The Housris of theMednet: Innovators of Improved Cancer Care

By Amy King, ASCO Publishing

Five years ago, sister-and-brother team Nadine Housri, MD, and Samir Housri had an idea about how to create an opportunity for more equitable outcomes in cancer care. They didn’t know if it would work, but they saw a need and ran with it. In 2014, they launched theMednet, an information-sharing platform for physicians, to help address disparities in cancer care.

As a medical student doing research about health disparities, Dr. Housri learned that patients who do not have access to care at the biggest, best hospitals in the country have worse outcomes.¹⁻⁸ “This was something that really, really bothered me,” she said. “I thought it was very unfair that a patient’s outcome was based on where they lived. That just didn’t seem right to me.”

When her own father was diagnosed with cancer, Dr. Housri, now a radiation oncologist at Yale University, reached out to her robust network for help and advice. She was able to get expert opinions on her father’s case—and her brother took an interest in how her professional connections informed their father’s care.

“Samir watched this whole process and he was surprised at how much information physicians share socially, whether it’s through phone conversations, through email, or at conferences,” Dr. Housri explained. “These conversations stay between two people and don’t make their way out to the greater community.”

theMednet grew from the question, “What if these conversations were available to all physicians?”

Knowing that patients with cancer and their care providers have an urgent need for the best cancer information, the Housris didn’t wait for someone else to find a solution. They realized that between them, they had the know-how to at least get started on the issue themselves. They used their distinctive strengths—Dr. Housri in medicine and Mr. Housri, an MIT graduate, in engineering technology—to build a platform where physicians can go for information to help their patients get the best care.

“In all honesty, we thought it was a really good idea, but we didn’t know. The best way to find out was to just build it and see if people used it. Samir and I just jumped into it,” Dr. Housri explained.

From Vision to Reality: theMednet in Action

The Housris envisioned a platform where the professional networks and casual conversations that informed their own father’s care could be available to all. On theMednet, physicians can access invaluable expert help to provide quality care and request advice and answers to their cancer care questions. Recent popular questions on theMednet include:

• When do you recommend patients get vaccinations with respect to their chemotherapy course?

• How would you approach a patient with grade 1/2 pancreatic neuroendocrine tumor after disease progression on octreotide?

• What is your approach to oligometastatic HER2-positive breast cancer, after excellent clinical response in all sites of disease to trastuzumab, pertuzumab, and a taxane?

• What is your preferred approach to metastatic PDL1-negative triple-negative breast cancer?

• How many cycles of docetaxel do you give to patients with metastatic castration-resistant prostate cancer?

“It’s not hard to convince people that information sharing is important,” Dr. Housri said. “What ASCO members need to know about theMednet is that it exists! I personally use theMednet every single day [in my practice].”

Over 10,000 U.S. oncologists are currently using theMednet. On the site, physicians can sign up for a daily newsletter, post and vote in polls on new cancer care questions, and follow Q&As on their own cancer specializations. There are currently over 4,000 expert responses to practical cancer care questions on the website and mobile app (available in the App Store and Google Play).

Oncology professionals who want to get more involved in theMednet have several ways to support its mission of making oncology expertise available to everyone, according to Dr. Housri:

At the very highest level some individuals may work as editors (many are currently junior faculty or senior fellows) to screen the Q&A and help moderate the site. Deputy editors serve for each cancer specialty.

theMednet’s associates’ program is “geared toward fellows and community oncologists who want to get involved by bringing up the important topics that are being discussed at their institutions every week. We’re always looking for new associates,” Dr. Housri said.

theMednet’s tumor board program has been a collaboration at National Cancer Institute designated comprehensive care centers, where the program can share the discussions that are going on at their institutional tumor board.

Experts are very involved with answering questions on theMednet. Dr. Housri said, “We always love bringing on new experts, both established faculty and up-and-comers as well.”

ASCO’s mission to conquer cancer through research, education, and promotion of the highest quality patient care aligns with theMednet’s goal to break down silos and make the best cancer expertise available to the entire oncology community. The Journal of Clinical Oncology (JCO), ASCO’s flagship journal, has a partnership with theMednet in the form of a journal club.

The JCO Journal Club “was initially conceived as an idea to start raising awareness of JCO articles that should be clinically important to oncologists,” Dr. Housri said. “We’ve been focusing on Oncology Grand Rounds articles to highlight clinical relevance. As opposed to a traditional journal club, we focus on the impact of the paper. Every time there’s a journal club we’ll reach out to the community about the paper and ask for questions about the topic and the author will answer those. We’ll share those answers with theMednet community.”

To access Q&As with JCO authors, physicians can simply register a new user account on themednet.org.

Through such partnerships, and both public and private funding, theMednet has quickly established itself as a valuable informational platform, and the Housris believe there is no time to waste. With patients’ lives on the line, Dr. Housri, Mr. Housri, and their respective oncology and engineering expert teams at theMednet work to empower all physicians, particularly community doctors, with the valuable expertise of highly credentialed and experienced colleagues. The site offers robust discussions on radiation oncology, medical oncology, and gynecologic oncology, with plans to add more oncology specialties in the future. Dr. Housri hopes that as theMednet platform becomes more comprehensive, it will be “the Google for cancer” and, someday, “the Google for medicine.”

Everyone Can Make a Difference

The Housris’ story is an inspiring reminder that everyone can use their strengths to make an impact on cancer care disparities. They didn’t ask for others to take their mission on, but instead tested out their idea for themselves and made a difference right where they were. Through the Housris’ efforts, theMednet’s 700-plus experts who answer clinical questions are also amplifying the reach of their knowledge and expertise, with an effect that ripples far beyond their own practice or institution.

When you see something that just doesn’t seem right, theMednet is evidence that one person (or in the Housris’ case, two people) can create real change.

References

Wolfson JA, Sun CL, Wyatt LP, et al. Impact of care at comprehensive cancer centers on outcome: Results from a population-based study. Cancer. 2015;121:3885-93.

Joshi SS, Handorf ER, Sienko D, et al. Treatment facility volume and survival in patients with advanced prostate cancer. Eur Urol Oncol. 2019;S2588-9311(19)30097-5.

Goyal G, Tella SH, Funni S, et al. Association between facility volume and mortality of patients with classic Hodgkin lymphoma. Cancer. 2020;126:757-64.

Go RS, Bartley AC, Crowson CS, et al. Association between treatment facility volume and mortality of patients with multiple myeloma. J Clin Oncol. 2017;35:598-604.

Boero IJ, Paravati AJ, Xu B, et al. Importance of radiation oncologist experience among patients with head-and-neck cancer treated with intensity-modulated radiation therapy. J Clin Oncol. 2016;34:684-90.

Tandstad T, Kollmannsberger CK, Roth BJ, et al. Practice makes perfect: the rest of the story in testicular cancer as a model curable neoplasm J Clin Oncol. 2017;35:3525-8.

Gutierrez JC, Hurley JD, Housri N, et al. Are many community hospitals undertreating breast cancer?: lessons from 24,834 patients. Ann Surg. 2008;248:154-62.

Housri N, Coombs M, Orandi BJ, et al. Ethics and the law: is there common ground on informed consent for disparities in hospital outcomes? Ann Intern Med. 2011;155:260-4.

Originally published on ASCO Connection; republished with permission.