The path following a cancer diagnosis can be so fraught with emotion and uncertainty that, for many, a second opinion has become de rigueur.
“The disease is terrible, the treatment options are complicated, and many of them are difficult,” said Abdul Rahman Jazieh, MD, MPH, Senior Oncology Consultant and Director of Innovation and Research at Cincinnati Cancer Advisors. “There are social, financial, and physical components to it. So it’s very likely that many patients will seek a second opinion, especially when they hit the tough point where a major decision has to be made in a life-threatening situation.”
But how to get that second opinion is also fraught with emotion and uncertainty. Should one seek out expertise from a competing health system? Travel to another city?
Cincinnati Cancer Advisors has developed an innovative answer to these questions. A young nonprofit funded by the Cincinnati Cancer Foundation, CCA provides objective second opinions to cancer patients and their primary oncologists at no cost to patients. CCA’s model, called the “20/20 Foresight Program,” is designed to provide reassurance that initial treatment plans are optimal or to make recommendations for improvement when appropriate. Completely independent and un-beholden to any health system or physician group, CCA is not a competing oncology practice and does not assume the patient’s care.
The three-year-old, still-evolving organization is the brainchild of William (Bill) Barrett, MD, Co-Director of the University of Cincinnati Cancer Institute and Medical Director of the University of Cincinnati Cancer Center.
“Bill had this concept of developing an entity that has only patient interest and welfare in mind without any conflict of interest or system control in its structure,” Jazieh said.
For Jazieh (pronounced JAH-zee), an internationally known oncologist, working at CCA is a dream job involving pure patient care. “There is no pressure about billing the patients, about insurance, about payments,” Jazieh said. “We provide detailed second opinions for patients in the region. We discuss the plan with their oncologist and send them back to be managed by their oncologist. Basically, we are a professional second brain for their primary oncologist. It is a win-win-win situation.”
When patients who are diagnosed by one medical practice seek second opinions from another, they sometimes move to the second-opinion practice. The primary oncologist loses the patient, of course, but the patient may also incur disruption by having to start over with a new team. The patient may also run into out-of-network insurance issues while incurring expenses related to travel.
Jazieh’s goal is to enhance the already-established relationship between the patient and primary oncologist. “When you go to an institution you are going to get the point of view of that institution; you get what that expert has access to. But when you come to CCA, since we are not competing, we look at what is best for the patient.”
In rare cases, Dr. Jazieh said, CCA will refer a patient to an out-of-town cancer center if that center has a new drug or clinical trial that is appropriate for the patient. A more likely approach, he said, is to secure the groundbreaking treatment or drug combination for patients in the Cincinnati-Northern Kentucky area, where they live. He believes the quality of cancer care in Cincinnati is high and has not been fully appreciated, in part because the area’s hospitals lack the hefty advertising and marketing budgets of better-heeled national competitors.
CCA’s second-opinion process begins with a simple phone call or online appointment request from the patient. In the case of in-person visits, complete medical records and scans are assembled, and the patient then travels to the Norwood, Ohio, office for a two-hour appointment with a physician and nurse. A medical history is taken, a physical exam is performed, and all of the patient’s questions are answered. Virtual appointments are also an option, and can be scheduled via CCA’s website.
No health issue is off the table. “It’s not just chemo,” Jazieh said. “We talk to patients about their emotional well-being, their physical activity, their nutrition. In addition, a very important aspect we added to our practice – which we pay for – is a financial navigation service. So I ask if they have any financial trouble with the cancer, any issue with co-pays or access to certain services. If we have any concern, we connect them with the service and help them navigate the financial aspect of their cancer care.”
After the two-hour session, the patient’s oncologist is called and provided with any additional insights or recommendations. In the event a new test is ordered to, for example, discover the presence (or absence) of a pertinent genetic mutation, the patient is asked to come back for a follow-up appointment.
Jazieh grew up in a suburb of Damascus, Syria. The doctors in his town became his role models, and from a young age, he said, “I did not expect myself to be anything but a physician.” His talents matched his aspirations, and as one of the highest-scoring students in his grade, he was steered toward medicine. He earned his medical degree at Damascus University, then came to the United States and earned a master’s in public health from Tulane University and performed a medical residency at the University of Illinois. He then earned his fellowship in hematology and medical oncology at the University of Arkansas.
Jazieh chose to specialize in cancer care because Syria was lacking in oncologists. In a quest to provide free care for Syrians, he helped create a not-for-profit, 40-bed cancer center in the center of Hama, the fourth largest city in Syria. But armed conflict in Syria upended those plans, vaporizing the medical infrastructure – imaging, pathology, even chemotherapy – necessary to support optimal oncology care.
Jazieh came to Cincinnati in 2000 and served 5½ years as head of the Division of Hematology and Oncology at UC. He then returned to the Middle East to serve as chairman of the Department of Oncology and director of the Cancer Center at King Abdulaziz Medical City in Riyadh, Saudi Arabia.
Barrett and Jazieh were longtime friends when Barrett began building CCA on his own, seeing patients at night and on weekends. In the summer of 2020, ready to ratchet up the program, Barrett called Jazieh and asked him to return to Cincinnati.
“When Bill Barrett called me, I told him, ‘That’s the job I want to do,’” Jazieh said. “It’s a novel concept for a noble cause. I don’t want to rush patients who are in a life-threatening situation. I don’t want to squeeze their co-pay from them. I don’t want to fight with their insurance. I want to sit with the patient who has all my attention. It’s unique.”
This content created with the support of Cincinnati Cancer Advisors.