“Healthcare in the Time of COVID-19” was hosted by Falguni Sen, Ph.D., a professor at the Gabelli School and the head of Fordham’s Global Healthcare Innovation Management Center. He was joined by Anthony Viceroy, CEO of Westmed Medical Group; Susan Fox, president and CEO of White Plains Hospital; and Jeffrey A. Meckler, CEO, and vice-chairman of Intec Pharma, Ltd.

Sen noted in his introduction that the same institutions that we rely on to help us survive the pandemic are now facing perils of their own, thanks to financial burdens brought on by a drop in elective surgeries, increased costs for ICU care, and physical and mental risks to staff working without enough protective gear.

“Flexibility is one of the most difficult of business challenges that we at the Gabelli School of Business have been trying to develop new theories and new practices on. On the one hand, it will require a lot of slack in resources, which can be very expensive. On the other hand, it demands creative uses of these resources, and the ability to build relationships and partnerships. It requires us to develop common goals and priorities,” he said.

Preparing for Financial Instability

Indeed, when asked for an example of a change his group made that had the biggest impact, Viceroy said conserving cash proved to be the biggest in retrospect.

“If you look at what was going on in March, overnight we lost 70% of our volume. There was also no end in sight of when things would improve,” he said.

That meant securing a line of credit from banks in February, instituting temporary furloughs, renegotiating with vendors, and taking advantage of grants offered by the state of New York. Viceroy was able to then direct resources toward securing personal protective equipment for his staff, in some cases from overseas.

‘No Playbook for This’

Fox said that one of the things that her hospital learned early on was that the normal response to crises that they’d trained for, such as active shooters or an Ebola outbreak, was insufficient.

“When started out, it felt very lonely, there was not a lot of information out there. There was no playbook for this,” she said, noting that a member of the hospital staff was infected with COVID-19 by the first patient on the East Coast, a lawyer from New Rochelle.

“Putting a command center together with a lot of people around the table; very quickly we learned that that didn’t work. There was so much coming at us so fast and furiously, so we put together a small command center of probably seven of the senior people in the hospital, and we weren’t there physically, but we were there mentally 24/7.”

Working Together to ‘Meet the Peak’

Viceroy and Fox both agreed that the emergence of telemedicine is the most obvious advance to emerge from the crisis. Fox said scaling up access to care was a lesser-known, but equally important success. When New York Governor Andrew Cuomo predicted that the state would require 140,000 beds to deal with a possible surge in infections, it was a daunting challenge, as the only 55,000 were available.

For her hospital, that meant adding 150 med-surge beds to its existing 225, an unthinkable expansion in a highly regulated industry, she said. Relaxing some of those regulations allowed them to innovate in real-time though.

“Ultimately, we didn’t have a need for 140,000 beds, but by challenging the system, increasing by 50%, and putting up field hospitals like the U.S.S Comfort and Javits Center, we put almost 100,000 beds into the system. We got darn close to needing almost every one of them,” she said.

Equally important, she said was the fact that disparate hospital systems worked together as one, in the same way, that her hospital works with 10 others in the Montefiore Network, transferring patients from overwhelmed facilities to those with room.

“Working together to create that one health system, we were able to meet those needs to the point where we were able to meet the peak, and obviously we’ve been coming down ever since. That is something for the history books,” she said.

Meckler likewise noted that the crisis has opened a door for new opportunities for the way the pharmaceutical industry operates.

“I think we have over 2,400 clinical trials ongoing worldwide and more than a dozen vaccines in mid-stage development, and this is all since that February/March time frame. That’s unprecedented,” he said.

Concern Over ‘Mindboggling’ Lack of Lessons Learned

The panelists were skeptical about the future though. Viceroy said the deep psychological impact of the pandemic on his staff is only just becoming apparent and is likely to still be a challenge should a second wave of infections take place in the fall.

Fox said it was mind-boggling that states such as Texas and Florida did not take to heart the lessons of the New York area and are now experiencing surges of infections and deaths after opening their economies prematurely.

“I’m disturbed by the lives that are going to be lost for no good reason when we can share these best practices. We had these experiences, we have these facts,” she said.

“Everyone did what they had to do, and now we’re sitting here bracing for that second wave, because a lot of people go to North Carolina and Florida in the summer, and we’re already seeing examples where our numbers are going up. Whether it’s our economies, our staff or our resources, we’re all in recovery planning now, and to go backward would be devastating.”

“I would call people in other countries and say, ‘What’s your facility fee for an operating room’,” said Rosenthal, author of An American Sickness (Penguin Press, 2017). “And I’d hear this silence and they would go, ‘What do you mean a facility fee?’”

Rosenthal was the speaker at an April 18 talk and panel discussion organized by the Gabelli School’s Global Healthcare Innovation Management Center. She holds an M.D. degree from Harvard Medical School and currently works as the editor-in-chief of Kaiser Health News, a nonprofit news service that reports on the health care system. A former health care reporter for the New York Times, she is best known for her award-winning series on the costs of health care called “Paying Till It Hurts.” Through her research and conversations with patients, practitioners, and other health professionals, she said, she learned that medical concepts like facility fees are “uniquely American.”

According to Rosenthal, there are evidence-based studies about how medicine should be practiced in the U.S., yet economic incentives remains a top priority for many hospitals.

“We know what things work, but there is a lot of financial interests against them working,” Rosenthal said.

Cautionary Tales 

According to the Centers for Medicare & Medicaid Services, U.S. health care spending increased 4.3 percent in 2016 to reach $3.3 trillion. The agency projected that national health spending will grow at an average rate of 5.5 percent per year to reach $5.7 trillion by 2026.

In an age of hospital consolidations, Rosenthal said illnesses have become a form of commerce. This has led many Americans to seek alternative options in countries like Canada.

“That’s a sign of a broken system if there ever was one,” said Rosenthal.

One cautionary tale Rosenthal told was the story of a 28-year-old college student from Texas who was charged $17, 850 for a routine test that checked her urine for a host of things, unbeknownst to her, including opioids, amphetamines, and other classes of drugs.

“If you don’t ask these questions upfront, this could be you,” said Rosenthal. “That urine test was sent off to a lab that tested it for everything under the sun and it was out of network.”

Rosenthal said patients are often left with astronomical medical bills because they are billed by out-of-network medical assistants and other hospital staffers who treat them after surgery without their knowledge. Advances in treatment for conditions such as diabetes and astigmatism can also lead to increases in the costs of care. As hospitals became conglomerates, she said, they also began to look less like medical facilities and more like luxury hotels equipped with everything from indoor waterfalls to flat-screen TVs.

“We’re paying for amenities rather than care, and that, I think is a flaw of our system,” she said.

Though ambulance companies used to be volunteer-run and operated mostly by the fire department and local EMS more than 30 years ago, Rosenthal said they too have adopted a business model. According to Rosenthal, many ambulances charge by the mile and bill riders different rates based on whether they were treated by a paramedic or EMT. The ride can cost up to $2,000, she said.

Rosenthal said fees like these can be a burden for middle-class and lower-class patients who are struggling to make ends meet.

“If you don’t have a disposable income, the weight is infinite.”

Pushing Back at the System

Rosenthal believes many hospital facilities and physicians get away with unfairly charging patients for visits, exams, and procedures because patients often “scarily write checks” to avoid having their bills being sent to collection agencies.

“Medical bills are not like you made a choice where you know upfront what you’re paying for and you’re being delinquent,” she said. “It’s often [that]you didn’t know. You get these confusing bills and you’re trying to figure it out and that can take months.”

She encouraged patients to become proactive about health care by negotiating hospital bills; requesting itemized bills; asking for referrals to in-network physicians, labs, and facilities; and requesting estimates of tests and surgeries beforehand so there are fewer surprises.

“There is something that everyone can do to push back at the system,” she said.

Financially Rational Decisions

After her talk, Rosenthal was joined by internist Barney D. Newman, M.D., co-founder of WestMed Medical Group, and Mitra Behroozi, executive director of the 1199 SEIU Benefit and Pension Funds, a labor-management fund, for a panel discussion about the state of health care.

Behroozi explained that the decision to go to the doctor or the ER is still a difficult decision for many Americans.

“People will make financially rational decisions— especially if a $50 co-pay [at the ER]could mean the difference between being able to afford their transportation to go to work or not that week,” she said.

Newman noted that these economic strains are often the result of hospital CFOs and other finance personnel looking to generate high return on investment rather than being concerned about efficient clinical care. Still, he believes there are ways to use business to enhance the health care system.

“The consolidation of health care and the idea of applying business principles to health care is not all bad,” said Newman. “It has been focused on only the financial part of the outcome. There are actually a lot of opportunities to reduce cost in this country and improve quality by trying to apply classic business practices of quality management and continuous quality improvement to the process of care and how care is delivered.”

To answer the industry’s pressing need, Fordham has created a new multi-disciplinary master’s degree in health administration that will launch in fall 2018.

The degree taps expertise from across the University, including the Graduate School of Social Service and Fordham School of Law. Befitting that multidisciplinary approach, the degree program is hosted in the Graduate School of Arts and Sciences and headed by Falguni Sen, Ph.D., professor of business at the Gabelli School of Business.

“People are beginning to understand that health care is not something that is just owned by business, or regulatory services, or social service people, or by ethics experts,” said Sen, who heads the business school’s Global Healthcare Innovation Management Center. “It’s something that everyone has to come together to really deliver.”

Sen said the 12-month degree program is meant to appeal to the burgeoning field of mid-level practitioners with titles like care coordinator, case manager, hospitalist, physician assistant, information technology assistant, nurse practitioner or medical entrepreneur.

The field is also drawing liberal arts undergraduates looking to join a growing sector of the economy. “They may never have to create a balance sheet but since they’ll be tasked with putting into action many of the changes under health care reforms, it’s important that they’re able to read one,” Sen said.

That’s because even though the industry has embraced “patient-centric care,” it still operates from a surplus-generating business model, he said. Those two models—one focused on doing whatever it takes to keep a person healthy and another with an eye on the bottom line—need to be balanced delicately.

“Ideally, we can achieve proper health care if we can bring together the clinical model and the business model to focus on patient centric care” Sen said.

“This master’s degree will help you understand how to make your organization work for both of these models.”

Of the 14 courses required for the degree, nine are brand new. They include Strategy and Operations in Health Care, Behavior Health, Patient-Centric Care, Population Health, Public Health and Outcome Measures, and Negotiating and Communicating in Health Care.

In the growing field of electronic health records, Sen hopes the new master’s degree will close training gaps among longer-term health care workers.

“We’re not going to make people IT experts or teach them how to create new systems, but we can teach them how to use the systems properly and not be intimidated by them,” he said.

Sen said that other big shifts are underway in the field. Health care companies are looking to increase ways to measure patient satisfaction. They are moving toward “value-based payments,” in which insurers place a higher premium on the quality of treatments over quantity. And they are improving transitional care, which takes into account how patients fare when they return home or their community or are moved to nursing or long-term care .

“These changes are here to stay, and I don’t see anything in the new plans being debated in Washington that will stop them,” Sen said.

“Will we have a greater number of uninsured people who will put a serious strain on hospitals? That’s a possibility, and those are serious issues that are being debated. But these administrators will be in demand and expected to perform.”

The future of the Affordable Care Act, aka “Obamacare” which was signed into law in 2010, is in doubt today, as Republicans who control both houses of Congress have begun the process of repealing and replacing it.

To get a sense of what this means for the future of healthcare in the United States, we sat down with Falguni Sen, Ph.D., professor of management systems at the Gabelli School, and head of Fordham’s Global Healthcare Innovation Management Center.

Full transcript below:

Patrick Verel: What do you make of the effort underway to repeal and replace the Affordable Care Act?

Falguni Sen: I was very gratified to hear our president-elect say that everyone’s going to be covered, there’s going to be insurance for health care for all, and that it’s going to be cheaper and better. How can one argue against that? What I’m concerned about is that in trying to do that, we may come up with a plan that is very expensive for some, for instance, those who had pre-existing conditions, and that your premiums based on this different what they call risk pools. We keep talking about the Affordable Care Act in terms of insurance access to people, but originally the Act was called Patient Protection and Affordable Care Act in order to bring in a patient-centeredness and an integrative approach to patient care. That’s already in place and I do not see any reason why that will change.

Patrick Verel: What would you say is the biggest risk to making changes to the law right now?

Falguni Sen: I think the biggest change right now is the transition period. There are far too many uncertainties. Economic growth may get affected if people suddenly feel that their health care … They’re unsure about their coverage. The good part of it is that everyone now knows that even in a Republican controlled administration, the fact that people deserve health care has become part of the conversation.

Patrick Verel: So, what changes do you think need to be made to make the law work better?

Falguni Sen: I consider a failure in the insurance part of it is that the healthy adults who are uninsured did not go in and get insurance. What that has done is that it has made the pools much riskier, thereby creating a much higher than anticipated cost to the insurance carriers than what would have happened if the healthy adults had also got into the pool.

It might sound strange to say this, but I think the primary change that needs to be made is to figure out how to reduce the risk to the insurance carriers by making sure that healthier people get into the pool.

Solomon described one of his research subjects, Clinton, who was diagnosed at birth with diastrophic dwarfism, a condition that led to more than 30 operations during his lifetime. Such operations can address the medical aspect of the dwarfism, he said. But Clinton’s inability to reach items off a store shelf is an example of a social problem, particularly if the store doesn’t provide staff to assist persons with disabilities.

When Clinton was born, doctors told his parents to leave him to die at the hospital, said Solomon. His mother didn’t see him for three days, at which time she decided to take him home and find a good specialist. Most doctors foretold only medical problems, but eventually she found one of the best specialists in the country. Solomon said that the doctor lifted the boy up and announced “He will make a handsome young man one day.”

“This [story]is an example of how much language or belief can alter medical reality,” said Solomon, author of Far from the Tree: Parents, Children, and the Search for Identity (Scribner, 2012).

The conference, sponsored by Fordham’s Global Healthcare Innovation Management Center and the Center on Religion and Culture, focused on spiritual and cultural diversity in healthcare. Solomon said that identity has played a large role in a person’s health in many of the cases he has studied.

A disabled person’s identity, he said, is defined in terms of “horizontal and vertical” influences. The vertical identity is one formed in the home and related to language, religion, ethnicity, and class. A horizontal identity is one discovered outside the home, where the identity is learned from a peer group.

For example, Solomon spoke of befriending a deaf person who introduced him to deaf culture. He went to deaf theater performances and deaf gatherings. He discovered a “beautiful society” of hearing-impaired people—something that a deaf child would likely not discover until he or she left the family and went out into the “real world.”

The horizontal culture of disabled people is very similar to the gay experience, said Solomon. There, too, the horizontal identity is often discovered in adolescence.

Solomon said he was a believer in medical progress and social progress, but that “I wish they could see each other more clearly.”

He reminded the audience that it was not long ago that homosexuality was diagnosed as a medical disorder: he read from a 1966 Time magazine article that described homosexuality as a “pernicious sickness.”

Regarding Down syndrome, he said, the Atlantic Monthly published a 1968 article that stated, “There is no reason to feel guilty about putting a Down syndrome child away, whether it is put away in a traditional sense of hidden in a sanitarium, or in a more responsible lethal sense.”

Today our understanding of diversity has so shifted that there are even Hollywood stars with Down syndrome, he said.

Yet even today, parents of children with Down syndrome could choose to have cosmetic surgery for their child that would reduce the size of the tongue and lift drooping eyes so that they’d appear “normal,” he said.

“That is a medical solution to a social problem, and it’s very deeply troubling,” he said. “It’s a kind of a tyranny of mainstream values.”

He then cited several medical breakthroughs that may also eliminate some of the identity cultures he celebrates in his book. A cochlear implant could be placed in a child’s ear so that he or she could grow up and function in the speaking world; and a substance, BMN 111, could soon block the gene that causes dwarfism.

“There is the question of what should be treated, what should be cured, and what should be left alone,” said Solomon. While Clinton needed surgeries to be able to walk, does a child with Down syndrome need plastic surgery?

“There are people who have been subjected to treatment who didn’t want to ‘get better’ or change in the way that was put forward,” he said. “What they wanted was to go on to live their lives as themselves.”

Months into her battle with Alzheimer’s, Jessica Morales’ mom developed aspiration pneumonia—the most common cause of death for Alzheimer’s patients. Breathing problems and infections led to frequent and frustrating trips to the emergency room. Morales knew her mother was dying. But she also knew she needed more extensive care than could be provided at home. So she brought her to Calvary Hospital in the Bronx, where staff treated her physical symptoms and so much more.

“I knew I needed the support to get through this time with her,” said Morales, FCRH ’97, an actress who grew up on the Lower East Side of Manhattan. ““The care there was so different from the beginning.” Hospital staff turned her mother in her bed every two hours, she said, brushed her hair the way she liked, and played her favorite Mexican music to soothe her. “It was an individualized approach.”

“Every time we have a meeting here, everybody’s hugging,” said Michael J. Brescia, MD, FCRH ’54, Calvary’s executive medical director. It’s a side effect, he said, of the culture of the facility, where alleviating emotional and spiritual suffering is as crucial as treating the physical symptoms of disease. “You have to touch your patients. You have to hold their hands. And it’s got to mean something to you.”

Fordham and Calvary have enjoyed a close relationship for years, forged in part by Brescia’s love for his alma mater. “Fordham gave me the gift of faith,” said Brescia, who says a silent prayer each time he enters a patient’s room. That personal connection led to a professional partnership. Fordham faculty have conducted research at Calvary, and Calvary medical staff have lectured in Fordham programs. An October 20 symposium at the University highlighted that research, fostering a discussion on the complex issues surrounding palliative care.

Mary Beth Morrissey, PhD, FCRH ’79, LAW ’82, GSS ’11, a healthcare attorney and researcher, and the director of Fordham’s Healthcare Management Certificate Program in Public Health, Palliative Care, and Long-Term Care, organized the conference.

“The relationship with Calvary is a very meaningful one for Fordham,” she said, particularly when it comes to research. “Our faculty is working across the whole spectrum of palliative care.” In one study, Fordham psychologist Barry Rosenfeld, PhD, and Fordham psychology graduate students explored meaning-centered talk therapy with Calvary patients as a way to provide a sense of peace at the end of life. “We’re trying to understand that palliative care is both medical and social,” Morrissey said.

Insurance companies have been slow to fund palliative care, and so Morrissey and her colleagues aim to put it in the larger context of healthcare reform and value. “This is really about changing a cultural paradigm,” she said. “I think the problem is, in our Western culture, we have been very reluctant as a society to engage in any discussions about limits on care or how we’re going to allocate resources.”

Fixing a Broken System

Presenting the keynote at the October 20 conference was Philip Pizzo, MD, FCRH ’66, pediatric oncologist and former dean of the Stanford School of Medicine. A nationally respected policy advocate, Pizzo has helped lead major studies on palliative care and end-of-life care for the Institute of Medicine: the groundbreaking Relieving Pain in America, published in 2011, and last year’s Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.

“It’s not whether to choose more or less care, but whether to honor individual preferences,” said Pizzo, a microbiology and immunology professor at Stanford and founding director of the university’s Distinguished Careers Institute. And pain, he points out, is not just an end-of-life issue. An estimated 100 million people in America suffer from chronic pain. A few years ago, he became one of them. “It became very personal,” he said of the chronic neuropathic pain he experienced after an injury. “Suddenly I was completely incapacitated, so I absolutely appreciated how it literally saps the energy and the sense of purpose from anyone.”

At Calvary, Brescia and his staff view depression and psychological pain as one of several types of suffering to focus on when caring for patients. Patients also struggle with spiritual suffering, he said, asking themselves, “Is there a supreme God that loves me and knows what I’m going through?” And Calvary staff are equally cognizant of familial suffering. Morales, who slept on a cot in her mother’s room during her stay at Calvary, received a massage through the Family Care Center, which she called “a little haven.” And when her mom died, a Calvary chaplain was there at Morales’ side.

When it comes to physical suffering, hospital staff fight aggressively, Brescia said. Calvary physicians have worked to find alternate methods of delivering opioids for pain relief, and they’ve perfected techniques like using a gastrostomy tube to alleviate nausea common in end-stage cancer patients.

Cost Versus Value

That kind of comprehensive care is not without its costs. Calvary, a nonprofit, loses millions of dollars a year, much of it made up in fundraising. But the world-renowned physician was never in this work for the money.

Before he got involved in palliative care, Brescia achieved fame in the mid-1960s for the Brescia-Cimino fistula, a surgically created connection between veins and arteries used in hemodialysis patients. People came to the Bronx from all over to be treated for chronic kidney disease, he said, and Calvary was beginning to collect full compensation for dialysis so they could build a new facility.

“But I went to tell my father, a little Italian immigrant,” Brescia said. He explained the invention and said that centers would open around the world in a year’s time, and he’d stand to make quite a bit of money. The older man said, “A year? Why a year?” When Brescia explained that it would take time to set up the lucrative contracts, his father asked, “How many die in a year?” Brescia told him 50,000, and his father’s face dropped. “‘Give it away,’” he told his son in Italian. When Brescia protested, his father said, “‘When you shave in the morning, the faces of the children will appear in the mirror, [children]who should be with their parents. They will not be because my son, who I should be so proud of, has to have five cars, five boats, five houses.” Brescia knew his father was right. “I left his house and [we]published [the research].”

Clinicians began using the procedure and contacting Brescia for his expertise. “Doors just opened,” said Brescia, who is considered a pioneer in modern palliative care. “They wanted to hear about all the renal work. The price of that was that they had to hear about the palliative work,” which he was now doing at Calvary. He said he and his colleagues were able to get many federal laws passed “that enabled us to survive and prosper.”

Collaborating on Care

But getting insurance companies to cover the cost of palliative care is still a challenge, despite the empirical evidence that it lowers hospital readmission rates, said Falguni Sen, PhD. Sen directs the Global Healthcare Innovation Management Center at Fordham, which presented the October 20 panel discussion in conjunction with the Fordham Science Council.

“Palliative care, in my opinion, has been the first group that has really tried to look at healthcare in an integrated way,” he said, noting that the Affordable Care Act has given providers some options through which they can include palliative care. He cited new accountable care organizations that accept a total fee for the care and well-being of Medicare patients rather than a traditional fee-for-service arrangement.

Sen said his center, part of the Gabelli School of Business, aims to build on Fordham’s collaborations with Calvary Hospital to explore programs based on these new provisions. He hopes to expand the University’s certificate program in palliative care—which includes Calvary medical staff as instructors—to offer “more skill-based” programs. The University’s Graduate School of Social Service also offers an increasingly popular palliative care program, which has MSW students completing fieldwork at Calvary. And Sen anticipates Fordham faculty from several disciplines wanting to make a difference in the way care is delivered.

“We’ve got to move out of the purely medical care model on palliative care. It’s not just a question of managing pain through medication,” he said. “Pain is something that is so complicated … and it requires care and consideration on so many levels.”

Listen to Dr. Pizzo discuss palliative care and his work at the Distinguished Careers Institute on WFUV’s Fordham Conversations.

On Oct. 30, the leading minds in cancer care gathered at Fordham’s Lincoln Center campus for a roundtable discussion on improving care both for patients whose cancer is active and for patients whose cancer is in remission.

“It’s a question of measuring the value of health, and not just good healthcare,” said Falguni Sen, PhD, director of Fordham’s Global Healthcare Innovation Management Center, which co-sponsored the event. “Value,” he continued, means increasing the quality of care while keeping costs under control.

A critical component of enhancing value is to coordinate care across all aspects of a patient’s treatment, said panelist Randall F. Holcombe, MD, professor of medicine at Mt. Sinai’s Icahn School of Medicine and deputy director at the Tisch Cancer Institute.

Cancer is a complex illness, he said—it entails multiple treatments over long periods of time, and it often involves multiple treating physicians, rather than a single oncologist. In addition, patients with cancer experience a high “symptom burden,” meaning that both the cancer and its treatment have steep physical and emotional tolls on patients.

Because of cancer’s complexity, it is critical that all members of the treatment team coordinate the care they provide, Dr. Holcombe said. Doing so can have marked benefits, for instance, reducing the number of emergency room visits and unnecessary hospital admissions. Quantitatively, this means lower costs; qualitatively, it means patients spend less time in a hospital and are spared the radiation-related toxicities of excessive imaging and scans.

The roundtable also touched on the importance of continuing care for patients once their cancer is in remission. This involves not only continuing medical care, but also complementary services such as nutritional counseling, psychosocial support, and rehabilitation services for late effects of the illness.

Patients may also need help grappling with the reality of having experienced a life-threatening illness and what this means going forward—a concept known as patient survivorship. Many patients embrace the term “cancer survivor” as a positive identity, while other patients are ambivalent about the term, and still others eschew it altogether.

“For many of our cancer patients, every day or every minute they’re reminded that they had cancer,” Dr. Holcombe said. “There is the constant concern that the cancer will come back, and that they’re not really ‘well.’ And they often have specific reminders of their cancer, such as neuropathies or other long-lasting toxicities.”

“One survivor told us that cancer survivorship needs to be looked at as if it is a chronic condition like diabetes, and it’s not,” said panelist Mandi Pratt-Chapman, director of the George Washington University Cancer Institute and co-PI for the American Cancer Society’s National Cancer Survivorship Resource Center. “Another told us that he had to go from the mindset of a ‘cure’ to one of ‘control,’ because he doesn’t know if he’ll ever be fully cured.

“There are some people who embrace survivorship, and others who don’t want to think about it or be reminded of the experience they had.”

The roundtable was sponsored by the Emblem Health Value Initiative, a partnership between EmblemHealth Inc. and the Global Healthcare Innovation Management Center at the Gabelli School of Business.

However, it is crucial to have those conversations, said renowned oncologist and Fordham alumnus Philip A. Pizzo, MD—especially when it comes to palliative care, a specialty of medicine that can help spare patients and their families from needless suffering.

Dr. Pizzo, FCRH ’66, offered the keynote address on Oct. 20 at “Humanizing Medicine: The Achievements and Future of Palliative Care,” sponsored by the Fordham University Science Council. The event, which also featured an interdisciplinary faculty panel discussion and a presentation by Calvary Hospital President Michael J. Brescia, MD, examined the latest discussions about palliative care in America.

Palliative care refers to a type of supportive care that focuses on controlling pain and relieving symptoms for a patient, rather than actively treating an illness, Dr. Pizzo said. Many people balk at this type of care when they or their loved ones are facing a life-threatening illness, because they believe it means eliminating medical treatment altogether.

“They don’t want to give up on active medical treatment,” said Dr. Pizzo, the David and Susan Heckerman Professor of Pediatrics and of Microbiology and Immunology at Stanford University School of Medicine.

“But palliative care is not a ‘handoff.’ I shouldn’t say to a patient, ‘It’s over, there’s nothing more I can do, so I’m handing you over to palliative care’… It’s not the removal of hope, but fusing it together [with active treatment].”

It was his Fordham education, Dr. Pizzo said, that taught him to prioritize human dignity. This humanistic approach stayed with him once he became a pediatric oncologist in the 1970s, a time when very few children survived cancer.

“I witnessed children dying with terrible pain that no medication could reverse despite our very best efforts,” he said. “I was constantly asking myself when these children were suffering: Is this appropriate? Isn’t this something we should help facilitate? Shouldn’t we help individuals to have as much dignity at the time of their death and not to suffer?”

In 2011, Dr. Pizzo co-led the groundbreaking Institute of Medicine report “Relieving Pain in America,” which included several recommendations pertaining to palliative care. One of the first recommendations was to reorganize the health care system so that high-quality end-of-life care was available and accessible to all individuals.

He cited a recent clinical trial published in the New England Journal of Medicine that studied the outcomes of adult lung cancer patients who received a combination of palliative care and active treatment. The study found that patients who received this combination of care lived on average three months longer than those patients who did not receive palliative care. (The patients were also happier, more mobile, and in less pain.)

“It’s important to not make a Faustian bargain between delivery of care and supportive care,” Dr. Pizzo said. “Every individual facing a serious prolonged illness that could lead to end of life would benefit from a palliative care physician working in tandem with their health care provider.”

The first step in these efforts, he said, is to have conversations about end-of-life care. In addition to more communication within families, the health care system needs to improve training for physicians, nurses, social workers, and other specialists so that they can better guide patients through these difficult decisions.

The event was co-sponsored by Fordham’s Global Healthcare Innovation Management Center, with support from Calvary Hospital.