Hospitalists who encounter the occasional late-stage colorectal cancer patient might be perplexed as to why the patient refuses to remove food from their in-room refrigerator and often are wearing mittens. But it would be immediately clear to them once they knew that the patient was on oxaliplatin—a less-than-decade-old medication delivered via the chemotherapy regimen known as FOLFOX—and that a common side effect is neuropathy resulting in extreme sensitivity to cold.
Why wouldn’t hospitalists know this? Because, according to a medical oncologist at Memorial Sloan-Kettering Cancer Center in New York City, oncologists traditionally have tried to holistically manage the care of cancer patients. In today’s age of new treatments and increased inpatient care for patients with aggressive cancers, though, Jason Konner, MD, says it’s time for hospitalists to take a greater role in the management of cancer patients.
The upshot: Dr. Konner envisions a new breed of oncologist-hospitalists. (Check out this in-depth look at specialty physicians adopting the HM model of care.)
“Universally, the hospitalist is going to have to be part of a team with the oncologist,” says Dr. Konner, assistant professor with the Gynecological Medical Oncology Service and Developmental Therapeutic Services. “We’re going to complement each other. There are definitely things that we can do that they can’t and definitely things they can do that we can’t. Right now, it’s just being part of the team to address the diverse medical complications of cancer. But I think that increasingly, [hospitalists] are going to be the primary caregivers, sometimes solely the caregivers, of patients with cancer complications.”
The concept, which was raised during an “Oncology for the Hospitalist” presentation at the fifth annual Mid-Atlantic Hospital Medicine Symposium at Mount Sinai School of Medicine in New York City, is not new, but it is particularly relevant as cancer mortality and incidence rates continue to drop. Dr. Konner counters that while improved screening techniques—mammographies and prostate-specific antigen (PSA) tests, to note a pair—have reduced incidences, the majority of “aggressive cancers and cancers that kill people” still require intensive inpatient care.
To wit, a pilot program at Mount Sinai several years ago dedicated a hospitalist to the oncology service in the hopes of developing a staffer with a new expertise. The brief program, which yielded little data because of its small sample size, was aimed at determining the efficacy of an oncology hospitalist.
Richard Quinn is a freelance writer based in New Jersey.