After a breast cancer diagnosis in 2004, Elna Vanderwerf of Austin went eight years without a recurrence. But a year ago, she noticed she had trouble moving her eyes from side to side. The cancer was back, but this time it was in the lining of her brain.
Vanderwerf, now 63, saw doctors in Austin before traveling to the world-famous University of Texas M.D. Anderson Cancer Center in Houston. There, she learned she could get the treatment she needed in Austin from Dr. Morris Groves, the city’s first neuro-oncologist. He had pioneered the treatment at M.D. Anderson before becoming head of Texas Oncology’s Austin Brain Tumor Center 13 months ago.
“If I couldn’t get my treatment here, I don’t know what we’d do,” Vanderwerf said Monday during a checkup with Groves. Driving through downtown Houston was a “nightmare” for her and her husband, she said.
A report being released Friday by the Livestrong Foundation, Central Health and the Shivers Cancer Foundation says that despite a perception that travel elsewhere might lead to better care, Austin area providers do a good job of caring for cancer patients. But there are gaps in the Austin area, which the report defines as Travis, Williamson, Hays, Bastrop and Caldwell counties. Some cancer treatment services aren’t available, such as bone marrow transplants, and people who lack health insurance have a harder time getting care and surviving, says the report by Health Resources in Action, a Boston consulting firm.
Gaps in local care?
Heading out of town for cancer care was often cited as a problem that needed fixing last year by supporters of a voter proposition seeking higher property taxes for expanded health care services. State Sen. Kirk Watson, D-Austin, the most visible backer of Proposition 1, had called for 10 goals in 10 years in September 2011, including a medical school for Austin and a comprehensive cancer center.
A political action committee mailed fliers and ran ads saying a vote for Proposition 1 would bring more medical services to Austin and reduce the need to travel for cancer care and other services. Texas Oncology — the largest Austin cancer group with about 50 doctors and 38 clinical trials under way — ran newspaper ads touting the comprehensive cancer services already here, although the ads took no position on the successful proposition.
A higher percentage of Austin-area cancer patients — 12 percent — seek treatment outside the region than in Dallas, El Paso, San Antonio and Houston, the new report says, citing data from the 2009 Texas Cancer Registry.
While that is much higher than the other big Texas cities, it was a surprise to some in Austin. “I had thought that the number would be higher than 12 percent. That was one reason we wanted to do this” report, said Ruth Rechis, Livestrong’s director of research and evaluation.
“It’s not like M.D. Anderson has the cure, and we all are waiting to follow it; it’s the patient’s misperception that it will be different there,” said Dr. Brian Shimkus, division head of medical oncology for Austin Cancer Centers. “I don’t think there is anything different in the quality of care.”
The message from the report, Rechis said, “is we have a lot of great resources in the community and there truly is an opportunity to innovate and to really prepare for the growing population in the Austin area.” The report provides a baseline on which to build, and although it didn’t answer all of the questions she had hoped it would or make recommendations, she envisions a future study will do that.
“It’s going to take collaboration,” Rechis said, echoing the report, which says collaboration is essential to improve the system and boost providers’ expertise.
That will become more critical as the population grows and ages, the report says. By 2020, the area’s population will rise by 28 percent, with the highest growth rates in Hays and Williamson counties, the report says.
Already, it says, there aren’t enough oncologists to meet demand — an assertion that a half-dozen local oncologists disputed in interviews with the American-Statesman.
But the oncologists also agree that there are gaps in services when cancers are rare or a certain clinical trial is needed. Not enough research is being done, they said, a problem the report says an Austin medical school will help remedy.
Cancer is the No. 1 cause of death in the Austin area, and more than 10 percent of residents, about 78,000 people in 2009, had been diagnosed with cancer, the report says. Some hospitals are devoting more resources to cancer. The Seton Healthcare Family’s Cancer Care Collaborative brings a team approach to patient care and video-conferencing to cut down on patient travel among doctors.
There are other bright spots, the report said.
Austin-area patients have death rates 12 percent lower than the state average. That is especially striking, the report says, because rates of breast and prostate cancer in the Austin area are higher than average.
People who lack insurance are the biggest worry, said Clarke Heidrick, chairman of the Shivers foundation board and a member of the Central Health board, both of which split the $185,000 cost of the study with Livestrong. The report says 21 percent of Austin-area residents lack health insurance.
Dr. J. Russell Hoverman, vice president for quality programs at Texas Oncology, said uninsured patients typically start treatment later and are more likely to have advanced disease than insured patients. Those higher costs often are borne by health care providers and taxpayers.
“If you want to affect the underserved, we need to see them earlier,” Hoverman said. “We need to expand the primary medical home so you identify these patients who need to be seen … and have a seamless network of care.”
Groves said Austin is progressing. The city has good doctors and a second neuro-oncologist, Brian Vaillant, at Seton Brain and Spine Institute, he said.
Groves is treating Vanderwerf with injections of the drug topotecan into her spinal fluid. She has been stable for a year.
At her checkup Monday, Groves asked her to follow his finger with her eyes. She had no trouble tracking it.
“See, she’s perfect,” Groves said. “I’m optimistic. I have been all along.”