Building an Oncology Center in a Remote & Underserved Area

Dr. Peter Brett brings cancer care to the CNMI

After more than two decades working as an Oncologist in private practice in Northern California, Dr. Peter Brett relocated to the tropical paradise of Saipan in 2019. A part of the Commonwealth of the Northern Mariana Islands (CNMI), Saipan is the largest of the 14 islands encompassed by the CNMI. Located about 130 miles north of Guam, deep in the Pacific Ocean, Saipan had never had direct access to an oncologist prior to Dr. Brett’s arrival.

While Dr. Peter Brett was attracted to the year-round warm climate of Saipan, along with the opportunity to build a practice from the ground up, it is the community of Saipan who has embraced Dr. Brett with open arms. The Commonwealth Healthcare Corporation (CHCC) opened the Oncology Center under Dr. Brett’s direction in 2020. Before then, all cancer patients seeking treatment or surgery had to be referred off-island.

In a low-income community and vulnerable population like the CNMI, traveling to Guam, Hawaii, the Philippines, or the mainland US for cancer treatment is an extremely expensive and uncomfortable undertaking. Most patients were forced to leave their families behind for months at a time in order to seek treatment in a foreign place and without moral or physical support.

Since the opening of the CHCC Oncology Center, Dr. Peter Brett and his staff have been educating residents, screening for cancers, diagnosing cancers, and offering treatments including chemotherapy, immunotherapy, and targeted cancer treatment medicines. They also perform simple surgeries on island. Dr. Brett is proud of how much the center has done to increase the accessibility of care and comfort for its patients.

“It’s hard enough to have cancer, but then they have to travel far away for your care and go away for months at a time, it’s just very difficult. Our cancer team here, we’ve been treating people locally, I think we’re doing a pretty good job doing it,” he said.

Getting to Work

When Dr. Peter Brett arrived in 2019, the only staff members at his disposal were experienced pharmacists, a caring nursing staff, and an internist who had an interest in cancer care. He immediately contracted with ASCO (American Society of Clinical Oncology) Practice Consulting Services to begin building the Oncology Center.

Two consultants made the 36-hour trip from the DC metro area to the island of Saipan. One consultant worked with the pharmacy staff to ensure that chemotherapy ordering, inventory control, mixing, labeling, and delivery were completed accurately and safely. The nursing staff was also trained in the safe delivery of treatment, and efficient documentation. 

The other consultant focused on the finance department to make sure the hospital purchased drugs correctly, billed for drugs and services correctly, captured all appropriate charges, and followed up with payers to make sure drugs and services were paid for. This consultant helped with securing pharmaceutical foundation support to provide discounted or free drugs for uninsured patients.

Open to the Public

In August 2020, the Oncology Center opened to the public and began treating cancer patients Monday – Friday, 8 am – 5 pm. But Dr. Brett and his staff of nurse practitioners, RNs, and physician assistants were alarmed by how many late-stage cancer cases were entering the center for the first time – including many residents in their 20s and 30s. 

“If cancer is detected early on…it is easier to treat and is more likely to have a better outcome compared to stage three or stage four cancer where it is spreading all over the body,” Dr. Peter Brett said. “We can still treat people [with stage three or stage four cancer], but the chance of curing that is much lower [and] the chance of a good long-term outcome is much lower.”

The team at the Oncology Center knew that they would have to begin outreach and education to the community. A comprehensive campaign was launched, including online “Doc Talks,” using social media platforms such as Facebook and Instagram, sending out press releases, creating radio ads, and speaking directly to residents at community events. The focus of the campaign was on overall patient health as well as early screening.

The CARES Program is Born

As part of their efforts to minimize the prevalence of late-stage cancers, the CARES program began being offered in 2022. CARES stands for Cancer and Associated Risks Early Screening and is a comprehensive, free-of-charge screening program offered to all residents of CNMI, regardless of health insurance or citizenship.

Through the CARES program, any resident over the age of 18 years old can schedule cancer testing that includes color genetic testing, mammograms, breast removal surgery, pap smears, colonoscopies, CT scans, and oral screenings. They also have access to preventative vaccines.

Dr. Peter Brett has also been vocal about the benefits of lifestyle changes that can reduce the risk of cancer developing, such as diet improvements, increased exercise, limiting alcohol consumption, and tobacco and betel nut cessation. 

More Work to Be Done

The Oncology Center has added Patient Navigation and a Palliative Care program since opening. They also make home visits when appropriate. But Dr. Peter Brett knows that there is more work to be done in engaging and educating the community on cancer prevention, cancer screening, and cancer care. 

“It’s a big effort, but we think we can do it. You don’t see this kind of program even in the U.S. mainland. Because we’ve got a population of 50,000 people, we want to get out and engage all 50,000 people who live on the island, and see what we can do to lower their chance of getting cancer or pick it up early if they ever get cancer…. We’re looking at common cancers and what we can do to screen for them.”

With so much already accomplished in the last three years, the future is promising for the CHCC Oncology Center and the residents of the CNMI.