Finally, Metastatic Breast Cancer Patients Get VIP Treatment

A First-of-Its-Kind US Clinic

Nick Mulcahy

February 01, 2019

For the past year and a half, the Koontz Center for Advanced Breast Cancer in Kansas City, Missouri, has been open for business, making it the first and only clinic in the United States devoted exclusively to patients with metastatic disease.

Dr Timothy Pluard

The new entity, housed within the larger St. Luke's Cancer Institute, has great ambitions for treating a patient population that has been historically underserved and even actively ignored by the American breast cancer establishment.

"One of the goals of the clinic is to try to change the care model for metastatic breast cancer patients," said Timothy J. Pluard, MD, medical director, St. Luke's Cancer Institute, who was the driving force behind the center's creation.

The Koontz Center was designed to take a two-tracked approach to care: it combines access to the latest clinical trials, medical research, and treatments with access to a wide array of supportive therapies.

In short, the Center aims to extend metastatic patients' survival and improve their quality of life.

The physical space, which cost $700,000 to renovate, facilitates the medical mission.

Koontz Center conference room

The Koontz Center includes traditional medical clinic facilities such as exam rooms, a waiting area, a library, and a conference room, but was designed to be "spa-like."

The space has hardwood floors; "farm" doors (which slide on rollers instead of swinging on hinges); lots of artwork; and patient rooms that are larger than usual and include a curtained private area for changing. Patients wear cotton robes, not gowns. "We tried to make it a little less medical," Pluard told Medscape Medical News.

The center is improvising a bit, suggested Pluard.

Metastatic breast cancer is increasingly complex and challenging, he explained, and has seen an expanding number of treatments and longer survival in the past decade.

"But there is very little research on how we can help these patients live better, have better quality of life," he emphasized.

The Koontz Center's supportive therapies address this issue and include diet planning, physical therapy, yoga, acupuncture, behavioral counseling, and spiritual support.

To ensure timely delivery of these services, the center provides offices for each corresponding "integrated care" professional, including a social worker, a psychologist, a nutritionist, a genetic counselor, a physical therapist, a chaplain, and a palliative care specialist.

The center also boasts a high rate of clinical trial participation, which is intentional. Currently, 22% of the centers' patients are or have been enrolled in clinical trials. This compares very favorably to national rates — the average oncology practice will enroll 3% to 5% of patients in clinical trials.

Katherine O'Brien, a woman living with stage IV breast cancer who is a patient advocate from Chicago, is a big fan of what's happening in Kansas City.

"The dedicated metastatic breast cancer clinic is impressive on several levels, including in its conception. Dr Pluard recognized that patients who are in active treatment for life have different needs than early-stage patients," she told Medscape Medical News.

Among other things, metastatic patients continually undergo chemotherapy or targeted therapies for as long as they live, whereas early-stage patients cease treatment at some point.

This difference can give rise to awkwardness and even anger when both groups are treated in the same setting, as previously reported by Medscape Medical News.

Frankly, most cancer centers aren't interested in catering to what amounts to a small subset of patients. Katherine O'Brien

O'Brien pointed out that in the United States, 3.5 million people are living with a history of breast cancer, but only an estimated 155,000 have metastatic breast cancer. "So we stage IV breast cancer patients are thousands among millions," she commented.

"Frankly, most cancer centers aren't interested in catering to what amounts to a small subset of patients," O'Brien continued. "But the Saint Luke's Koontz Center example shows what can be done."

Pluard said the center, named after Paul Koontz, MD, a revered and now retired breast surgeon at St. Luke's who helped endow a position that Pluard now holds, is financially viable.

Word Is Spreading

Word is spreading about the new clinic. This week, Pluard and the Koontz Center hosted visitors from Johns Hopkins University in Baltimore, who are interested in starting a similar facility. "They were very impressed," he said.

Recently, METAvivor, a prominent advocacy group for metastatic breast cancer patients, recognized the Koontz Center for leading the way nationally in the treatment of stage IV breast cancer. Likewise, the Association of Community Cancer Centers previously highlighted the Kansas City facility as an exemplary care model for advanced breast cancer.

Consultations Are Video-Recorded

The Koontz Center has cared for patients from 11 different US states and also conducts remote consults.

Consults, both for on-site and remote patients, are facilitated by WebEx, an online-based video meeting software application that allows family and friends who may be remote to "drop in" and join the patient consultation live. Pluard said this capability speeds understanding. For example, CT scans can be viewed simultaneously by all parties.

The consults take place in the center's conference room, where dual, wall-mounted 72-inch monitors enable all parties to be together and see and hear each other.

The consult is video-recorded, and patients are given a digital copy so they can review or share it later. "Data show that cancer patients on their first visit only recall 10% of what was discussed," said Pluard, who came up with the idea of recording the meetings.

St. Lukes' lawyers were hesitant about video recording clinic consults, but Pluard won out.

"Patients love it," Pluard said about the center, adding that the staff are continually learning how to serve their patients.

"Most metastatic breast cancer patients in the United States are not mismanaged, but, as a group of caregivers, we have not fully understood the extent of the patient's needs and the impact of metastatic breast cancer on patients and their families," he emphasized.

The Koontz Center also acts as a gathering place and includes a Web-based support group for the metastatic breast cancer patients.

O'Brien is familiar with the group. "With the online support group, patients can talk to other metastatic breast cancer patients, as well as to a social worker and Dr Pluard. It's a testament to St. Luke's commitment to its patients outside of clinical visits. A lot places talk about treating the whole patient, but Dr Pluard and his team really do."

Follow Medscape senior journalist Nick Mulcahy on Twitter. For more from Medscape Oncology, follow us on Twitter.

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