HomeMy WebLinkAbout770508.tiff e `, .» _ RECEIVED AUG 1 2 1977
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GREELEY, COLORADO 806
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COLORADO
August 10, 1977
Board of Directors
Central-Northeast Colorado Health Systems Agency, Inc.
7290 Samuel Drive, Suite 316
Denver, Colorado 80221
Re: Plan Development Committee Report, Oncology:Radiation
Having reviewed the proposed plan with local medical staff involved in
this field, the overall ideas and content of the plan seem generally
satisfactory. The material within it appears to be accurate and drawn
from well known and established sources. However, there appear to be
major omissions which will affect the future of Northern Colorado health
and will be discussed later in this letter.
Much of the technical data seems to be somewhat redundant as it represents
requirements which are already established for hospital accreditation by
the joint commission on hospital accreditation or by the State Board of
Health, Radiation Division. The technical nature of the plan may be
somewhat of a burden to place on a group of individuals who are not
technically oriented and must rely on the written word to evaluate such
material , particularly since many of us do not have the benefit of actual
personal experience nor the technical background with which to judge the
content.
The most serious omission in the report seems to be the lack of concern
for the patients in the large rural area covered by HSA-1. It appears to
be a technical report more concerned with statistics than with people.
Although much of the early portion of the report was obtained either
directly or indirectly from a booklet entitled, The Role of Radiation
Oncology, some of the most important portions of this booklet, particularly
those regarding the patient, were not included. The booklet, a report
to the National Cancer Institute of the National Institute of Health,
is a proposal for integrated cancer management in the U.S. and the role of
radiation oncology within such a plan.
There are some fundamental principals regarding radiation oncology which
I believe should be incorporated into the plan and are basic to providing
good medical care to all the people of HSA-1. The following quote from
Simon Kramer, Chairman of the Committee for Radiation Therapy Studies which
formulated the booklet, states some of these fundamentals.
770 50 8
Oncology: Radiation 8-10-77 Page Two
"Certain concepts are fundamental to our proposals. There
must be one optimal level of care for all cancer patients
regardless of how and where they enter the health care
system. Modern cancer management requires an integrated
approach by many different specialists each with his own
expertise. The significant improvements in results obtained
in the few centers of excellence must now become available
to all patients. And most importantly it must be recognized
that the initial management decision is the most critical
component in the treatment of the cancer patient. Therefore,
the expertise of the cancer surgeon, radiation oncologist,
and the medical oncologist and pathologist must be available
where and when that management decision is made."
Also from the introduction to the same report:
"Optimal care must be uniformly available to all patients
with cancer regardless of geographic constraints, manpower
limitations, economic restrictions, and variations in
methods of health care delivery. "
Pages three and four discuss the old method of center satellite referral
and consultation, which describes our present health care delivery system. . .
"Unfortunately, this stratification may generate three levels
of patient care. The level of care has, therefore, often been
determined by the patient's point of entry into the system,
which, in turn, depended upon geographic or economic considerations,
patterns of referral , custom, or accident. Though economically
sound, the development of a restricted number of highly centralized
cancer facilities has the disadvantage of separating the radiation
oncologist and other specialists from the primary physician who
sees the cancer patient at other points in the health care system.
If a radiation oncologist is not available for consultation at
the patient's point of entry into the system, the benefits of
irradiation are often lost to the patient."
This latter point becomes clear in studying the need for a radiation
oncology center in Greeley. The plan states that in the Denver area, the
percentage of cancer patients treated by radiation is approximately 50 percent.
However, in Weld County, only 28 percent of the cancer patients diagnosed
were receiving radiation therapy; in Ft. Collins, only 16 percent were
receiving radiation therapy. It is obvious that the lack of available facilities
and oncology specialists denies many patients the type of therapy they need.
Some of these patients were offered treatment in Denver but refused treatment
or became discouraged and stopped treatment after beginning such therapy
because of the time and travel involved in making daily trips over periods of
from three to eight weeks. This was despite the fact that both Ft.. Collins
and Greeley have organizations which provide free private transportation to
Denver to the radiotherapy centers for treatments.
Oncology: Radiation 8-10-77 Page Three
At the present time, with the exception of a low volume cobalt machine in
Sterling and the proposed unit in Weld County, all available radiation
oncology facilities and their related specialists are in the metropolitan
Denver area.
Cancer being the type of disease it is, does not lend itself to hospitalization
in Denver as does cardiac surgery, etc. , where the patient may stay 10 days
to two weeks or sometimes longer, then return home. Most cancer treatments
are given on an out-patient basis, even though the patients may be somewhat
debilitated or ill . As noted in the proposed plan, they are usually lengthy
courses of therapy ranging from three to eight weeks. Frequently, these
individuals have only a short time to live; lengthy separations from their
families and local environments become very difficult during the valuable
time remaining to them.
The heavy reliance on the technical data in the plan may limit the plan's
usefulness because of the rapid pace' of technological development in the
medical field, particularly in radiology. Portions of the specific
evaluations are probably already out of date; if not, they will be shortly.
Another important omission, as far as Northern Colorado is concerned, is
the impression left by the plan that no more facilities will be needed in
HSA-1 by 1985; in fact, this is true only in the metropolitan Denver area
which presently has an excess of facilities available. The presence of an
oncology center in Northern Colorado will probably decrease the volume in
Denver; it may decrease the referrals received by each of the centers by
approximately five percent.
The estimated population of the Northern Colorado medical trade area is
expected to be 410,804 by 1985. By the criteria set forth in the plan,
i .e. , 250 per 100,000 crude cancer incidents; percent of new cancer patients
receiving radiation therapy of 54 percent; and a radiation therapy facility
treatment rate of 250 previously untreated patients per year, there will be
a need for two therapy facilities in the Northern Colorado area by 1985.
Very little consideration was given in the plan to megavoltage treatment
with electrons. It is doubtful that a third machine will be needed in
Northern Colorado by 1985; however, the plan should not be so rigid that
it would not accommodate that possibility. If a third machine were needed,
the most logical size would be in the 12 to 18 mev range so that electron
therapy would also be available to the people in Northern Colorado.
I have been speaking primarily of the rural area and HSA as it relates to
Northern Colorado, but a glance at the map of the area reveals a large area
of rural Colorado involved in HSA-1. It would seem remiss to consider those
patients in Northern Colorado without considering the remainder of the patients
in rural HSA-1 as well . There are, of course, the Boulder and Longmont areas
which are becoming bedroom towns for the metropolitan area. It would be up
to the people in those regions to indicate whether they feel the need for
separate radiation therapy facilities so close to Denver or not. There do
not appear to be any other communities of sufficient size to support a
radiation oncology department.
Oncology: Radiation 8-10-77 Page Four
The concept of a cancer committee as outlined in the report is an important
one: Through such a committee, the areas east of Denver could perhaps be
provided with the expertise that is available in Denver by the formulation of
a visiting cancer committee. At the present time, similar attempts are being
made by a traveling radiation oncologist to Longmont and possibly to Boulder.
Perhaps the same type of arrangement might be made in some of the larger
communities in eastern Colorado. This has been done in the past in other
states.
Those people working toward the formation of the oncology center in Weld
County have felt very strongly that such services should be provided to the
surrounding communities. In fact, all applicants for the position of
director of the center were informed that they would be expected to travel
to the surrounding communities of Ft. Morgan, Ft. Collins, Loveland, etc.
to share their expertise with the doctors in these communities. I would
suggest that some form of a traveling cancer committee be incorporated within
the plan and not just made a requirement within the hospital requesting
radiation oncology facilities.
In closing, it would seem to me that if the plan is to truly serve all of
the people in HSA-1, a greater effort should be made to see that the
geographical constraints imposed by radiation oncology are kept to a
minimum throughout the area. Unfortunately, the metropolitan area of
Denver seems to be oversupplied with radiation therapy facilities at this
time. Regardless of that fact, it would seem to be unreasonable to expect
a very large population in Northern Colorado, which may well exceed half
a million people by 1985, to be denied ready access to radiation oncology
because of the excess of facilities in the Denver metropolitan area.
Thank you for your attention to these rather lengthy remarks, and my
regrets that I am unable to deliver them in person.
Sin erely,
r� EjyZdei.
une K. Steinmark, Chairperson
Board of Weld County Commissioners
JKS/clb
cc Dr. Franklin Yoder
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