The Community Setting Is Where the Patients Are

Shah: I really wanted to see patients and take care of patients in a community. Luckily, I have been able to do that in northwest Indiana for almost 13 years now. And luckily, we have grown enough to where we are able to provide all the functions of an academic center right in our community. Indiana University has a satellite center near us. I am able to teach medical students. We have clinical trials, so we are able to do research. We have tumor boards with oncologists from 6 or 7 different institutions, and we have different specialties. So, I think the idea of bringing all that to the community setting—so that the care is equivalent or superior for patients—was really my goal.

What led you to wanting to work in oncology?

I volunteered during my undergrad at a cancer center and [during] my hematology/oncology rotations. And just seeing patients go through it during my rotations, and then finally doing my residency and taking care of some patients [with cancer] and dealing with some hematologic issues, I realized that I wanted to take care of patients in a serious way. I realized quickly that I did not want to be doing procedures all day. I wanted to use my skill set to learn new treatments to help patients. All that fit together and led me to this field.

How have clinical trials evolved in your region? Why do you think it's so critical to offer these options in a community setting?

I think the community setting is where the patients are. First of all, we service more patients than some large academic institutions in our practice. That is where patients are. And most of the patients in the area like their doctors, and they do not really want to drive to get some investigational therapy.

Luckily, at Northwest Cancer Centers, we were able to put the first patient on immunotherapy prior to it being approved. So, before we had all these newer drugs, we were participating in that. I think we became a little bit known for that. And now, immunotherapy is approved in many different indications.

Thankfully, my partners and I have launched a clinical research trials program. And so, by the end of next year, I think we may have more trials than, again, larger academic institutions. But really, I think at the end of the day, it is about taking care of patients. And we service a lot of patients, and that has led us to be able to delve into other areas, including the clinical trials.

We also have a Cancer Center Foundation. Anyone in the area, whether they come to our institution or not, we have a foundation that helps them. If they cannot afford it, if they have financial insecurity, the foundation helps patients with cancer with basic needs, including paying for their utilities, gas, groceries, and transportation. We have been able to do all this in a community center. We are really proud of it, and it is not just me, but our practice. We are really proud of what we have done.

What are some of the biggest challenges and rewards of working in the community setting?

Thankfully, Northwest Indiana is a fantastic community. There are some fantastic people that I have met—patients, all our staff—and it really makes going to work something we enjoy every day. As oncologists, some of the patients become part of our family. We see them more than we see our own families sometimes.

I think the reward is what I’m doing right now, just going to work, [and] knowing that we are going to take care of patients in the best way possible. Knowing that cancer deaths are down 30% since the year 2000. Knowing that we contributed to that. Knowing that when a patient comes to our practice, we believe they are going to get just as good care as anywhere in the entire world. Thankfully, we have built a great team here in northwest Indiana. Being part of that team, being here from almost the beginning, seeing the growth, building the relationships.

I think every day, those relationships are kind of what keep me going, whether it is with my patients, with our staff, with the other doctors in the area, and that really being part of the community. I think whatever you do, when you are part of the community, it just makes it more rewarding.

How does your multidisciplinary training impact your approach to patient care?

Knowing some general internal medicine when situations arise, and knowing what to do, even when maybe [it's just about recognizing something], I think it helps to just have a broad knowledge about not just hematology and oncology, but some basic knowledge about other areas. Obviously, I am not a specialist in other areas as much as my colleagues are. Luckily, since we have been in the area for over 10 years, we have good relationships with the other doctors.

So when taking care of a patient, I actually tell this to patients every day, it is kind of nice to be able to just text a doctor and say, “Hey, what do you think about this?” or “Can you help this person?” or whatever it may be, vs a patient calling an office, showing up, and the doctor not knowing why they’re there. I think that communication has really changed the way we take care of patients and makes them feel a lot more comfortable.

You are the president of the Northwest Cancer Centers Foundation. Can you speak to how support services like groceries and transportation affect treatment adherence and outcomes for your patients?

Yes, our practice was the founder, but I am the president of the foundation. My friend who actually asked me to come and join him—otherwise, I am not sure I would be part of this practice—is Mohamad Kassar, MD. And thankfully, he brought me in, hired me, and now we are all partners.

A few years ago, we had the idea for the foundation. It took a little while, but thankfully, we were able to create a foundation where the community could get involved. A lot of times, we treat patients who do well, they come in once a year, and they ask me, “What can we do to help other people who have gone through the same experience?” And everything helps, right? Sometimes we have volunteers. Sometimes people drop off gifts, especially during the holidays.

But I think having something where someone comes in, they have just been told this devastating diagnosis, and maybe they cannot work for a little while, or maybe they just need a little extra help, and we want to make sure we can provide that for patients.

So, we decided to form a foundation that all of our practice donates to, as well as the broader community. It is something that can really be supported by anyone, because I think we are all affected in some way by cancer. The goal is to help people who may not have room in their budget for a diagnosis like this and to be able to fight it. Hopefully, if we can take some stress off someone’s life, to provide them with transportation, or some extra help with basic needs, those things that sometimes I know I take for granted, and I think it is a great thing to be able to do.

We often think: why should someone fighting cancer also have to worry about affording something like healthy groceries? We want to make sure that not only are we treating the cancer, but we are truly supporting our patients’ basic needs, especially for those who need it. And not everyone needs it forever. Some people just need it for a short time. We just want to make sure we’re supporting our community and our patients as best as we can.

With the rapid pace and change in oncology, especially with targeted therapies and immunotherapy, how do you stay ahead in offering the latest treatments in your practice?

There is new stuff coming out all the time. I think there are companies providing that education. I'm involved in Targeted Oncology events probably at least a couple of times a month. We have our national conference and luckily, it is here in Chicago. I will be attending the American Society of Clinical Oncology [ASCO] and going to some meetings there.

Thankfully, the internet and technology have changed everything from the way I used to do things when I was in medical school. I used to wait in line at the library just to use a computer. Now, all the information is right at our fingertips. We even have AI on our phones to look up anything. So, I think part of it is just taking the time, and I know all of our physicians do this, look up things that are new almost every day.

We [also] have our tumor boards, and I feel really lucky. My partners are some of the smartest, best physicians you could find. We joke that our tumor board is one of the best in the country. We have doctors from Rush University, University of Chicago, Loyola, University of Illinois, all these different institutions, so we are constantly getting varied and high-level perspectives. That is really important.

And finally, attending live meetings with doctors from across the country, we are able to do that, thankfully, through Targeted Oncology and other organizations that host national conferences. I think by doing all of that, we’re able to stay on top of everything.

What advice do you want to give others to further ensure that patients receive cutting edge treatment and compassionate care?

I work with academic centers, and I come from an academic background. But when it comes to providing care in a community setting, you are seeing a high volume of patients. I think that is very much needed, especially in different parts of the country. I also think it’s incredibly rewarding.

With today’s technology, if you go into community oncology, I do not think you have to feel like you are giving up teaching or research. You can absolutely do all of those things in a community setting nowadays.

One thing I am seeing more and more, though, is a lack of confidence sometimes among new grads. There is uncertainty about whether they can manage things on their own in a more independent environment. But I think our practice is proof that you can do that. Everyone should really look at all their options when deciding how they want to provide care and what’s most meaningful to them.

For me, the priority has always been taking care of patients, but I also enjoy teaching and doing some clinical research. In the community setting, I am able to do both. So, I would say: there is a real need for this work. I do not think any robots are taking our jobs anytime soon.

We also learned during COVID just how important and rewarding human-to-human connection is. As I have said before, I do not consider many of the people I take care of just patients. I consider a lot of them friends. You know them for years, especially when you’ve been rooted in one place. So, yeah, I think it is really rewarding.

I really believe the future continues to get better. I know we are constantly hearing negative things, but I think with more cancer screening, ongoing research, and better treatments, we are moving in the right direction. The average person is living much longer than they did 100 years ago, and hopefully, we will continue to improve from here.