Next-Day Access Program at MUSC Hollings Cancer Center Provides Timely Appointments for Abdominal Cancer Patients

When Dr. Kevin Roggin came to the MUSC Hollings Cancer Center last year, he arrived with a plan.

Roggin is a surgical oncologist specializing in upper gastrointestinal and hepato-pancreato-biliary (HPB) cancers, which include cancers of the stomach, pancreas, liver, gallbladder and related areas. He serves as chief of surgical oncology in the MUSC Department of Surgery and clinical director for surgical oncology at MUSC Hollings Cancer Center.

"One of the great challenges in our field is being able to provide timely access for cancer patients," Dr. Roggin says. "The reality is that our hospitals are busy, and clinics are full of patients. If another health care provider calls me, we often are able to expedite access for patients in a timely way. I wanted to be able to provide this high-level access to every patient in South Carolina, regardless of where they live, their socioeconomic status or their knowledge of how to optimally access complex health care systems."

And with that idea in mind, the Next-Day Access (NDA) program was born.

Dr. Roggin's immediate goal with Next-Day Access was both simple and practical: to provide abdominal surgical oncology and HPB cancer patients immediate access to the surgical team. Next-Day Access helps patients accomplish that goal.

With Next-Day Access, people with qualified diagnoses can call and speak with an experienced nurse coordinator. The coordinator will review the patient's information and schedule a one-hour combined appointment with a cancer surgeon and an advanced practice provider.

In most cases, the in-person appointment (or virtual meeting using telehealth for patients who live a significant distance from MUSC) will be on the next business day, and if that's not feasible, the goal is to have an appointment scheduled as soon as the patient wants.

How Does Next-Day Access Work?

Dr. Roggin has been working with the concept of Next-Day Access for long enough that he's produced a perfect hypothetical example of how the program works after a diagnosis of stomach, small intestine, liver, pancreas or hepato-pancreato-biliary cancers. The program also covers assessments of rare benign or malignant tumors like GIST, neuroendocrine tumors, pancreatic cystic neoplasm (IPMN) and choledochal cysts.

The first step is simply for the patient to call 843-985-7262 (or 843-985-PANC) to join the program.

"If you called me today and told me that you were just diagnosed with pancreatic cancer," Dr. Roggin says, "I could get you an office appointment in Hollings Cancer Center with experts in Surgical Oncology tomorrow."

We would start the evaluation process the moment you called and see you the next day," he continues. "And even in the interval between the phone call and the appointment, our teams know about that patient and are working to help collect any records, scans or other health-related information that could help us treat that patient better and more efficiently."

How Next-Day Access Helps

Dr. Roggin notes several advantages to utilizing Next-Day Access, both in terms of cancer recovery and peace of mind.

"There are some cancers that require expeditious treatment," he says, "and pancreatic cancer, which I treat often, is a great example of that. Pancreatic cancer remains an aggressive disease that spreads rapidly. There appears to be a positive correlation between decreasing the time between the work-up (or staging tests) and the initiation of cancer-directed treatment in pancreatic cancer that is associated with better outcomes."

But sometimes, having fast access to your medical team after a scary diagnosis is about more than just acting quickly.

"From the moment someone tells them they have cancer, it is a nightmare for the patient and their family," Dr. Roggin says. "With rapid access to the Internet, patients often learn about the workup, treatment and outcomes from their computer. This is suboptimal. While we appreciate having informed consumers, ideally, this information should be transmitted to the patients by an experienced provider who can put it into context, outline the treatment plan and help them emotionally through this challenge."

Between the feelings of fear and urgency, Dr. Roggin says that sometimes patients act out of confusion, not confidence.

"It can be very scary," he says, "and the patients often just want to go to whoever will see them the fastest. Sometimes they will go to centers that don't have as much experience in treating a particular cancer just because they can get them in faster. We know that the outcomes in pancreatic cancer, especially with surgery, are related to the experience of the surgeon, the volume of cases that are treated at the hospital and the ability of the health care providers to rescue patients from common postoperative problems."

"My goal is to try to provide timely evaluation and treatment at a medical center that has the most experience in the state," he continues. "The only logical approach was to break down any barriers to access so that we could get patients into our busy system as quickly as possible so that their treatment planning can start tomorrow."

Moving Parts: Building Next-Day Access

After decades of treating complex UGI/HPB cancer patients, performing translational research on combating ageism in pancreatic cancer treatment, adopting advanced minimally invasive operations for pancreatic cancer and serving as a surgical leader for general surgery residents and surgical oncology fellows, Dr. Roggin has centered his approach around one central idea: improving patient-centered care.

"One of my philosophies on providing cancer care as a surgical oncologist is that we should try to make decisions that are in the best interest of our patients from their perspective," Dr. Roggin says, "and that involves understanding who they are, their background and personal beliefs and values that influence how they want to be treated."

Dr. Roggin received approval to launch the program in November of 2023, and he hit the ground running, assembling a team quickly.

"I've spent the last six to 10 months bringing together a team of people that share the same sort of philosophy," he says, "and then organizing them to be able to deliver on what we promise."

Solving The Staffing

This brings us to perhaps the most challenging part of running Next-Day Access: Scheduling providers to be available.

"It's hard," Dr. Roggin admits, "but one of our strengths is the buy-in from our entire team. Everyone has a role and has shown great flexibility and a willingness to help. We have a back-up plan in case that surgeon or advanced practice provider is encumbered by other important tasks, and Courtney helps us make sure that there's always someone available. It involves a lot of operational flexibility behind the scenes. Sometimes, it's an all-hands-on-deck philosophy."

And that philosophy includes the program's creator, as well.

"I didn't just want to create the program, I wanted to be actively involved in seeing these patients," Dr. Roggin says. "I make Next-Day Access a high priority and will reschedule a meeting or conflict any time to see the patients. In my opinion, if you want to be successful, you have to show with your own actions that this is a priority and important. In many ways, this is a culture shift in how we are now seeing patients."

Having said that, the program's schedule doesn't seem to have many gaps, thanks to the other providers at MUSC Hollings Cancer Center.

"I've been so pleased that my colleagues share my enthusiasm for the initiative," he says. They want to take care of patients, and they want to be available. Our advanced practice providers, like nurse practitioners and physician assistants, are especially critical, as they will often be the first health care team member to contact the patient. We have been fortunate to cultivate and recruit a stable, experienced group of truly outstanding and compassionate providers."

Next-Day Access also includes services that go beyond the actual next day.

"The nurse practitioner and RN oncology navigation team will set up all the downstream appointments, including presenting their case at our multidisciplinary tumor board, reviewing their biopsy results and prior records, seeing allied providers, like nutritional support or clinical genetics, and ordering any necessary imaging tests or diagnostic procedures," Dr. Roggin says. "Most patients will have a follow-up 'treatment' appointment within one week, where they will meet with the other members of our experienced multidisciplinary team, learn about promising clinical trials and finalize a personalized treatment plan."

Practice Makes Perfect

Of course, a program of the size and scope of Next-Day Access doesn't happen overnight. Dr. Roggin and his team spent months preparing it, and they've kept up their active roles after the program launched on July 1, 2024.

"We've been meeting on a weekly basis for the last eight months to try to figure out how to create a seamless operation," he says. "We've thought through all the contingencies, and we've even had a 'Day in the Life' event where mock patients came to the hospital for a day so that we could get feedback on our patient experience. And I think that's the level of detail that we've tried to create to ensure that when this launched, it was a good experience for the patients and it was efficient. We know that there are going to be things that need to be improved, but that's part of the process."

Dr. Roggin adds that the hard work isn't just for this version of Next-Day Access.

"We look at this program as a pilot," he says. "If we can do this successfully in the domain of abdominal surgical oncology, then down the line, we can implement it for all other types of cancer."

All About The Patient

The more he talks about Next-Day Access, the more obvious Dr. Roggin's passion for prioritizing patient needs becomes, even in the face of mounting a massive program like this one.

"We sometimes overlook the fact that when cancer patients are waiting for answers, it is natural for them to be anxious and desperate," he says. "Most have friends and loved ones reaching out to suggest alternatives or options for second opinions based on their experiences with cancer. We want to make our patients feel like we are working tirelessly behind the scenes to make sure that all South Carolinians have prime access to our NCI-designated cancer center and should have no need to leave the state to receive both efficient and high-quality cancer care."

"It's time to truly be patient-centric and meet their needs," he adds. "I don't want anyone to get cancer. But if they get it, I want them to come to MUSC."

Call 843-985-7262 (PANC) to make an appointment.

Learn more about Next-Day Access.