in the last eight years, I have not lost a single patient. That help is very important. For example, having our cancer center so close to the ER, so close to the hospital, if some patients we feel are unstable, and they may need a higher level of care because of the allergic reaction, or anaphylactic reaction, or any other reason, we just need to push the button and the ER and the whole team of doctors — anesthesiologists, people who can incubate, people who can do CPR is here within ten seconds. That help is very important because, at that time, timing is very, very important.

Second, the chemotherapy patients — we don't hire any nurse or any RN at the cancer center without chemo certification. They not only finished their regular, routine RN program but then they take extra effort to do the chemo certification. They know what chemotherapy they are giving, how it should be given, and if there is a reaction, what they can do. They go through a special program to take care of the cancer patients. It is very important, and many times you will see in the community programs, they will not have the chemo certified nurses.

We also have an on-site lab, so patients do not need to walk far away. They can come and do the labs in the morning, and then get the chemotherapy. Many other private clinics have similar labs on site, but they are very, very limited, so they do only CBC and CMP. Here, we have a full-fledged lab and the transfusion. For example, if you go to the private clinic, and if somebody's hemoglobin is six or five, they need a transfusion, and they need to go to the hospital or a different place to get the transfusion. Here, if you have low hemoglobin, we can cross, and match, and transfuse you on the same day or the next day. You don't need to run around to 20 different places to get the transfusion.

Host: So convenient, so important. Thank you so much, Dr. Sidhu. It's very easy to see why the Mercy UC Davis Cancer Center has obtained the ACOS Accreditation. To learn more about the programs offered at the Mercy UC Davis Cancer Center, call the Oncology Social Worker at (209) 564-3669, that's (209) 564-3669. You can also visit DignityHealth.org/Merced/CancerCare. And if you like what you've heard, please share it on your social channels, and make sure you check out our full Podcast library of topics of interest to you. This is Hello Healthy, a Dignity Health Podcast. I'm Bill Klaproth. Thanks for listening.