Telling a patient that she has or may have cancer can be one of the most challenging tasks a physician faces. And what typically follows — recommending an oncologist — can be one of the most important services a physician provides to that patient.

Whether you are a primary care physician evaluating concerning blood work results, a gastroenterologist reviewing a colonoscopy biopsy report, or a dermatologist who has identified recurrent melanoma, that recommendation or referral sets the trajectory for the person’s entire cancer journey.

Regional Cancer Care Associates (RCCA) is a group of more than 90 medical oncologists and hematologists who treat patients who have solid tumors, blood-based cancers, and benign blood disorders at more than 20 locations near you throughout New Jersey, Connecticut, and Massachusetts. Two medical oncologists with RCCA say that employing a decision-making framework known as ACE can help clinicians take a comprehensive approach to making a truly individualized referral.

“ACE is an acronym that stands for access, collaboration/communication, and experience/expertise,” explains Seth H. Berk, MD, a board-certified medical oncologist and hematologist who practices at RCCA’s Moorestown, NJ, offices and serves as RCCA’s Board Chairperson.

The Importance of Access to Cancer Care

Dr. Berk adds, “The access component of the acronym encompasses four important considerations. First, is the oncologist you are considering in the patient’s insurance plan? If not, there are going to be considerable, potentially unsustainable, financial toxicities entailed in going out of network. Second, how quickly can the patient be seen for an initial consultation, can all required additional testing be conducted, and can a care plan be developed and implemented? Third, does the clinician offer access to the latest therapies being used to treat the patient’s condition and to clinical trials evaluating new approaches to treatment? Fourth and finally, access is a matter of proximity. Is the oncologist located within a reasonable distance from the patient’s home? This is a huge consideration not only in terms of quality of life but also for provision of care. To cite one example, a patient experiencing a side effect may decide not to call the oncologist’s office to report the problem if he thinks he will be told to drive an hour or more to an academic medical center in a large city at a time when he feels miserable. By comparison, if his oncologist is located 10 or 15 minutes away, that patient will be much more likely to seek help — and to be seen promptly, if needed.”

How Collaboration and Communication Enhance Cancer Treatment

Niloo Prasad, MD, a board-certified medical oncologist who practices at RCCA’s Edison, NJ, office notes that the C in the ACE acronym stands for collaboration and communication. Dr. Prasad says, “I can’t remember the last time I saw a patient with cancer who didn’t have at least one comorbidity, whether that be hypertension, diabetes, asthma, or some other chronic condition. We appreciate how hard our primary care and other colleagues work to manage these conditions, and we know that the oncologic therapies we use can have significant drug-drug interactions or otherwise affect patients’ overall health. For this reason, we collaborate closely with a patient’s other providers, informing them of our treatment plan and the implications it has for the conditions they treat, and consulting with them frequently in terms of any indicated dosage adjustments and similar steps.”

Dr. Prasad adds that one advantage of practicing oncology in the community setting is close working relationships with a patient’s other physicians. “In many cases, my patients’ primary care providers, cardiologists, endocrinologists, or other physicians are on staff at the same hospital where I practice, and I typically have known them for many years. Further, we often share a common electronic medical record, which can greatly facilitate collaboration for whole-person care.”

She adds that when considering a referral, an oncologist’s skill in communicating with the patient and the patient’s caregivers can be even more important than how well the specialist interacts with colleagues. “Cancer is a complex disease that affects every facet of a person’s life. Similarly, the therapies we now have to treat cancer, while offering greater efficacy than ever before, often have mechanisms of action with systemic effects and can have significant side effect profiles. Beyond his or her clinical acumen and technical skills, an oncologist needs to be a clear, patient, and compassionate communicator to engage the patient in shared decision-making and deliver optimal care. That’s an intangible, but it’s an invaluable one,” Dr. Prasad says.