Pontchartrain Cancer Center Pushes Limits of Community Care in Southeast Louisiana

David N. Oubre, MD

David N. Oubre, MD

Pontchartrain Cancer Center was founded in 2005 to serve an area of Louisiana that lacked the necessary resources for cancer care. This community cancer center, with 2 locations in Southeast Louisiana, accommodates any patient to walk through its doors, filling a major unmet need for the community in this rural area.

In addition to providing specialized care for blood disorders and solid tumors at their locations in Hammond and Covington, Louisiana, Pontchartrain Cancer Center Founder David N. Oubre, MD, and his team have launched several initiatives to take their center to the next level.

In an interview withTargeted Oncology, Dr David Oubre, a medical oncologist and hematologist and the sole physician at Pontchartrain Cancer Center, and Kathy W. Oubre, MS, the center’s chief operating officer, said they believed that offering clinical trials could provide their patients with even better access to cancer treatments and also help the center remain competitive within the field. In 2016, the center launched its clinical trial program. It now has 3 members on its research staff and approximately 20 open phase II, III, and IV trials.

Another initiative included opening their own in-office dispensary in 2016. Offering this service has saved patients an extra trip to the pharmacy by dispensing their prescribed drug that day on-site.

There are several other initiatives in the works that aim to keep the center competitive with hospitals in the area while also improving cancer treatments for their patients, including the founding of their own hot lab. This will allow the center to administer some radiopharmaceuticals for their patients. Pontchartrain added another building to their center that is more than 2 times in size so that they can grow into this new area of treatment, Kathy Oubre said.

She also recently updated the center’s treatment education program. Previously, patients that were to receive chemotherapy were given a 1- to 2-page document and a brief meeting with a nurse practitioner prior to the start of treatment. The patient was given all the information on their new medications, the expected adverse effects, and how to manage them. Under this new program, the patient is given a patient and caregiver guidebook including all of the necessary information, as well as a more in-depth look at their treatment plans.

“We felt that we were leaving the family out with our initial plan,” Kathy Oubre said. She stressed the importance of including family members and caregivers in this discussion since they are often heavily involved in the patient’s life. The guidebook also includes discussions on financial toxicity concerns, as well as end-of-life and survivorship care.

“We decided to include this in the program so it’s not such a shock later on,” she said. “We decided to do that looking at the patient in a 360° manner.”

Pontchartrain Cancer Center puts everything out there for their patients, so patients and their caregivers know exactly what to expect. The cost of cancer care is often a hard conversation to have, but Kathy Oubre hopes this new education program will make it easier by addressing these concerns early on.

“Everyone likes to say money is not an object, but money is an object for everyone,” said Dr David Oubre. “When there are multiple options on the table, the out-of-pocket expense for the patient is a huge issue, and they’re generally able and happy to have those conversations.”

Dr David Oubre advises other community oncologists to be up front with these conversations as well. “It helps [the patient] have a clear idea of their choice, without burying some important decision points.”

Another initiative Kathy Oubre aims to kick off in 2019 will be survivorship classes. By working with a psychologist that specializes in cancer patients, they are developing a small group program focused on moving forward and dealing with the emotions that come after therapy. Kathy said, “Whoever says you just go back to your old life, you’re kidding yourself. It’s going to look different.”

To start, this program will include 6 patients in a group therapy setting focused on goal setting. Patients will be seen in 2-hour sessions every other week for 3 to 4 months. Eventually, the goal is to expand this so that the mid-level nurses are trained to run the program, and it can be offered to more patients.

Community oncology practices like this offer a lower-priced and more efficient alternative to cancer care in an area that could be deprived of cancer specialists and centers. The Pontchartrain Cancer Center continues to advance its programs and efforts so that its community members receive the exact care that they need.

“If we were to close, per se, there would definitely be a percentage of those patients who would not be able to afford the initial cost for travel, additional copays, and out-of-pocket costs to be treated in a hospital setting,” said Kathy Oubre. “[That is] a percentage of patients that would not be treated if we were to go away.”

During our interview, Dr David Oubre discussed his experiences at the Pontchartrain Cancer Center and what this center has been able to do for the community. He also shared his own advice for other community oncologists that aim to provide the best cancer care for their patients despite potential challenges in the community.

TARGETED ONCOLOGY:About how many patients would you say you see on a weekly basis?

David Oubre:My nurse practitioners and I have about 150 to 175 patient contacts per week. That probably accounts for about 140 to 150 different patients. Some of those we see multiple days, [such as when] they are hospitalized. We also see about 20 new patients per week.

TARGETED ONCOLOGY:Are there any cancer types you see more often than others at your center?

David Oubre:No. I’m a frontline hematology/oncology doctor, so I see whatever walks in the door. It’s a pretty good mix of everything.

TARGETED ONCOLOGY:Are there any cancer types or challenges that are perhaps more prevalent in your area?

David Oubre:We do see quite a bit of cancers that possibly have environmental causes, lung cancer is certainly one of them. The other problem in our state is we have a generally poor population that doesn’t have access to all of the different options that are available. Some of that is because the out-of-pocket expense is too high, some of it is they’re underinsured or uninsured, and they simply don’t have the ability to get some of the treatments we would offer because of those considerations.

TARGETED ONCOLOGY:How do you get around that issue with your patients?

David Oubre:We can generally find less expensive alternatives for them. That’s one way, but it still doesn’t give them the newest, latest, and greatest treatment all the time. The Medicaid program in Louisiana doesn’t adequately reimburse for chemotherapy drugs. A large portion of chemotherapy drugs are under water in Medicaid patients.

TARGETED ONCOLOGY:How do you stay up to date with the latest treatment options?

David Oubre:We’re members of lots of organizations. We’re members of the Community Oncology Alliance. We’re heavily involved with that. We’re a member of the Quality Cancer Care Alliance, which is a group of independent practitioners and independent oncology practices. We’re [also] a member of the American Society of Clinical Oncology (ASCO).

I attend meetings, such as the ASCO [annual meeting] and the like. On a day today basis, I ultimately have the UpToDate app. I refer to that quite frequently. I refer to the NCCN guidelines quite frequently. You can [also] basically get up-to-date information on your cell phone these days and certainly on our PCs. In the modern age, information is there. For any question that you have, you can generally find it. You just have to know where to look.

TARGETED ONCOLOGY:What kind of clinical trials do you offer at your institution? Why do you think is it important that you offer these?

David Oubre:We have interventional trials in leukemia, lymphoma, myelodysplastic syndrome, and lung cancer. We have [also] had breast cancer and colon cancer trials. We try to give patients access to medications that are not FDA approved. They give patients hope for being treated with a unique drug which may have greater efficacy or less toxicity. It increases the options for patients. Many of the trials provide free drugs for patients who would otherwise have large out-of-pocket expenses.

Also, participating in research keeps you on the forefront of the latest in oncology care for all of your patients, not just the patients on clinical trials but even the ones who aren’t. In some ways, they benefit from your experience with some of the newer drugs.

TARGETED ONCOLOGY:How would you say your center stands out among the rest?

David Oubre:We are a combination of local care and community care, but we also provide a high-level standard of care oncology practice, including clinical research. We are a combination of local care, but are also up to date in advanced care at the same time.