BYLINE: Michele W Sequeira

Newswise — A cancer diagnosis scares most people. Those outside of large population centers like Albuquerque have the additional concern of having to travel to get timely, specialized medical treatment.

Now, a new program at The University of New Mexico Comprehensive Cancer Center aims to streamline the process for all New Mexicans, regardless of where they live in the state.

The program is currently focusing on those diagnosed with cancers of the liver, pancreas or bile ducts, which are also called hepato-pancreatico-biliary (HPB) cancers. A successful version of the program that was limited to Presbyterian Healthcare Services was launched in 2021 and has remained active since.

“This program brings community providers together with HPB cancer experts at UNM to guide and formulate a personalized plan for each specific patient,” says Itzhak Nir, MD, leader of the HPB team at UNM Comprehensive Cancer Center.

Cancers of the liver, pancreas, gallbladder and bile duct can grow and spread quickly, and they can be hard to treat, Nir says. Often, these cancers require a combination of chemotherapy, radiation therapy and surgery. Bringing providers together electronically for a consultation is not an easy task. The process of sharing large image files and other relevant medical information during the call must meet stringent federal electronic security standards. 

With data security in mind and with the strong support of UNM Cancer Center Chief Medical Officer, Zoneddy Dayao, MD, Nir and the UNM Cancer Center HPB Team nurse navigator, Lynn Saavedra, turned to Project ECHO (Extension for Community Health Outcomes).

Project ECHO has perfected a telementoring model for doctors to learn and share knowledge about best practices in a virtual community of practice. Nir, Saavedra and their team of radiologists, medical oncologists, interventional radiologists and gastroenterologists worked with Project ECHO to successfully test the model with their established Presbyterian partners. They are now ready to expand the program to all cancer providers across the state.

“We are providing service line access for the management of HPB [hepatobiliary] cancers,” Nir says.

He explains that community doctors are highly valued because they provide a broad range of services, but they do not sub-specialize in treating rare diseases such as HPB cancers.

“Easy access to our multispecialty panel is imperative to first reach accurate diagnosis and then formulate the optimal care plan,” Nir says.

Nir is one of two HPB surgeons in New Mexico; the other is Matthew Hernandez, MD, who also practices at UNM Cancer Center. They, along with UNM HPB experts in medical oncology, diagnostic and interventional radiology, gastroenterology and clinical research, meet each week to review cases that are referred by community providers.

“The benefit [of this HPB-ECHO program] is that it provides a platform to allow community providers to share our expertise,” Nir says. “They can approach us from any remote location and have an in-depth clinical discussion with us.”

And just as important, he says, they don’t need to send their patients to UNM Cancer Center prematurely.

Using the ECHO Model, community providers can share a patient’s imaging results, lab testing results, and other information with the UNM Cancer Center HPB experts and get real-time feedback and recommendations. The whole panel can agree on a treatment plan and refer that patient to the appropriate subspecialty as needed.

Saavedra says that if the treatment plan calls for surgery or interventional radiology treatment or enrollment in a clinical trial — all appointments that the patient must attend in person at UNM — she facilitates the needed appointments for the patient in the meeting.

Before the HPB-ECHO program was in place, people diagnosed with HPB cancers would have to make appointments on their own, send their imaging and lab results to the UNM Cancer Center HPB team and then attend a consultation in person.

Any missing information meant that the trip to Albuquerque wasn’t as fruitful as it could have been and might have to be repeated.

The new program eases the burden on patients, Saavedra says. The only time they need to travel now is when they must get a treatment that cannot be provided in their own community.

UNM Cancer Center plans to extend the program to include other cancers and all New Mexico providers.

Itzhak Nir, MD, is a Professor and Chief of the Division of Hepato-Pancreatico-Biliary Surgery in the Department of Surgery at the UNM School of Medicine. He leads the Liver, Pancreas and Gallbladder Cancers Team at the UNM Comprehensive Cancer Center.

Lynn Saavedra, RN, MSN, OCN, is a Nurse Navigator and Program Coordinator for the Liver, Pancreas and Gallbladder Cancers Team at the UNM Comprehensive Cancer Center.

In addition to Nir and Saavedra, the hepato-pancreatico-biliary (HPB) multidisciplinary panel includes medical oncologists Ursa Brown-Glaberman, MD, and Erika Maestas, MD; surgical oncologist Matthew Hernandez, MD; radiologist Steven Eberhardt, MD; interventional radiologist Christopher Gutjahr, MD; and gastroenterologist Gulshan Parasher, MD.

UNM Comprehensive Cancer Center

The University of New Mexico Comprehensive Cancer Center is the Official Cancer Center of New Mexico and the only National Cancer Institute-designated Cancer Center in a 500-mile radius.

Its more than 120 board-certified oncology specialty physicians include cancer surgeons in every specialty (abdominal, thoracic, bone and soft tissue, neurosurgery, genitourinary, gynecology, and head and neck cancers), adult and pediatric hematologists/medical oncologists, gynecologic oncologists, and radiation oncologists. They, along with more than 600 other cancer healthcare professionals (nurses, pharmacists, nutritionists, navigators, psychologists and social workers), provide treatment to 65% of New Mexico's cancer patients from all across the state and partner with community health systems statewide to provide cancer care closer to home. They treated approximately 14,000 patients in about 100,000 ambulatory clinic visits in addition to in-patient hospitalizations at UNM Hospital.

A total of nearly 400 patients participated in cancer clinical trials testing new cancer treatments that include tests of novel cancer prevention strategies and cancer genome sequencing.

The more than 100 cancer research scientists affiliated with the UNMCCC were awarded $35.7 million in federal and private grants and contracts for cancer research projects. Since 2015, they have published nearly 1000 manuscripts, and promoting economic development, they filed 136 new patents and launched 10 new biotechnology start-up companies.

Finally, the physicians, scientists and staff have provided education and training experiences to more than 500 high school, undergraduate, graduate, and postdoctoral fellowship students in cancer research and cancer health care delivery.