Gabby Cinnamon (Host): Access to quality cancer care close to home plays a vital role in patients well being and treatment outcomes. Having to travel far for treatments can add stress, not only emotionally, but also financially for cancer patients and their families. Joining us today to talk about the importance of community oncology programs like the Riverside Cancer Institute is Dr. Cassandra Lacher, an oncologist and hematologist at the Riverside Cancer Institute.

Intro: Welcome to Conversations on Cancer, brought to you by the Riverside Cancer Institute. Providing answers, debunking myths, and sharing patient stories.

Host: Welcome back to Conversations on Cancer, brought to you by the Riverside Cancer Institute. I'm Gabby Cinnamon. And today, I am very happy to be joined by Dr. Lacher, an oncologist and hematologist at the Riverside Cancer Institute, to talk about the importance of community oncology programs. Thanks for coming back on the podcast, Dr. Lacher.

Dr Cassandra Lacher: Of course. Thank you for having me.

Host: As a little refresher, can you just tell us a little about yourself and who you are?

Dr Cassandra Lacher: Yes. My name is Dr. Cassandra Lacher. I'm an oncologist and hematologist at Riverside. I did my training at Michigan State University. And I've been here at Riverside since 2022, and prior to that, was working in other community oncology centers.

Host: So, you have a lot of experience in community oncology, so perfect person to talk to for this. Can you kind of tell us what community oncology is?

Dr Cassandra Lacher: Sure. Community oncology is where we're bringing all the studies and all the clinical trials that have been done in regards to cancer treatment into the community so that patients aren't having to travel for tertiary center care but can receive treatment for their cancer close to home.

Host: Why is community oncology so important?

Dr Cassandra Lacher: Well, I actually heard a statistic just this morning that 80% of cancer care happens in the community.

Host: Oh, wow.

Dr Cassandra Lacher: And because of that, it makes it that much more important. And as a result, many studies are being done even at this time to try to evaluate how do we make sure that we're bringing the best quality care into the community, because that's where the majority of our patients will be.

Host: Yeah, I think, too, especially in Kankakee County, I just think about how rural, I know I'm from a little bit more of a rural part of Kankakee County, and there's nothing between, you know, even like south until you get to Champaign, but there's not a lot around us, so it is around here especially so important, because the county's so large and vast that people need access to that or else they'd be driving so far for what they need.

Dr Cassandra Lacher: Absolutely. And I think, in relation to that, so many cancer patients are elderly or they're just sick from their diagnosis. And so, even trying to drive into a place like Chicago and trying to manage traffic when you already don't feel well is just not fun for anybody.

Host: Yeah, I cannot even imagine. What are some differences between community oncology programs and academic medical centers?

Dr Cassandra Lacher: So, academic medical centers are places like at tertiary facilities where they're really performing the frontline clinical trials in regards to management of cancer. In the community setting, we're trying to bring those results and that data back to the community to treat people at home.

When we talk about tertiary care facilities, this is where people are being trained into oncology. This is where people are specializing and really the niche areas of oncology. So rather than seeing all the different cancer types, you might have a physician who's only doing breast or only doing lung or only doing neuroendocrine. And so, they have that luxury of being able to do focused clinical trials and being able to have some of that more expertise in those specific areas.

In the community-based oncology, we're seeing people from all walks of life with all sorts of histories and from every type of cancer diagnosis. And in our facility, we follow what's called the NCCN guidelines. And that's what really gives us the information about what's appropriate in each individual patient based on the clinical trials that were performed at a tertiary center.

Host: I think, unfortunately, sometimes there's these preconceived notions, you know, "Oh, I have to go to the University of Chicago," or "I have to go to Northwestern," or a large academic medical center. And that's not usually the case. Can you kind of talk about why those notions exist and why you don't always have to go up there to get the treatment you need?

Dr Cassandra Lacher: I think a lot of people have those notions just based on maybe historical information from previous family members or experiences other people have had. When I was in Indiana, everyone wanted to go to MD Anderson or Vanderbilt, and those are great programs. And what I love about oncology is it's a very collegial field. And so, it's easy to reach out to a physician who specializes at MD Anderson or Vanderbilt or Mayo to still get recommendations from those people without causing a patient the burden of travel. But when we are looking at treatment because treatment is so standardized now for cancer care outside of a clinical trial, the majority of patients are receiving the same therapy for especially common cancers like breast cancers and lung cancers.

Host: I will say that's one thing you guys do a great job of is, if your cancer is in a later stage or it is rarer, you guys have access to people at large medical centers in Chicago where people can go and maybe get a second opinion or if they need that super specialized care, you guys have colleagues who work up there who you can get access to them.

Dr Cassandra Lacher: With our facility in particular, we are really coordinating care, especially with Rush because we have that relationship with that facility. But even Rush doesn't have every specialized individual. And the beauty of being so close to Chicago is that we do have multiple academic centers that may have different people at different places. And so, we are able to kind of build those relationships over time and be able to make those connections for patients to the right specialist. And then, ideally, even if they see a specialist, hopefully we can still provide that same care locally to still limit that burden of travel.

Host: For sure. What are some benefits for patients who get treatment at a community cancer treatment center, like the Riverside Cancer Institute, as opposed to going to an academic for all their treatment?

Dr Cassandra Lacher: I think some of the benefits are primarily the burden of travel, is one big one. And, you know, trying not to have to pay for tolls trying to go up in Chicago, avoiding all the traffic and all the construction is a big deal for me to try to avoid going to Chicago. But also, I think being in the community and I live in the community as well, it's nice to have those connections with patients too to talk about where our kids are going to school or we talk about this person that we all know that's a community leader or whatever those connections might be. I have a brother who works at BBCHS. And so, I get to see patients who maybe have worked with him or have known him and those connections I think really make the care more special, because we're able to not just be a physician and patient. But ideally. We become friends through that treatment process and can really work together, to know each other well, to feel comfortable with each other. And that way, treatment is really that much more specialized to the goals of care for each individual patient.

Host: For sure. And I think that's something people might not think about too, is that when you're getting treated in your own community, like you said, there's Especially a place like this, there's usually a mutual connection, so that helps with that comfortability and making you kind of feel at home when you're going through something like this, I'm sure.

Dr Cassandra Lacher: Yeah, absolutely.

Host: Are there situations where a patient may not be able to be treated at a community cancer treatment center? You kind of touched on a few. Are there any other instances where they may not be? be able to do that?

Dr Cassandra Lacher: Sure. There are certain treatments that we just can't offer locally, because we just don't have that ability. So, things like stem cell transplants, bone marrow transplants, certain types of even imaging technology or modalities. Some of those things aren't available locally, just because we're not using it often enough to make it a feasible option. And then, the other piece would be clinical trials.

There are several clinical trials we're going to work on trying to get more locally for patients, for drugs that we're commonly using, but maybe in a different way or a different system. But there are new drugs still coming out all the time in regards to especially hematologic malignancies. And so, sometimes we can get access to those things by having someone be seen at a tertiary facility.

Host: What do you enjoy most about community oncology?

Dr Cassandra Lacher: Well, my favorite part is just being friends with my patients. I love being able to not just talk about their treatment, but to know about their pets and to know where their kids live and to know what their holiday plans are. And that part for me is my favorite part in managing oncology, because I feel like I'm taking care of people that I really care for. They're not just another number, but it's somebody that I've grown to know well, who hopefully has grown to know me well, and we really feel comfortable working together.

Host: What are some of the highlights of the Riverside Cancer Institute?

Dr Cassandra Lacher: Well, at our facility, we have three oncologists who are board certified in oncology who are able to help make treatment plans and make appropriate therapy options. We work with a tumor board locally as well and oftentimes that includes physicians even from the Rush Center in terms of surgical specialists and radiation options. We all have good relationships with the teams in Chicago. And so, we're able to reach out to them and get recommendations or get suggestions on patients, even if the patient doesn't go up there to see them, we can still reach out and get an opinion and get a thought process about maybe a more specialized case or more rare case.

And the other thing that we offer locally is we have a great new radiation machine. Well, I'm not the radiation oncologist, I can't speak to all the nuances and technology. I know that it has given us the opportunity to do more specific types of radiation and that's going to expand even further in the coming months and coming year for offering different radiation treatments for different types of cancers.

Host: The amount of stuff you guys are able to keep in the community is amazing, especially for the size of this community and that the technology that you talked about speaks to that.

Dr Cassandra Lacher: Yeah, I agree. Absolutely.

Host: Before we go today, is there anything else you would like to add?

Dr Cassandra Lacher: The other thing that we offer at our Oncology Center is supports for patients outside of just treatment. And so, we have social workers who work directly with our patients and helping manage treatments and helping manage social needs at home, making sure that they have what they need to be healthy at home, even during chemotherapy or other cancer treatments. We also have a pharmacist on site who's been helping us with oral chemotherapy drugs, which is such a big part now of what we're doing for cancer management. And so, having those supports in place as well really helps patients do better by offering them dietary support and all of those things too.

Host: I think that's a great place to end off on. You guys have so much to offer. And until you need cancer treatment, you probably aren't thinking about it, but to know that we have this right here in the community is amazing. And you guys are a wonderful group of people and the care that you provide for your patients is remarkable. So, the community is very lucky to have this right here for people, for sure. I think that's all we have for today. Thank you so much for coming on the podcast, Dr. Lacher.

Dr Cassandra Lacher: Yes. Thank you so much for having me.

Host: And thank you listeners for tuning into Conversations on Cancer brought to you by the Riverside Cancer Institute. For more information about Dr. Lacher and the Riverside Cancer Institute, visit riversidehealthcare.org/cancer. Also, make sure to rate our show and leave a review on Apple, Spotify, or wherever you listen to Conversations on Cancer.