People have the preconceived notion that people in Alaska are still living in igloos. The truth is we practice excellent oncology care here.
—Latha Subramanian, MD
Located in Anchorage, Alaska, the Denali Oncology Group faces the dual challenge of serving a diverse and large population of more than 731,000 spread across a vast state of 586,000 square miles, with just 20 medical oncologists and 5 radiation oncologists located mainly in Alaska’s two biggest cities, Anchorage and Fairbanks. An ASCO affiliate since 2008, the group was founded 30 years ago by James M. Sprott, MD, and Dale I. Webb, MD, whose goal was to sponsor a yearly scientific meeting.
For the past 2 years, Latha Subramanian, MD, has served as President of the Denali Oncology Group. The ASCO Post talked with Dr. Subramanian about the issues unique to her state society, including the difficulties of increasing patient participation in clinical trials and improving communication among physicians in remote locations.
Why did the Denali Oncology Group decide to become an ASCO affiliate?
What prompted us to become affiliated with ASCO was the problem we were having getting health insurers to pay for routine costs of care for patients enrolled in clinical trials, and that is where we focused our efforts at first. During its inaugural year as an ASCO affiliate, the Denali Oncology Group sought to get legislation passed mandating coverage by insurers for patients with cancer entering clinical trials.
In February 2009, the group was supported in its effort by then ASCO President Douglas W. Blayney, MD, who testified by conference call at two Alaska Senate committee hearings on the importance of passing the bill. The following year, Senate Bill 10, requiring health insurers and Medicaid to provide coverage for cancer clinical trials, was passed. I don’t think we could have gotten that bill passed without ASCO’s help and reputation.
Being an ASCO affiliate has helped us stay in touch with what is going on nationally in terms of medical advances and in finding ways to raise public awareness regarding clinical trials and the importance of cancer screenings. ASCO has also helped bring the problem of drug shortages in Alaska to the forefront. I don’t think the Denali Oncology Group alone could have done that.
Clinical Trial Enrollment
Is it difficult to get patients to enroll in clinical trials?
Several issues make it difficult to increase participation in clinical trials in Alaska. One is that most of the native population is treated at the Alaska Native Tribal Health Consortium, which is based in Anchorage, but it doesn’t conduct clinical trials or have a clinical trial referral system in place, so we don’t see most of those patients. In addition, people are located in such distant and isolated areas that the only way to get to a clinical trial facility is by plane or ferry.
Another challenge is overcoming people’s skepticism about the value of clinical trials and educating them about the concept of randomization. Some people don’t want to be randomly assigned to therapy—they want to be able to choose their treatment—so that’s another barrier.
Other Unique Challenges
How are you able to serve such a large and diverse population spread over such a great distance with so few oncologists?
Our oncologists are concentrated in Anchorage and Fairbanks, so patients in the southeast go there. An oncologist from Seattle flies into Juneau once a month and takes care of patients there. There are no oncologists in Valdez, which is about a 6-hour drive east of Anchorage, so patients are seen by internists who administer chemotherapy under our supervision. We have a similar arrangement with family practitioners in Kodiak, which can only be reached by plane. We have very good phone communication, but it is a big challenge.
Can you use video conferencing technology to communicate with physicians in other cities?
We are looking into how to overcome the obstacles of instituting video conferencing capabilities among the various institutions. We also need to contend with issues related to complying with HIPAA privacy rules, and we’re trying to resolve those obstacles.
Another issue for us is that electronic health records are not commonly in use throughout the state. Even in hospitals and private practices that have electronic health records, they often can’t “speak” to each other because of the different software and hardware platforms. The Alaska Native Tribal Health Consortium does have a sophisticated telemedicine system, but it serves only the Consortium’s patient population.
What else would you like ASCO members to know about the Denali Oncology Group?
In addition to our emphasis on technologic improvements, we are focused on how to use more evidence-based medicine and practice more cost-effective care. Despite our logistical challenges, we are able to provide our cancer patients with excellent care.
We hold general cancer conferences in Anchorage every week, every other week we have a breast cancer conference, and once a month we have a brain tumor conference. We get together to learn and present cases, and we also use e-mail and the telephone to confer with colleagues, so patients often do not have to travel long distances for specialized care.
We are a growing group, and our oncologists practice state-of-the-art medicine. People have the preconceived notion that people in Alaska are still living in igloos. The truth is we practice excellent oncology care here. ■