UW Carbone Myeloma Expert Looks to Improve Care in Caribbean Nations
As one of 27 members of the National Comprehensive Cancer Network (NCCN), the UW Carbone Cancer Center and its physicians are asked to sit on committees that pour through the medical literature and then set guidelines for the evaluation and treatment of most types of cancer. NCCN committee recommendations are used by oncologists to make informed treatment recommendations, by other providers to understand the current oncology landscape and by insurance companies to determine coverage.
“NCCN’s recommendations are now acknowledged in many parts of the world as the gold standard of care,” said UW Carbone hematologist Natalie Callander, MD, vice chair of the NCCN committee on the blood cancer, multiple myeloma. “However, in many parts of the world, some of the things we take for granted at places like the Carbone Cancer Center aren’t available.”
For that reason, NCCN has previously sent physicians to Africa and the Middle East to discuss with physicians there how the “gold standard” can be adapted to what is practical in those regions. This past May, Callander was asked to visit the Caribbean as a myeloma expert. Other NCCN doctors went to provide expertise on colorectal, breast, prostate and lung cancers.
“We started by having in-person meetings with teams of physicians. And my role wasn’t to say, ‘This is what you should do,’” Callander said. “It was, ‘Tell me what you do. Tell me about your clinics and your health system.’”
Once Callander learned what healthcare technologies were available in the Caribbean nations, she could help those physicians make recommendations based on NCCN guidelines but within the resources that were available. For example, bone marrow transplants are a common treatment option for myeloma patients in the US, but there is only one transplant center in the Caribbean – and while the 24 Caribbean nations are geographically close, it is neither simple to travel between the islands nor easy to receive care in another country with its different health system.
“And then, some of the newer drugs we use here are just not available,” Callander said. “So, we revised some of the treatment options to include regimens that we use much less frequently here because they are older drugs. These older drugs aren’t bad, they just may not be quite as effective, but you have to work with what you’ve got.”
At the end of her three days there, Callander and the other NCCN physicians took the current NCCN guidelines and made a Caribbean version. They are finalizing the guidelines now and will make them available on the NCCN website for any physician to use.
Overall, Callander called the experience “humbling,” and said she was impressed by the level of expertise of the Caribbean physicians.
“Our current NCCN guidelines don’t add in the reality that some parts of the world face, and I think the emphasis of our visit was that these are all very well-trained, very knowledgeable oncologists,” Callander said. “It’s not that they don’t know or don’t want to implement the top treatments, it’s that they can’t. And they’d like to come up with the best way to treat their patients effectively with the resources that they have.”
Date Published: 07/11/2018