The Big C

If you live in West Hawaii and you receive a cancer diagnosis, there’s a good chance you’re going to cross paths with Dr. Anthony DeSalvo.

DeSalvo is the go-to oncologist at Kona Community Hospital and also works out of North Hawaii Community Hospital, treating patients with pretty much any insurance provider except Kaiser Permanente. He said there are two ways people go from a cancer diagnosis to getting treatment. The faster route, he said, is when someone’s doctor refers the person to the emergency room and blood work shows signs of leukemia.

“They see their doctor, they know something is wrong,” DeSalvo said. “The emergency room calls me.”

In those cases, DeSalvo often advises patients they need to get on a plane and fly to Oahu to begin treatment immediately. Getting that treatment started is relatively straightforward, he said.

Cases diagnosed after a tumor is found are a little more complicated, he added. In those situations, someone sees a doctor, the doctor finds what he believes to be a tumor and orders a biopsy. The patient has to wait for an appointment for the biopsy, then for the surgeon to refer the patient to DeSalvo.

“In most places (on the mainland), that takes two weeks,” DeSalvo said. “Here that can take upwards of a couple of months. This adds a huge amount of anxiety. It’s very hard. We try to push it through the system as quickly as possible.”

The issue isn’t a lack of skill, DeSalvo said, but more a combination of limited resources and, for the high number of Hawaii residents using Medicaid as their primary insurance coverage, bureaucratic procedures doctors must follow just to request treatment.

“We have to go through a process with that provider that adds a 10- to 14-day delay at each step of the way,” DeSalvo said.

If someone is diagnosed with non-Hodgkin lymphoma, the established standard of care is performing a positron emission tomography, more commonly referred to as a PET scan, to look for the disease, DeSalvo said. Hawaii has only three places to do such a scan, and all those are on Oahu.

That makes it hard for someone on a neighbor island to get a scan, which can slow down treatment. On the other hand, DeSalvo said, sometimes he begins treating a tumor, for example, before taking some of those first steps national care standards set out, because the cancer needs immediate treatment and the time needed to get to Oahu would be too lengthy of a delay. In those cases, a patient may read online about standard care practices and wonder why certain tests are being skipped, DeSalvo said.

“Everyone involved in the system, they are all working hard at trying to overcome this,” he added. “We understand the process here. We can compensate quite well.”

DeSalvo sees another major stress for cancer patients. Cancer, he said, has a way of taking away patients’ ability to remain in control, especially when the patient is the breadwinner and insurance provider.

Patients begin to ask themselves, “How am I going to pay my bills? Feed my family?” DeSalvo said. “The logistical problems, people underestimate. It’s out of their hands. Their lives are no longer theirs to conduct.”

Some health care centers, in treating patients with cancer, have expanded the treatment beyond just disease and symptoms. In Boulder, Colo., DeSalvo said he saw a cancer treatment procedure that included offering yoga classes and other amenities that treat the entire person.

Similar efforts are under way here in West Hawaii, said Carol Dinmore, an oncology nurse with Kaiser Permanente at the Kona Clinic. Dinmore will be leading a class on how to cope with cancer beginning March 23.

The class is offered through the American Cancer Society and is free of charge.

Kaiser connects newly diagnosed cancer patients with a patient advocate, who can help them navigate the complex treatment process, as well as medical social workers, Dinmore said. Those workers are on Oahu, but are available by phone and email.

“It’s almost as though they’re right there in your living room,” Dinmore said.

Someone is always available for patients to call, she added.

Kaiser tries to get a patient’s first visit with its oncologist, who flies to Kona once a week, within 10 to 12 days of the initial cancer diagnosis, Dinmore said.

She doesn’t warn against consulting “Dr. Google,” as some people refer to the search engine, but does try to direct patients to credible medical websites. Dinmore said she’s had patients come in and correctly predict their diagnosis, just based on online searches of symptoms.

Having a support system, whether it’s friends, family, church or something else, is an incredibly important component of facing a cancer diagnosis, Dinmore said. Kaiser’s social workers have, in the past, even encouraged Hawaii residents to consider moving closer to family or friends after being diagnosis.

Despite all the challenges, and despite carrying a patient load that’s in the top 10 percent nationwide, DeSalvo is full of praise for the Hawaii Island community and Kona Community Hospital, where the new administration has worked hard to find more resources for cancer treatment, he said.

One thing DeSalvo has seen in Hawaii, which he said he can’t see happening in other parts of the country, is the understanding and gratitude he gets from patients and their families, even though patients may struggle to get the treatment they need here.

People approach him at the bank and the grocery store years after their treatment ends, or even family members after a patient dies, to thank him.

“They don’t forget that,” he said. “The amazing tolerance and patience of people here — in New York someone would be screaming at you. Here, it’s ‘thank you for trying.’”