Latest / Becker’s Healthcare Podcast / Rural Cancer Care, Prevention, and the Future of Oncology with Dr. James McGee

Transcript

Rural Cancer Care, Prevention, and the Future of Oncology with Dr. James McGee · Becker’s Healthcare Podcast

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  - Hello, and thank you so much for tuning
• 1:00
  - into the Becker's Oncology Leadership podcast.
• 1:03
  - I'm Elizabeth Rygerson, a reporter here at Becker's,
• 1:07
  - and today, I am talking to doctor James
• 1:09
  - McGee.
• 1:10
  - Doctor
• 1:11
  - McGee is the president of the OSF Health
• 1:14
  - Care Cancer Institute.
• 1:15
  - Doctor McGee, thank you so much for taking
• 1:17
  - the time to speak with me today.
• 1:19
  - Sure. No.
• 1:20
  - Before I dive into my questions, I'd love
• 1:23
  - if you could share a bit about your
• 1:25
  - background and your role at OSF
• 1:27
  - and the Cancer Institute for our listeners.
• 1:31
  - Well, I'm I'm, board certified in radiation oncology,
• 1:35
  - and,
• 1:35
  - grew up in a very rural environment
• 1:38
  - in Central Illinois,
• 1:39
  - extremely rural,
• 1:41
  - And then, had
• 1:43
  - training in Chicago, University of Chicago Northwestern, and
• 1:46
  - then did
• 1:48
  - the follow-up,
• 1:49
  - training at the University of Paris in various
• 1:51
  - aspects of, radiation treatment and then a master's
• 1:55
  - in health care management, Harvard School of Public
• 1:57
  - Health,
• 1:58
  - and came back to, practice in, Central Illinois.
• 2:02
  - And after,
• 2:03
  - eight years in,
• 2:05
  - Decatur,
• 2:06
  - moved to Peoria and started a cancer program
• 2:08
  - for OSF Health Care about about forty years
• 2:11
  - ago.
• 2:12
  - And, over that time,
• 2:14
  - we've
• 2:16
  - been able to develop more cancer treatment programs
• 2:19
  - for people in rural environments,
• 2:21
  - which is,
• 2:22
  - the nature of our health care system.
• 2:26
  - And our,
• 2:27
  - big priority is always
• 2:29
  - to give access to those
• 2:32
  - types of treatments that people in rural environments
• 2:35
  - usually,
• 2:36
  - struggle to have. So
• 2:39
  - we've put in a proton unit we for
• 2:42
  - enhanced radiotherapy and put in a brachytherapy area
• 2:45
  - for that type of access for patients.
• 2:49
  - But our our main work in many regards
• 2:52
  - has been to improve health,
• 2:54
  - since we are a health care organization.
• 2:56
  - And so we always focus on integrating with
• 2:59
  - primary care
• 3:01
  - and working on ways to improve early detection
• 3:04
  - and prevention of cancers,
• 3:06
  - so just to really try to
• 3:08
  - improve the health of, our our populations
• 3:10
  - in in rural environments.
• 3:13
  - Absolutely. And I appreciate you kinda, you know,
• 3:16
  - laying the land for our listeners to know,
• 3:19
  - where, you know, where you're coming from and
• 3:21
  - where OSF kind of stands in the broader
• 3:23
  - landscape landscape today.
• 3:25
  - I know you talked a lot about, you
• 3:26
  - know,
• 3:27
  - it's not just cancer. It's also, you know,
• 3:29
  - general health and partnering with primary care physicians
• 3:32
  - and all the different priorities
• 3:33
  - that you probably are juggling and balancing,
• 3:37
  - not just today, but in the coming months
• 3:39
  - and years and and the vision for everything.
• 3:42
  - What would you say, if you had to
• 3:44
  - narrow it down, is your biggest priority
• 3:47
  - at OSF Health Care Cancer Institute today?
• 3:51
  - Well, the biggest priority is trying to prevent
• 3:53
  - cancers
• 3:54
  - and to detect them early. That
• 3:56
  - that is our biggest priority.
• 3:59
  - You know, we can treat cancers. We we're
• 4:01
  - bringing in phase one research trials for
• 4:04
  - strange and exotic cancers that, you know, very
• 4:07
  - few people get. We're also doing a lot
• 4:10
  - of, work
• 4:12
  - in advanced radiotherapy
• 4:14
  - techniques and they're agnostics.
• 4:17
  - But in the end,
• 4:19
  - you know, any patient that gets cancer, especially
• 4:22
  - when it's found at a late stage,
• 4:24
  - that that's really a failure of health care.
• 4:27
  - Right? Mhmm. So our
• 4:30
  - ten years ago, we started a program for
• 4:32
  - low dose CT screening,
• 4:34
  - and, now we're at very high rates.
• 4:37
  - So probably the highest in the nation
• 4:40
  - in terms of percentage of people in our
• 4:42
  - roles of holistic health care who've
• 4:45
  - met the criteria
• 4:46
  - to warrant
• 4:47
  - screening for lung cancer and who've had low
• 4:50
  - dose CT screening done and are enrolled in
• 4:53
  - a formal program for that. We've been able
• 4:55
  - to get low dose CTs placed in our
• 4:57
  - many hospitals across the landscape of rural Illinois
• 5:01
  - and
• 5:02
  - have engaged in research trials with blood tests
• 5:06
  - to see who's most in need of getting
• 5:08
  - those scans done. So that's really our emphasis
• 5:11
  - is, you know, when you look at all
• 5:13
  - these
• 5:14
  - different
• 5:15
  - health issues, cancer is obviously the one that
• 5:18
  - keeps growing and keeps getting worse.
• 5:20
  - And when you look look at sort of
• 5:21
  - what you might call a heat map of
• 5:23
  - where cancers are at,
• 5:25
  - it's right right here in in rural America,
• 5:29
  - especially in Illinois and Iowa
• 5:31
  - and, extending into Indiana.
• 5:33
  - So we're right in the midst of the
• 5:35
  - worst of it, and that's that's our job
• 5:37
  - is to reduce that incidence and the mortality
• 5:39
  - from that.
• 5:41
  - I think the way you,
• 5:43
  - you phrase that is is so,
• 5:45
  - important. And
• 5:47
  - I, you know, cover so much about the
• 5:49
  - new innovations and and, like you said, exotic
• 5:52
  - cancers,
• 5:53
  - and and everything, but, really, that prevention piece
• 5:56
  - is so critical. So I appreciate you
• 5:58
  - really honing in on that for our listeners.
• 6:01
  - Are there any pressures you feel like cancer
• 6:03
  - centers, oncology service lines, or maybe even, you
• 6:06
  - know, rural cancer providers are facing right now
• 6:10
  - that maybe isn't getting talked enough
• 6:14
  - talked about enough?
• 6:16
  - I think the problems of rural America are
• 6:17
  - not being talked about enough.
• 6:19
  - Mhmm. And in the midst of all that,
• 6:22
  - you know, reimbursement's always
• 6:24
  - a always an issue, always a problem.
• 6:26
  - Access is an issue.
• 6:28
  - Workforce is an issue. All those things,
• 6:31
  - are major issues, and
• 6:33
  - they're worse in rural America, it seems. I
• 6:36
  - chaired the state of Illinois Board of Health
• 6:38
  - for ten years. And during that time, we
• 6:39
  - had a lot of crises,
• 6:41
  - where people were, having high morbidity and mortality
• 6:45
  - rates in various neighborhoods around Chicago.
• 6:47
  - And a lot of projects were done to
• 6:50
  - try to help those,
• 6:52
  - individuals and those populations,
• 6:54
  - so called underserved and, you know, less privileged,
• 6:58
  - etcetera, etcetera.
• 6:59
  - But whenever I came down here to Central
• 7:01
  - Illinois and looked at our data versus Chicago,
• 7:04
  - we were always worse, but nobody was sending
• 7:06
  - us you know, those types of programs. So,
• 7:10
  - I think that if you ask me what
• 7:12
  - what we're facing right now is that we're
• 7:14
  - not getting special attention like we should for
• 7:17
  - rural America. As I know there are some,
• 7:19
  - you know, fundings now for various research projects,
• 7:22
  - etcetera, etcetera.
• 7:23
  - But it's it's it's it's a major problem
• 7:26
  - in terms
• 7:28
  - of what where are all these cancers coming
• 7:30
  - from? Are they coming from pesticides and chemicals
• 7:32
  - put on crops?
• 7:34
  - You know, where where is this where is
• 7:36
  - this abundance of cancers really coming now that
• 7:39
  - we're seeing
• 7:40
  - less industrial pollution?
• 7:42
  - We're seeing
• 7:43
  - less smoking, and yet our incidence rates of
• 7:46
  - cancers, especially on younger people
• 7:49
  - and different organs, just keeps going up. So
• 7:51
  - there's something that's going on that we're not
• 7:55
  - tracking, we're not aware of,
• 7:57
  - and we're not doing enough, you know, to
• 7:59
  - really determine right now. So I think that's
• 8:01
  - the big pressure that I see for us
• 8:03
  - is we have all these people getting cancer,
• 8:05
  - and we don't really know how to turn
• 8:07
  - that around.
• 8:09
  - Yeah. That's such a interesting point too because,
• 8:11
  - you know, when I think about, you know,
• 8:13
  - rural funding initiatives and programs that I've covered,
• 8:17
  - You know, it's not just about the clinical
• 8:19
  - care or it's not not just about, you
• 8:21
  - know, providing access to treatment, that piece that
• 8:24
  - you mentioned of, you know, why is it
• 8:26
  - happening, how are we studying, you know, why
• 8:29
  - these rates are going up. It's it's just
• 8:31
  - as important,
• 8:32
  - if not more important, you know, than than
• 8:34
  - the treatment piece itself.
• 8:36
  - Yeah. Very much so. You know, the treatment
• 8:38
  - piece is, you know, based somewhat on access.
• 8:41
  - But, you know, again,
• 8:43
  - when you get these late diagnoses of advanced
• 8:45
  - cancers, you're really spending a lot of money
• 8:49
  - using a lot of resources
• 8:51
  - and in the end, not having a very
• 8:53
  - satisfactory outcome for so many people. So it
• 8:56
  - it's the emphasis really has to move
• 8:59
  - toward early detection and and prevention
• 9:02
  - and, finding out why we're getting some of
• 9:04
  - these cancers and what needs to be done
• 9:06
  - to change that.
• 9:08
  - Absolutely. Well, I'm gonna shift gears, make a
• 9:11
  - hard left here right now because it is
• 9:13
  - a Becker's podcast, podcast, and I do have
• 9:15
  - to ask you about AI.
• 9:18
  - So I'd love to know from your point
• 9:20
  - of view,
• 9:21
  - we are mindset around AI and, you know,
• 9:24
  - where the technology is genuinely
• 9:27
  - changing care, where is the hype kind of
• 9:30
  - outrunning the reality of the technology,
• 9:33
  - are you navigating safety concerns at the Cancer
• 9:36
  - Institute, kind of what is,
• 9:39
  - just taking your temperature there?
• 9:41
  - Yeah. So radiation oncology is benefiting from AI
• 9:45
  - because of the ability to do some of
• 9:47
  - the tests that we do, like outlining
• 9:50
  - tumors and normal volumes of organs to avoid
• 9:53
  - in the treatment planning process.
• 9:55
  - Some of those things can be done by
• 9:57
  - AI, and it'll it'll save us time on
• 9:59
  - each individual case, you know, that we're planning.
• 10:03
  - In the medical oncology arena, I think it's,
• 10:06
  - going to help us as we develop our
• 10:08
  - own medical oncology practice. It'll help us to
• 10:11
  - know where various patients are,
• 10:14
  - what
• 10:15
  - the dem demographics of those people are, etcetera,
• 10:18
  - and allow us to really structure our practices
• 10:21
  - to find ways to get experts in those
• 10:23
  - cancers in front of those patients and vice
• 10:26
  - versa. So I think there's a lot with
• 10:28
  - scheduling in medical oncology and also then matching
• 10:31
  - to clinical trials,
• 10:33
  - that will be useful for AI to do.
• 10:36
  - So I think it has, you know, a
• 10:37
  - lot of promise in that regard.
• 10:39
  - On the other hand, you know, you gotta
• 10:41
  - keep your,
• 10:42
  - hand on the switch. You know, the other
• 10:44
  - day, we had a patient's,
• 10:46
  - contours done. Treatment plan was developed,
• 10:49
  - and was,
• 10:50
  - almost ready to go, and it was realized
• 10:52
  - that what what had been contoured as bladder
• 10:55
  - was really a seroma from a prior lymph
• 10:57
  - node dissection,
• 10:59
  - and not the bladder itself at all. So
• 11:01
  - that would have been that would have been
• 11:03
  - a bad error had that, you know, gone
• 11:05
  - forth. So so, you know, AI can present
• 11:08
  - you with,
• 11:09
  - opportunities for improvement,
• 11:11
  - but
• 11:12
  - you really have to realize that it's not
• 11:14
  - perfect,
• 11:15
  - and you have to not be lulled into
• 11:18
  - complacency
• 11:18
  - about double checking everything. So we we, feel
• 11:21
  - like, you know, we're opting have its general
• 11:24
  - day to day utility.
• 11:26
  - But you're still gonna have to have smart
• 11:28
  - doctors, in order to take advantage of of
• 11:31
  - that,
• 11:32
  - technology. And
• 11:33
  - I don't think I don't think AI is
• 11:35
  - gonna make,
• 11:37
  - that
• 11:38
  - equation change very much. Although, you know, just
• 11:41
  - like today, you know, wanted to know how
• 11:43
  - long a patient should be on,
• 11:45
  - hormone medication for their problem. So put that
• 11:48
  - in into open access
• 11:51
  - AI, and, it said right immediately,
• 11:54
  - you know, that it was,
• 11:55
  - you know, for a period of,
• 11:57
  - no more than six months. Okay. That's great.
• 12:00
  - Got that. Gave the reference. I could have
• 12:02
  - gone and looked that up in the reference,
• 12:03
  - but I saved myself five minutes of of
• 12:05
  - looking and searching for that
• 12:07
  - by just asking that question on my phone,
• 12:09
  - you know, of open evidence.
• 12:11
  - So lot of lot of conveniences and so
• 12:14
  - forth, but we we we have to be
• 12:15
  - very very much in in line with doing
• 12:18
  - what we've always done in terms of quality
• 12:19
  - and safety.
• 12:21
  - Absolutely. I love that kind of metaphor of
• 12:23
  - keeping your hand on the lever. Right?
• 12:25
  - I think it's something not all of our
• 12:28
  - listeners will will agree with and relate to.
• 12:31
  - The question I've been asking oncology leaders,
• 12:35
  - you know, who are in the leadership position
• 12:37
  - today, as you look towards the next generation
• 12:40
  - of oncology leaders, you know, who are just
• 12:41
  - joining the field or maybe working their way
• 12:43
  - up,
• 12:44
  - Is there any challenge or problem
• 12:47
  - you think will be in their hands to
• 12:49
  - solve that the field isn't
• 12:52
  - fully tackling right now, but you see kind
• 12:54
  - of in the future that they're those leaders
• 12:57
  - are gonna have to figure out some solutions?
• 13:01
  - Well, I think we have
• 13:03
  - done a lot, you know, with cigarettes and
• 13:05
  - so forth over the years.
• 13:07
  - And and what we're not doing enough with
• 13:09
  - is obesity.
• 13:10
  - Right. You know, it's driving so many cancers
• 13:13
  - developing, and it's also
• 13:15
  - so hindering of patients being able to tolerate
• 13:18
  - cancer therapies or even have some
• 13:21
  - cancer therapies, certain surgeries, certain radiations.
• 13:24
  - So, I think obesity is something that we're
• 13:27
  - still
• 13:28
  - turning our heads to a little bit, you
• 13:30
  - know, ignoring,
• 13:32
  - but it's it's a huge
• 13:34
  - problem.
• 13:35
  - And it's the new cigarette smoke. You know?
• 13:37
  - It's the new thing. It's the new cause
• 13:39
  - of cancer. It's the new thing that's everywhere,
• 13:42
  - and it's it's the thing we have to
• 13:44
  - do something about. So we have started a
• 13:46
  - clinic,
• 13:47
  - for, our cancer patients.
• 13:49
  - You know, a lot of a lot of
• 13:51
  - women have had treatment for breast cancer or
• 13:53
  - GYN cancers who have hormonal imbalances, or maybe
• 13:57
  - on some hormone medications, you know, suffer from
• 14:00
  - a lot of weight gain.
• 14:02
  - So we're looking, and have developed a clinic
• 14:05
  - that integrates
• 14:06
  - some of the resources of the cancer institute,
• 14:09
  - including the teaching kitchen,
• 14:11
  - and,
• 14:12
  - general medical care, sometimes
• 14:15
  - medications,
• 14:17
  - also
• 14:18
  - exercise training,
• 14:20
  - various measurements of body mass,
• 14:23
  - muscle, and fat. All of that is coming
• 14:26
  - together in a in a clinic
• 14:28
  - for our patients that, for example, are
• 14:31
  - forty pounds overweight after breast cancer therapy,
• 14:34
  - depressed about it.
• 14:36
  - And so they're getting a lot of help
• 14:38
  - from
• 14:39
  - a little bit of psychological help, but then
• 14:41
  - the reality of
• 14:42
  - this is what in the teaching kitchen I'm
• 14:44
  - learning. This is,
• 14:46
  - something I've talked with them about GLP ones.
• 14:49
  - I'm getting my exercise prescribed and getting my
• 14:52
  - muscle mass and fat
• 14:54
  - ratio measured on a regular basis, getting my
• 14:57
  - weight checked, getting encouragement,
• 14:59
  - going walking with a group of, like minded,
• 15:03
  - patients,
• 15:04
  - every every day,
• 15:06
  - to get my exercise in. That that type
• 15:09
  - of clinic is really starting to take off
• 15:11
  - for us. I think I think that,
• 15:14
  - is a way that we're trying to address
• 15:16
  - this obesity epidemic in our patient population. And,
• 15:20
  - you know, some of these people were in
• 15:22
  - much better shape, you know, prior to getting
• 15:24
  - cancer and having this, you know, treatment. So
• 15:26
  - we we feel like that's a great step
• 15:28
  - for us right there. That's that, I think,
• 15:30
  - is,
• 15:31
  - the big challenge, though.
• 15:34
  - Absolutely. I think you're the first who may
• 15:36
  - have answered that way.
• 15:38
  - So I'm excited,
• 15:40
  - to see kind of what, you know, comes
• 15:42
  - from programs like you mentioned and and, like,
• 15:45
  - you know, with the medications that you mentioned
• 15:47
  - and the different therapies, you know, what
• 15:49
  - what that future solution will be.
• 15:52
  - Anyone who listens to the podcast knows my
• 15:55
  - favorite way to end conversations with oncology leaders
• 15:58
  - is asking them what's giving them hope about
• 16:00
  - the future of cancer care. So I'd love
• 16:02
  - to hear from you, doctor McGee, about what,
• 16:05
  - you know, what's on the horizon that's giving
• 16:07
  - you optimism when it comes to oncology.
• 16:10
  - Well, we're doing a lot to improve access
• 16:13
  - and decrease cost of care.
• 16:16
  - So in radiation, for example, we're doing a
• 16:18
  - lot of research with our proton unit on
• 16:21
  - flash radiation therapy, which is, increasing the rate
• 16:25
  - at which a radiation treatment is delivered,
• 16:28
  - and increasing that dramatically,
• 16:30
  - you know, changing from an output of, 2,500
• 16:34
  - grads a minute to 700,000
• 16:37
  - grads a minute. And in that scenario then,
• 16:40
  - potentially, there's much less
• 16:43
  - reaction of normal tissues to radiation,
• 16:46
  - an equal reaction of tumor tissue to radiation,
• 16:49
  - and the number of treatments with radiation can
• 16:51
  - be reduced dramatically from, like,
• 16:54
  - 30 to three.
• 16:56
  - Oh. And so you you can you know,
• 16:58
  - I think we have a hard time with
• 17:00
  - the infrastructure we have now with radiation across
• 17:03
  - the landscape because you've got
• 17:05
  - many
• 17:06
  - radiation machines scattered all over the place
• 17:09
  - of varying quality.
• 17:11
  - You have people under pressure financially trying to
• 17:13
  - do as many treatments as possible
• 17:16
  - in order to get compensation.
• 17:18
  - I think what gives me hope are that
• 17:20
  - there will be modalities
• 17:22
  - like FLASH developed
• 17:24
  - that would allow for
• 17:25
  - the very expensive equipment to be used much
• 17:28
  - better by larger groups of patients,
• 17:31
  - but
• 17:32
  - only,
• 17:33
  - you know, in short intervals of time, not
• 17:35
  - requiring, you know, moving to, you know, a
• 17:38
  - faraway city for two months to get radiation,
• 17:40
  - but maybe making, you know, a a short
• 17:43
  - enough visit that you could come,
• 17:45
  - stay in provided housing for a couple of
• 17:48
  - nights and get your entire course of radiation
• 17:50
  - treatment.
• 17:51
  - And those types of things, I think,
• 17:54
  - decrease
• 17:55
  - cost of care,
• 17:56
  - decrease overpopulation
• 17:58
  - of
• 17:59
  - equipment that's difficult to pay for and maintain
• 18:01
  - and which drives a lot of unnecessary treatments,
• 18:05
  - quite honestly.
• 18:06
  - And I think if we can get our
• 18:07
  - handle around things like that
• 18:10
  - in many ways,
• 18:11
  - that we'll be able to do a much
• 18:13
  - better job
• 18:14
  - of reducing cost, improving access for everyone,
• 18:18
  - and, just making more sense out of all
• 18:20
  - this.
• 18:21
  - Amazing. Well, I appreciate you, you know, tying
• 18:24
  - in that radiation oncology perspective too for our
• 18:26
  - listeners because I think it's so key and
• 18:29
  - crucial, to these kinds of discussions. And that's
• 18:32
  - actually all the time we have for today.
• 18:34
  - So I just wanna thank you again for
• 18:36
  - taking the time out of your day to
• 18:38
  - talk with me and, share your perspective with
• 18:40
  - our listeners.
• 18:41
  - Thank you. And thank you to our listeners
• 18:44
  - for tuning in to Becker's Oncology
• 18:46
  - Leadership podcast.
• 18:48
  - I invite you all to check out even
• 18:49
  - more Becker's Healthcare podcasts
• 18:51
  - at beckerspodcastsdot,
• 18:54
  - Thank you again to doctor McGee for joining
• 18:56
  - me and to our listeners for tuning in.
• 18:58
  - Have a great day.