“We’re facing a big challenge,” Alfano says. “The science of oncology is developing so rapidly that it’s led to hyper-specialization in both cancer research and treatment. On the one hand, this is a good thing because we have so much more data available to us to help us treat an individual patient’s cancer specifically. But on the other, with the increase of cases diagnosed, the rising complexity of treatments, and shortages of clinicians, we’ve inherited a perfect storm that has inadvertently created siloes of disconnected specialists and gaps in care.”

To put it another way, we’ve gotten so good at studying the individual trees that we now need someone who can step back and look at the forest. What Alfano and her team are proposing is a clinical position that’s never before existed in oncology care: a specially cross-trained internal medicine/cancer provider working with the patient’s oncology team who holistically assesses a patient’s needs and enables a comprehensive care team surrounding the patient. Supported by data, this provider will quarterback a team to deliver a patient’s treatments at Northwell’s state-of-the-art oncology centers, investigate possible inclusion in innovative research trials, manage the toxicities of cancer treatments, and provide access to mental health and social services, all while considering the patient’s health history and comorbidities. 

“Survivorship thinking starts at diagnosis,” Alfano says. “Patients want their lives saved at the same time that they want to have a high quality of life after cancer. Our new program is based on balancing these two goals.”

Based on her life experience, this kind of innovation can happen only at an integrated health system like Northwell. Alfano recalls how, when she was 12, her grandfather died of cancer. As an Italian immigrant, he did not receive the care he deserved. Cultural and care access barriers all contributed to a late diagnosis, and by the time he began treatment, it was too late. He died without being able to say goodbye to his family.

The experience inspired her to dedicate her life to cancer research. But a few years ago, she had a revelation: Big changes in health care start with health care systems that want to be innovative and create the future, showing others what is possible. When Northwell Health called on her to head this new comprehensive cancer care initiative, she jumped at the chance.

“Northwell has everything needed to be a leader in a new kind of cancer care,” Alfano says. “As a fully integrated health care system with access to the best clinicians using cutting-edge care to serve a diverse population, we have the resources to fully wrap our arms around each individual patient, with this new kind of clinician helping to coordinate the team.”

This new comprehensive cancer care will tackle two big challenges simultaneously.

• First: Cancer treatment is not a one-size-fits-all proposition. Accordingly, the care team’s priority will be to individualize each patient’s care from diagnosis, through cancer treatment, and beyond. By evaluating a patient’s ongoing symptoms and their ability to participate fully in life, their social determinants of health and their personal health history, the care team can help the patient decide on which treatment options best meet their quality-of-life goals.
• Second: Better care requires better data. Northwell’s goal is to develop a “learning health system,” a living, breathing registry of all the data generated by all Northwell’s cancer research and patient cases. This learning health system will help provide personalized care to patients. 

“When people are diagnosed with cancer, they’re flooded with big questions: What treatment will work best for me? How’s it going to go for me? What will the rest of my life look like?” Alfano explains. “And we’re getting better at answering these questions, but right now, the answers look like a map with many twists and turns. With better data that incorporates all of the patients’ data with our centralized data, we can predict the answers more accurately.”

A learning health system

This learning health system will inform patients and clinicians, but the information can also be disseminated into the community using a population health approach. The goal is not only better care for patients after they’re diagnosed, but also better education for the community before they’re diagnosed so they can be involved in their care going forward. As Alfano likes to say, health care is not something that happens to you, it’s something that happens with you.