When Sarah, a mother of two, was diagnosed with breast cancer in 2021 at the age of 43, she carefully considered where to go for care.
She had been referred by her doctor to Beth Israel Deaconess Medical Center, where she received a mammogram and the cancer diagnosis. But Sarah, who asked that her last name not be used, ultimately chose the Dana-Farber Cancer Institute, wanting a place that was known for cancer treatment.
Like many cancer patients, Sarah’s treatment at Dana-Farber was co-managed by its longtime medical partner, Brigham and Women’s Hospital: Her three surgeries were performed at the Brigham, by Brigham doctors; her five rounds of chemotherapy at Dana-Farber. She found the care as integrated and connected as the skybridge walkway that physically knits the two buildings together, she said.
Sarah continues to see doctors at both institutions and was shocked when Dana-Farber announced last week that it would break from the Brigham after a nearly 30-year relationship. Instead, Dana-Farber is pursuing a deal with Beth Israel Deaconess Medical Center that will include building a freestanding cancer hospital.
While few things will change before Dana-Farber’s contract with the Brigham expires in five years, for Sarah and some patients like her, the announcement raises questions about what will ultimately happen with their care.
“Cancer is a stressful time, and adding this on top of that can only add stress and uncertainty,” Sarah said. “It’s difficult putting people in that situation where they will have to choose.”
Patients, physicians, and health care experts are now contemplating what the pending split from the Brigham will mean. Unwinding the relationship and the teams that care for patients will likely be extremely complicated, and could prove disruptive to patients and doctors alike.
If approved, the new partnership would give rise to two competing approaches to cancer care in the region: one that is embedded and integrated within a larger, full service hospital, as it is within the Brigham; the other more focused in a single dedicated facility connected to a hospital, as envisioned by Beth Israel and Dana-Farber. More changes are likely, including shifting residency and fellowship programs, and possibly fiercer competition for patients among the two systems.
“This is going to be really tricky for five years between now and the end of our contract as we figure it out,” said Dr. Gerard M. Doherty, surgeon in chief at both Brigham and Women’s Hospital and Dana-Farber Cancer Institute.
The split presents unique challenges to both institutions: for Dana-Farber, convincing patients the new program with Beth Israel will offer them as good, if not better, care; and for Brigham, rebuilding a program without the reputation and expertise of Dana-Farber staff.
Dana-Farber declined to make an official available for this story. But in an interview last week on the announcement of the new venture, Dana-Farber chief executive Laurie Glimcher described a “state of the art facility” that “we think meets the pace of change in oncology care.”
As it stands now, Dana-Farber’s cancer program, in partnership with the Brigham, is one of the most respected in the country. The program ranks fifth for cancer care in US News and World Report’s best list, while Beth Israel’s program is ranked 17th. By contrast, the cancer program at Massachusetts General Hospital is currently ranked 28th.
Ben Harder, managing editor and chief of health analysis at US News and World Report, said the ranking is a reflection of many factors, including feedback from patient surveys and a targeted survey of oncologists. But the biggest factor in the methodology is outcomes: the patient’s health after receiving treatment, compared to when he or she got to the hospital.
Driving those high rankings are the people within Dana-Farber and the Brigham, Doherty said. Not only do the hospitals have a number of clinical trials and successful treatment outcomes, but the physicians have a depth and breadth of expertise in the subspecialized areas of cancer care.
Those specialists have grown so interwoven that patients can sometimes not realize when they are seeing a Brigham doctor versus a Dana-Farber doctor. A patient who comes to the Brigham emergency room and is diagnosed with cancer — one-quarter of patients in Brigham’s ED have cancer — is seen by a Dana-Farber medical oncologist who oversees their care.
Pathology services or radiation, for example, are delivered by the Brigham, and all operations are performed by Brigham surgeons. Should the patient need IV immunotherapy or chemotherapy, he or she would visit Dana-Farber for outpatient infusions. Complications, such as an allergic reaction, would be addressed at the Brigham emergency room.
“I’ve compared it in the past to a bicycle, where the Dana-Farber is the front wheel of the bicycle. Medical oncologists are steering the direction of the strategy. It’s the first thing [the patient] sees,” Doherty said. “But all the power is in the back wheel. The specialized work, other than medical oncology, is on the Brigham side. That’s been built up over decades. People have come here, trained here, developed expertise here. They are here because of this relationship. It takes a long time for that whole ecosystem to be built.”
Beth Israel has said its physicians would provide surgical oncology care at the new location. The agreement includes that pathology and radiology services — currently provided by the Brigham — will be provided by Dana-Farber and BIDMC. Radiation oncology will be provided by what Beth Israel said would be a newly formed and jointly governed physician organization made up of clinicians from across the organization.
Having a dedicated space for adult cancer care leads to better outcomes, Dr. Kevin Tabb, chief executive of Beth Israel Lahey Health, the parent organization of BIDMC, said in an earlier interview.
”It is very rare that institutions can have the ability to come forward and do something that is unique and new and will make a difference for our communities for a long time to come,” he said in an interview last week.
The Brigham plans to eventually construct its own new building to house its own cancer care. The health system will either have to hire medical oncologists to run it or partner with Mass. General Hospital’s cancer center.
But based on national reputation and rankings, MGH’s cancer program currently isn’t robust enough to supplant all Dana-Farber does now, Doherty said.
“Certainly it will make it easier for us to collaborate across the MGB system,” said Doherty. “But we’re stronger with the Dana-Farber people together with us at the Brigham,” Doherty said.
As cancer care evolves in the region, one thing seems clear: Hospitals want more beds focused on cancer care, which could alleviate wait times. On any given day, an estimated 200 of the approximately 800 inpatients at the Brigham are medical oncology patients. In addition, approximately 60 or so cancer patients are in the hospital on a surgical floor.
A source with knowledge of the discussions said Dana-Farber hopes to construct between 280 and 300 beds. Brigham is planning an inpatient, state-of-the-art facility focused on cancer care.
There are different advantages to each institution’s approach to cancer care.
Beth Israel and Dana-Farber executives have said a focused center could target all of its services to the unique needs of cancer patients.
Brigham experts tout their more integrated structure, which allows patients to be cared for in one place no matter their ailment. Doherty said that, at the Brigham last week, doctors performed a large operation to remove a tumor from the heart and liver — a procedure that was possible because the hospital had a cardiac ICU. At freestanding cancer hospitals, if a patient has a heart problem, they are sometimes taken by ambulance to another hospital.
Patients will likely be steered to one of the two organizations when they ultimately split. While many insurance plans have both Mass General Brigham and Beth Israel in network, some plans with more limited networks may prohibit patients from seeing doctors at one of the two new systems.
For existing Dana-Farber/Brigham patients who elect to move their care, that will mean establishing new relationships with half of their care team.
Lora Pellegrini, chief executive of the Massachusetts Association of Health Plans, said patients will need individual transition plans to ensure their care is uninterrupted as Dana-Farber moves to Beth Israel.
Ultimately, coordinating patient care will require the work of everyone involved, from Brigham to Dana-Farber to Beth Israel.
“We don’t want patients to become some kind of tug of war between the institutions,” Doherty said. “I think I can speak that both sides don’t want that.”