Transforming Grand Rounds into Chartrounds: Technology and the Improving Cancer Care Grant Advance Patient Care

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When Patricia Hardenbergh, MD, moved from her academic position as a breast radiation oncologist at Duke University to a small, rural practice in Edwards, Colorado, she realized that being a community oncologist was a very different experience. She was an expert in treating breast cancer and also treated some pediatric cancers, but now, as the only radiation oncologist at her practice, she was treating cancer in every organ. “How can you be an expert at everything?” she asked. “You can’t.” She looked for resources, but found that the technology changed so quickly that her best resources were academic colleagues at major cancer centers who saw a large number of patients and could discuss their experiences in treatment planning with her.

Improving Cancer Care Grant

At the same time, the Conquer Cancer Foundation of the American Society of Clinical Oncology, through a collaboration with Susan G. Komen for the Cure®, was developing a new grant program: a large research grant focused on making a major impact on the quality of cancer care and access to that care. Unlike previous grants, the new grant would be open not only to academic investigators but also to oncology providers like Dr. Hardenbergh who practiced in community settings. Dr. Hardenbergh applied for the inaugural $1.35 million Conquer Cancer Foundation of ASCO Improving Cancer Care Grant, funded by Susan G. Komen for the Cure®, with a simple concept: online “rounds.”  “Grand rounds” is a teaching method in which an expert provides insight and feedback on the care of a patient to other oncologists. Dr. Hardenbergh proposed that with recent advances in technology, grand rounds could also be facilitated online as a way to continuously improve cancer treatment and patient care.

Dr. Hardenbergh was one of the first two recipients of the Improving Cancer Care Grant and used it to launch Chartrounds ( in December 2010. The concept remains simple. Each session includes a disease-area expert from a major academic cancer center.  Doctors present difficult cases and the treatment plan that they are considering and then get feedback from the expert and the other attendees during a one-hour online discussion.

Addressing an Unmet Need Among Providers

Building on Dr. Hardenbergh’s expertise, the initial pilot phase of the program was to just focus on the treatment of breast cancer with radiation. Two years later, Chartrounds has grown immensely and now covers both medical and radiation oncology for 10 different types of cancer. The success of this program has demonstrated that Dr. Hardenbergh recognized an unmet need among oncology providers. As a result, she presented data about the impact of Chartrounds at ASCO’s Quality Care Symposium on December 1, 2012.

Chartrounds has amassed almost 750 members from the United States and 15 other countries in just two years. More than half of the members practice in rural communities with less than 50,000 people—doctors who are unlikely to have a lot of local colleagues with whom to discuss treatment plans. Nearly 250 sessions have taken place, with a combined attendance of 1,932 professionals. Most importantly, 80% of those who attended a Chartrounds session reported that they planned to change their patients’ treatment plans based on what they learned. Participants also report that the sessions are useful even to the 20% of doctors who did not change their treatment plans after the discussion. Dr. Hardenbergh, who often presents cases for feedback, notes that this has been true in her own practice. “Having discussed the case gives you more confidence when presenting the treatment plan to the patient,” she said. “It is really valuable to the patients to be able to tell them that you discussed their case with a national expert.”

“I think that it was really insightful for the Improving Cancer Care Grant funders to recognize and fund a project that came from within the community,” Dr. Hardenbergh says of the Conquer Cancer Foundation and Susan G. Komen for the Cure®. “There was trust and vision that there were needs in the community that this project could meet. Chartrounds may not have existed if the funding required an academic appointment, as many grants currently do.” ■

© 2013. American Society of Clinical Oncology. All rights reserved.