At most hospitals across the country, diagnosis and treatment revolved around the care team, with a series of visits with medical, surgical and radiation oncologists and other specialists at different locations. Numerous appointments for tests, care decisions and treatments were spread out over time. At the Kimmel Cancer Center, our experts started following an opposing model, in which the care team revolved around the patient in one central location.

The Johns Hopkins multidisciplinary clinics — the multiDs, as they are known — were born out of the desire for the Center’s clinical programs to match the strength of its basic science research programs. They have played a vital role in improving the treatment of difficult cancers, such as pancreatic, liver and lung cancers, and others.

“I can’t think of another place like this, with this level of interaction,” says Bert Vogelstein, M.D., Clayton Professor of Oncology and co-director of the Ludwig Center for Molecular Therapeutics, whose genetic discoveries were an example of the basic science woven throughout the multi-Ds, informing and improving cancer diagnostics and treatment. “You can’t manufacture that kind of environment. It has to be built from the ground up, and we’re very fortunate to have it here.”

Our experts envisioned a clinic in which patients could come to the Kimmel Cancer Center, and after a single day’s visit, receive an integrated treatment plan representing the multispecialty expertise of all specialists involved in the treatment of each cancer type. The multidisciplinary care model ensured that every expert involved in the treatment of a particular cancer has a seat at the table when recommending a treatment plan to the patient. The clinic seamlessly incorporated all elements of cancer care, including diagnosis, therapy, follow-up care and surveillance, palliative medicine and survivorship.

Feliciano

“We’re not just discussing the treatments that patients will need for their particular cancer, but also what other resources we will need to enlist for each patient based on what we know about them, their medical history, social history, and their life circumstances, because treatment isn’t just about the cancer itself,” says Joy Feliciano, M.D., thoracic cancer expert and Cancer Diagnostic Clinic medical director. “It’s about how this patient might need rides to chemo, or that one might need us to coordinate care with their cardiologist because they have a pacemaker.”

The clinics marked a major step forward from the early days of the Center, when cancer care was often a singular approach. If a tumor could be removed with surgery, the patient was treated first by a surgeon then handed off to medical and radiation oncologists for chemotherapy and radiation therapy.

A radiologist would image the tumor and send a report to the oncologist. All of the experts would perform their tasks well, but there was no concerted effort.

WOLFF

“Cancer therapy transcends the boundaries of medical and surgical disciplines, so it was important to have all of the key players involved in the plan and execution of therapy from the onset,” says Elizabeth Jaffee, M.D., deputy director of the Kimmel Cancer Center and co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care. “The department lines have really been blurred here. Our patients are getting a first, second and third opinion all at the same time.”

HOLDHOFF

This single-day approach is highly unusual in cancer care, says Russell Hales, M.D., radiation oncologist and director of the Thoracic Oncology Multidisciplinary Clinic. His research has helped prove its benefits.

Although he knew patients liked the multi-Ds, he wanted to be sure, by examining objective data, that it was the best approach for them. In 2017, he compared outcomes of patients with lung cancer who received care through the multidisciplinary clinic with patients who received their care outside of the clinic with individual providers through a more traditional care model.

VOONG

Their findings showed that one-year survival at the clinic was 82% compared with 64% for patients treated outside the clinic. The next year, Kimmel Cancer Center radiation oncologist Ranh Voong, M.D., presented additional findings showing that the clinic provides a cost savings of 30% over traditional care, presumably because patients receive more streamlined planning and treatment, avoiding unnecessary appointments and tests.

LAHERU

“You don’t see this magnitude of improvement in some of the newer drugs coming out, and it’s even more significant because patients in the health care system are saving money,” says Hales.

The Kimmel Cancer Center has a multidisciplinary clinic for every cancer type.

Patients travel from around the world, across the U.S., and throughout the state and region.

SHARFMAN

“This kind of care is in the DNA of the Kimmel Cancer Center,” says Director William Nelson, M.D., Ph.D. “The collaboration across disciplines is part of our history, and it continues today. We never forget the science, and that puts us at the forefront of clinical breakthroughs.”