The Power of Sharing Your Story

One in an occasional blog series on topics from Oncology Issues, the journal of the Association of Community Cancer Centers.

By Susan van der Sommen, MHA, CMPE, FACHE, ACCC Editorial Committee Chair

Talking heads At the upcoming ACCC 33rd National Oncology Conference October 19-21, in St. Louis, Missouri, the 2016 ACCC Innovator Award winners will be showcasing their pioneering efforts aimed at improving the provision of care to cancer patients with initiatives that can be replicated in other community cancer programs.

Spreading the Word

In addition to speaking at the National Oncology Conference, every ACCC Innovator Award winner has the unique opportunity to write a feature article for Oncology Issues, ACCC’s bi-monthly journal.  The just-released July/August 2016 issue presents in-depth, “how we did it” articles from several of the 2015 Innovator Award winning programs. But opportunities for ACCC members to share their cancer program’s initiatives and successes are not limited to Innovator Award winners. Oncology Issues features insightful articles from ACCC member programs throughout the country – large and small. And every issue includes a “Spotlight” article profiling an ACCC Cancer Program member.

For instance, in the January/February 2016 issue, authors from two ACCC Cancer Program member institutions wrote about how to “Unlock the Potential of the Cancer Registrar,” describing the integral role their cancer registrars are playing in their organizations’ lung screening programs. And the May/June 2016 issue featured an article from ACCC Cancer Program Member The Valley Hospital’s Blumenthal Cancer Center on its Oncology Nursing Fellowship Program. In feature articles such as these, ACCC members share their real-world strategies for overcoming challenges and improving oncology care delivery, enriching the oncology community as a whole.

What better way to feature your cancer program’s success than through an article or profile published in a journal with national coverage? Many of our colleagues have used the opportunity to garner local media coverage in their respective markets; others have showcased their work among their peer group – which sometimes includes much larger centers.

In a recent ACCC Communications Survey, ACCC members were polled on the association’s journal, Oncology Issues:

  • 90% said that Oncology Issues is the “primary benefit of ACCC membership.”
  • 98% said that Oncology Issues “contains practical information, insights, ideas, and tools.”
  • 92% said that Oncology Issues “contains information that I do not find in other sources.”
  • 88% said that Oncology Issues “helps my cancer program stay ahead of the competition.”
  • 88% said that Oncology Issues is “must reading for me to stay ahead in my profession.”

What makes the Oncology Issues so successful? Input from ACCC cancer program members like you! To help spread the word to ACCC members about opportunities to contribute to the journal and how Oncology Issues’ content can be leveraged to benefit your program, this year’s National Oncology Conference will feature a new agenda item – “Oncology Issues Live!” hosted by members of ACCC’s Editorial Committee. Interesting in learning more about contributing or having your program featured in Oncology Issues? Want to be part of the Editorial Committee? Come to “Oncology Issues Live!” at the ACCC 33rd National Oncology Conference, October 19-21 in St. Louis, and connect with us.

 

MACRA Update—Will CMS Delay the Start Date?

By Brittney Fairman, Policy Analyst, ACCC

Calendar pages and clockLast week Andy Slavitt, Acting Administrator for the Centers for Medicare & Medicaid Services (CMS), told the Senate Finance Committee that the agency was considering “alternative start dates,” for Medicare Access and CHIP Reauthorization Act (MACRA) after receiving more than 3,000 comments on its proposed rule implementing the Quality Payment Program. The final rule is expected in November, leaving only a few months before the proposed reporting start date of January 1, 2017. Slavitt also said the agency is taking a close look at how the proposed rule would impact rural and small providers, particularly the low volume threshold that would exempt small practices from certain reporting requirements.

In our June 27 comment letter on the MACRA proposed rule, ACCC urged CMS to:

  • Delay implementation for six months to one year, to give physicians the time needed to build infrastructure and implement the Quality Payment Program effectively
  • Ensure that the agency provides adequate accommodations and protections for small group practices and solo practitioners
  • Modify the “resource use” methodology to ensure that eligible clinicians are held responsible only for the costs they can control
  • Include all Oncology Care Model (OCM) quality measures in MIPS
  • Refine the APM requirements to offer a meaningful alternative to MIPS and adopt policies to promote the availability of a wide variety of APMs and Physician-Focused Payment Models (PFPMs).

With this proposed rule, CMS aims to transition Medicare to a new physician payment program focused on quality, value, and accountability over volume. The MACRA legislation enacted by Congress outlines essentially two separate payment pathways for physicians under Medicare: The Merit-Based Incentive Payment System (MIPS), and the Alternative Payment Models (APMs). Both pathways are intended to drive the development of value-based payment. ACCC supports payment reform efforts; however, it is critical that CMS construct these pathways so that they are realistic, achievable avenues to Part B reimbursement.

ACCC will continue to keep members informed as MACRA implementation unfolds. For a deeper dive on new requirements under the Quality Payment Program, ACCC members can access the recent ACCC webinar, “MACRA CMS Proposed Rule: What You Need to Know” on demand (login required). The American Medical Association (AMA) has created a MACRA Checklist that outlines steps providers can take now to prepare, as we await the final rule.

Helping Patients Cope with “Chemo Brain”

By Sandy Balentine, MSN, RN

Gears in Bubble HeadHave you ever had your chemotherapy patients say that they “can’t remember anything,” they “just can’t concentrate,” or they “feel foggy”? The term “chemo brain” is often used to describe these phenomena. So, what is “chemo brain,” and is it real?

Chemo brain has been described as cognitive or thought problems that occur during and after cancer treatments—with either chemotherapy or whole brain radiation. Patients report having trouble concentrating or focusing, problems with word or name recall, and slowed thinking that results in a longer time to complete tasks. While chemo brain is a real condition, clinicians still do not know which cytotoxic agents are responsible, which characteristics make patients vulnerable, and which biologic mechanisms are involved. To date, there have been no large-scale research studies on this phenomenon, so much more research is needed.

However, because chemo brain symptoms can mimic other disorders, it is important that clinicians rule out other medical issues first. For example, the same symptoms attributed to chemo brain can be related to mental or mood disorders, such as anxiety or depression, or a medical disorder, like a thyroid dysfunction. Further, these symptoms can result as a side effect of medications or medication interactions. And while dementia can also create these symptoms, dementia is progressive and chemo brain is not. If the patient truly has dementia, an evaluation by a neurologist may be indicated.

The good news is that chemo brain is not viewed as a progressive condition. Most cancer patients notice improvement over time. Sometimes people see improvement within a few months, but for others chemo brain symptoms continue for a year or two after treatment. Some patients have reported long-term symptoms and may experience lasting effects from their chemo brain.

Tips to Help Your Patients Cope

While unfortunately there is no cure for chemo brain, a multi-modal rehabilitative approach that includes medical, psychological/behavioral, and wellness teaching can make a difference. This can include diet, exercise, talk therapy, and sleep hygiene. However, a multi-modal rehabilitative approach takes time and effort. The goal is to restore functioning and/or learn how to compensate for functions that cannot be restored. The tough reality is that some chemo brain effects may linger; however, patients can learn to live and cope with these limitations.

Here are some of the lessons we’ve learned at our cancer program in helping our patients cope with chemo brain. Step one: Rule out any other medical cause for their symptoms.

After that, be sure that your patient understands what chemo brain is and what he or she can do to diminish its effect on their quality of life. Our providers—both physicians and nurses—include chemo brain as a part of the discussion with patients about potential side effects of the treatment they are receiving. Our social workers, palliative care staff, and registered nurses reinforce that discussion when they meet with the patient. More detailed information about chemo brain is provided through support groups and other presentations to our patients.

It is also critical to be sure your staff understands the implications of chemo brain and how it affects patients, so they can help their patients understand it. We provide that education to staff, as well as to our patients. There ARE techniques that can help:

  • Start slow. We encourage patients not to attempt to try everything all at once, but pick one “thing” to work on and then add on tasks as they go. For example, a first goal might be to simply focus on the amount of sleep they get and set a goal for a consistent bedtime each night. The aim is to try to avoid becoming overwhelmed.
  • Would medication help? While there is no “magic pill” to cure chemo brain, some medications in some situations have shown promise. Anxiety, depression and fatigue are common in patients going through treatment for cancer. Left untreated, these conditions can lead to increased fatigue, difficulty concentrating and focusing, and insomnia. Plus, physical symptoms can seem worse—for example, patients with untreated depression and anxiety report more pain. SSRIs (selective serotonin reuptake inhibitors) and Wellbutrin (bupropion) have been reported to decrease fatigue in some patients and improve their ability to better focus.
  • Walk on. Moderate exercise, such as brisk walking, can help cancer patients cope with stress, fatigue, and depression—all which can contribute to memory problems. Plus, exercise has beneficial effects on cognitive function, perhaps through an increase in blood flow to the brain or through reduction in inflammation.
  • Quality sleep. Normal, quality night-time sleep lends itself to full day-time alertness. Encourage patients to avoid napping during the day, get enough sunlight each day, and practice good sleep hygiene. For example, establish a bedtime routine, avoid caffeine and alcohol before retiring, avoid electronic devices and falling asleep to a TV, read a pleasant book before bed, and use meditation/guided imagery.
  • One thing at a time. Remind patients that while you can multi-task, you can’t multi-focus.
  • Put tools to work. Patients can benefit from supportive tools. This can be as simple as identifying a quiet space to organize tasks (at home and work) or making a basic “to-do” list so that they can cross off items that have been accomplished. Encourage patients to use learning styles that are already working for them. For example, if they learn by writing notes, then write things down. If they are better with visual rather than verbal information, empower them to have visual cues rather than just relying on providing information verbally. Crossword puzzles, word searches, and Sudoku are all activities patients can use to help keep their brains processing. Finally, ask patients to consider what time day of works best for them to tackle their most complicated tasks.

They must redefine what is normal for them now!

References

OncoLink. Cognitive Dysfunction (“Chemo Brain”). May 5, 2016.

CancerCare: www.cancercare.org.


ACCCBuzz contributing blogger Sandy Balentine, MSN, RN, is the Director of Clinical Oncology at ACCC Member Program, The Valley Hospital.

 

Patient Navigation—Process Mapping by Disease Site

By Tricia Strusowski, MS, RN

ThinkstockPhotos-467463476For this patient navigation blog post, let’s talk about a recent hot topic on ACCCExchange, the online discussion forum for ACCC members: At what point in the care continuum do you initiate navigation and support services?

Many cancer programs have a difficult time identifying when to initiate these services. Cancer programs know that staff are duplicating services, but they don’t want anything to fall through the cracks for patients and their families. At busy cancer programs, staff may be challenged to find the time to sit down and work out these details. Plus, getting all the healthcare professionals together for one more meeting can be a daunting task. Cancer programs want to provide the best experience for their patients while utilizing staff efficiently. One way to support this goal is by involved the entire team in creating a disease-site-specific process map to review the continuum of care; discuss staff roles and responsibilities; identify gaps, barriers, opportunities for improvement; and goals of care—all with the patient at the center of the discussion. Simply put: Increasing communication among the team and decreasing duplication for the patient.

Who Should Participate?

Ideally, the team participating in the disease-site mapping process should be representative of the offices and departments that will touch the patient during his or her journey. Keep in mind: You need to include the “worker bees,” the staff who really know the details of the patient flow. Let’s consider a head and neck cancer patient for example. In this instance, the following individuals should be invited to participate:

  • Surgery
  • Medical oncology
  • Radiation oncology
  • Inpatient unit case manager and/or discharge planner
  • Speech/swallowing therapist
  • Navigator
  • Social worker
  • Financial counselor
  • Behavioral health
  • Rehabilitation/Prehabilitation
  • Dental office
  • Others (We all know there is always someone we forget to invite!)

Plan your first session for 1.5 to 2 hours. Admittedly, this may be a challenge to schedule but it can be done, and the results will be amazing. Utilizing a large paper flowchart (i.e.,15 feet long x 4 feet wide), the group needs to talk through and record the process starting at the patient’s earliest point of entry. Each detail must be discussed, including length of time from one episode of care to the next, delays, gaps, and opportunities for improvement. Encourage participants share their goals during the discussion and write everything down!

Revisit & Revise

Process mapping exercises are not a one-and-done experience. It takes several meetings to review and revise the process map. There may be key individuals or a process that are missed in a previous session; no big deal, add them to the group. A great facilitator is key to keep the team on task and keep the discussion moving.

After the entire disease-site process is complete, overlay when you would like the navigator and the support staff to intervene. Remember: the goal is to provide the intervention as soon as possible, hopefully in a proactive manner so that you are “staying one step ahead of the patient.” Incorporate when you would like to initiate the distress screening process, identifying periods of highest distress for the patient/family.

The draft process map is also an excellent tool to share with the disease-site-specific healthcare providers who are often are not aware of all the details, delays, and opportunities to enhance the patient experience. Further, your process map will also be excellent tool for on-boarding new staff and for succession planning. Review and update your process map on a bi-yearly or annual basis.

 Go Team!

I always share that the disease-site-specific team is like a football team; the better all the players understand everyone’s role and how to best support the patient and each other, the stronger the team will be. Every team always wants what is best for the patient. The mapping process is a valuable approach to not just identify gaps or delays in the care continuum, but to also then go the extra mile to identify “what is best for the patient.”

Work smarter not harder; teamwork makes the dream work!

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Guest blogger Tricia Strusowski, MS, RN, is a consultant with Oncology Solutions, LLC.

Geriatric Oncology: Caring for the Older Cancer Patient

by Chad Schaeffer, MS, FACHE

nurse and patient holding handsWhen we first recruited a geriatric-trained medical oncologist to our practice two years ago, we wondered if his background could be helpful with treating our more elderly patient population in some superior manner. And indeed, our new physician expressed an interest in developing a more formalized elderly cancer clinic. Not surprisingly, some of the physicians in our program did not see the need for this specialized clinic. After all, they were already providing proper care for our older patients who comprised a significant portion of our patient population. And because cancer is most prevalent in older individuals, there was a great deal of truth to this.

Increasing Geriatric Oncology Population

However, when we look at national statistics, more than 50 percent of all cancers and more than 70 percent of cancer-related deaths in the U.S. happen to patients who are 65 years old or older. A new study by Bluethmann and colleagues published in Cancer Epidemiology, Biomarkers & Prevention calls attention to the fact that improvements in cancer screening and detection along with demographic trends are resulting in larger numbers of older cancer survivors who are likely to have other health conditions affecting their care and well-being. Of note, the study finds that among cancer survivors ages 65-69, 27 percent had a history of severe comorbidity. Among cancer survivors ages 85 and older, 47 percent had severe comorbid conditions.1

Further, despite this population trend, the elderly tend to be under-represented in clinical trials for newer cancer treatments.2 This means that we have less assurance that the drugs that come into the market will be as equally effective on the older cancer patients.

Under-treating a curable disease would be mistake, just as it would be a mistake to over-treat any patient such that it would severely diminish his or her quality of life. The NCCN guidelines point out that the proper selection of patients is the key to administering effective and safe treatment for older cancer patients (NCCN Guidelines Older Adult Oncology, Version 1.2016).

All of the above factors make a compelling case for considering the addition of a geriatric oncology clinic to cancer program services.3

Establishing an Outpatient Geriatric Oncology Clinic 

Here at Marshall University/Cabell Huntington Hospital, we have established our outpatient Geriatric Oncology Clinic as a consultative service that can be ordered by any physician within or outside the cancer center. Eligibility requirements for the clinic are: “any patient that is older than 75, or any patient who is age 70 or older with 2 or more significant co-morbidities.”

We modeled our clinic after the Thomas Jefferson University/Sidney Kimmel Cancer Center Senior Adult Oncology Center. Our board certified geriatrician-medical oncologist, and a team of other professionals from Huntington visited Dr. Andrew Chapman in Philadelphia to learn more about how their clinic runs. You can learn more about their amazing program here.

Our Geriatric Oncology Clinic is based on using the right assessment tools (see below). The clinic involves a multidisciplinary group of skilled individuals, including a nurse navigator, a social worker, a dietitian, a clinical pharmacist, and our physicians. The patient is seen in one clinic appointment by all of the individuals on the team. Based on the information received from the testing and evaluations and the input from each discipline, a treatment plan is developed designed to meet the needs of the patient.4 In a large number of the patients seen in our geriatric oncology clinic, standard treatment plans are often modified based on the discussion of the geriatric oncology team as well as the patient’s own personal goals of treatment.

Approach to Decision Making in the Geriatric Oncology Patient

Important considerations for identifying patients who would benefit from treatment include the following:

  • Conducting a Screening and Comprehensive Assessment (CGA)—a multidisciplinary, in-depth evaluation to assess life expectancy and risk of morbidity and mortality in older patients.
  • Determination of life expectancy—chronologic age is less important in risk assessment, prognosis, and treatment decisions than “functional” age for geriatric patients.
  • Assessment Tools—tools to determine functional status, co-morbidities, polypharmacy, nutritional status, cognitive function, psychological status, socioeconomic issues, and geriatric syndromes.
  • Obtaining patient’s goals and values regarding the approach for managing the cancer. Just because a treatment can be well tolerated, is it consistent with the patient’s wishes?

In our experience, we have found that by doing the extra work that is needed to fully evaluate our elderly patients, there is a very high level of satisfaction by both the family and the patients who elect to move forward with cancer therapy at our cancer center. Referring physicians are also pleased with the recommendations that are developed after the patient has been seen in clinic. While the program is still relatively new and has room to grow, it is clear that the geriatric oncology clinic will be a vital part of our success moving forward.

References

  1. Bluethmann SM, Mariotto AB, Rowland JH. Cancer Epidemiol Biomarkers Prev. 2016;25:1029-1036.
  2. Talarico L, Chen G, Pazdur R. Enrollment of elderly patients in clinical trials for cancer drug registration: a 7-year experience by the US Food and Drug Administration. J Clin Oncol. 2004;22:4626-31.
  3. McNeil C. Geriatric oncology clinics on the rise. J Natl Cancer Instit. 2013;105(9):585-586.
  4. Chapman AE, Swartz K, Schoppe J, Arenson C. Development of a comprehensive multidisciplinary geriatric oncology center, the Thomas Jefferson University Experience.  J Geriatric Oncol. 2014;Vol. 5 (2):164-170.

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ACCCBuzz contributing blogger Chad Schaeffer, MS, FACHE, is Executive Director of the Edwards Comprehensive Cancer Center at Cabell Huntington Hospital. He serves on the ACCC Editorial Committee.

Meals or Mammograms? A Decision No One Should Have to Make

By Renea Duffin

Guest blogger Renea Duffin is Vice President of Cancer Support and Outreach, Mary Bird Perkins Cancer Center in Baton Rouge, LA .

Mary Bird Perkins Cancer Center Mobile Medical Clinic

Mary Bird Perkins Cancer Center Mobile Medical Clinic

For many people living in Southeast Louisiana, choosing between paying for a mammogram (or other preventive health screening) or a meal for their family is a decision that can lead to a late- stage cancer diagnosis. And, unfortunately, this happens far too often in many Louisiana communities. Read on to learn how Mary Bird Perkins Cancer Center, a 2016 ACCC Innovator Award winner, has grown its outreach and screening efforts to improve early detection of cancer for the medically underserved.

Collaboration for Comprehensive Outreach

In Louisiana, one in five residents live in poverty, so it is no surprise the state’s cancer mortality rate is the fourth highest in the nation. There are only three other states with a greater uninsured population. In 2002, Mary Bird Perkins Cancer Center began its comprehensive community outreach program to address Louisiana’s disproportionate cancer death rates. Through this innovative initiative, the Center collaborates with many community partners and generous donors to provide free breast, prostate, colorectal, skin and oral cancer screenings for the underserved, underinsured and uninsured members of our 18-parish service area.

Integrating Patient Navigation to Improve Access

As the program continued to grow and evolve, it became evident that not only were screening participants medically underserved, but they faced many other barriers to care such as low health literacy levels, unreliable transportation, and other restricting socioeconomic factors. This led to the implementation of a patient navigation program in 2008 that assists patients receiving an abnormal screening result in accessing additional testing, physician specialists, financial resources, as well as removing other barriers to care.

By the Numbers—Education, Screening, & Early Detection

The following are some additional facts and information about the Center’s education and early detection program:

  • Each year, two mobile medical clinics deliver more than 8,000 free screenings for five types of cancer.
  • More than 74,000 screenings provided and 503 cancers diagnosed since 2002. The Cancer Center’s screening program rate of cancer diagnoses is nearly double the national rate per 1,000 adults screened.
  • Provides screenings outside regular business hours in convenient locations and in areas where they are most needed. Locations and populations are targeted based on zip code data using a powerful database solution.
  • Average time from screening to resolution (diagnosis or all clear) is 10 days compared to the national standard of care, which is 60 days. This expedited timeline is due to collaborative, close working relationships with service providers and the patient navigator’s hands-on approach to patient interactions.

After over a decade of providing education, early detection and navigation services to the medically underserved, we know there is still much to do. We constantly reassess our programs and strategies to ensure we are meeting the needs of those we serve in the hope there will be a day when no one must choose between accessing healthcare services and feeding their family.

At the upcoming ACCC 33rd National Oncology Conference October 19-21, in St. Louis, Missouri, Mary Bird Perkins Cancer Center and all the 2016 ACCC Innovator Award winners will describe their inspirational approaches to complex challenges in delivering quality care to serve their communities. View conference agenda and register today!

Financial Advocacy Services—A Patient’s Perspective

Hands-creating-circle-of-supportScott Steiner’s experience working with oncology financial navigator Dan Sherman, MA, at Mercy Health Lacks Cancer Center, started nearly nine years ago in 2007, when Scott was first diagnosed with a rare gastrointestinal cancer.

Recently Scott was interviewed for a Washington Post article on the growing field of financial advocacy for cancer patients, Tackling the Financial Toll of Cancer, One Patient at a Time.  One reason he’s telling the story of his experience is to spread the word about the difference these services can make for a patient.  In this conversation with ACCCBuzz Scott shares his perspective on the importance of financial advocacy services for patients with cancer.

ACCCBuzz: How did you first start working with Dan?

Scott Steiner:  I kind of stumbled across financial advocacy by good fortune. Dan was actually assigned to me as my social worker, my case worker, when I was first diagnosed with cancer.

ACCCBuzz: What was the process like, working together?

Scott Steiner: The first obstacle that we ran into was the treatment that was prescribed was not approved by my insurance company. Dan actually found that out before I did. He told me before I’d even submitted the claim to the insurance company that it would be refused. And then Dan told me not to worry, that there were options available and that he would help me walk through it to get the situation figured out.

Dan contacted my insurance company to appeal (again) the need for the treatment. They again refused coverage.  Then Dan secured free drugs from the pharmaceutical company as they provided assistance for off-label use. Over the last eight years we have also used multiple co-pay assistance programs when my physician put me on treatments that were covered by my insurance but the co-pays were unaffordable for me. So I have always been able to get access to all of my treatments via free drugs from the manufacturer or via co-pay assistance programs when my co-pays were too costly.

ACCCBuzz: So basically having someone knowledgeable about the resources instead of having to go it alone?

Scott Steiner: Absolutely.  A little bit about our experience. . . about four or five months before I was diagnosed, my son-in-law was diagnosed with cancer, and I had heard so many horror stories from my daughter about how she was battling to get any assistance at all, and they were doing everything themselves. They were contacting the drug manufacturers. They were contacting insurance companies. They were doing all of the leg work.

You don’t know what you don’t know, when you’re going into it. You don’t know the answers to the questions. You don’t even know what questions to ask. You don’t know what help is available. You don’t know the different organizations that are available to help with the different types of cancers. You don’t know which manufacturers have which financial assistance programs. You just aren’t aware of that information unless someone is there to tell you that it’s available.

ACCCBuzz:  You seem to have a collaborative relationship in terms of Dan working with you as you’ve moved through care.

Scott Steiner: It always felt like Dan was a step or two ahead of me, helping me to know what was coming next.  For example, he’s the one who recommended that I apply for disability. I really fought that at first. There’s the pride issue of wanting to provide for your family. And, if at all possible, I wanted to do that. But over the course of a few months, Dan walked me through that whole process and got me to a place where I agreed to go ahead with the disability application. Dan told me that most likely the first response would be denial. He told me what to expect. These are things that I know other people who are going through the disability process and the application process just give up on. You get denied, who wants to keep going?

You’re already fighting enough battles and having to process enough information. There is just so much going on. For either the patient or family to have the resources and time to fight these additional battles, it’s just overwhelming.

ACCCBuzz: What would you tell new oncology financial advocates who are just getting started in the field?

Scott Steiner: I think that financial navigators who know what patients are going to face have to understand that they are not just helping us to navigate the pitfalls that are coming. They have to educate us to know that there are pitfalls that we have to be aware of—especially when it comes to providing for your family. There may come a point with the cancer journey where you just can’t. Patients have to understand that. What Dan has always been good about helping me understand and work through is that the financial aid that is available, the disability that I paid into when I was working, these are all ways for me to provide for my family. And by not taking advantage of these resources, I put my family at risk.

ACCCBuzz:  Why do you feel it’s important to spread the word about the impact of financial advocacy services?

Scott Steiner:  I’ve been battling this for so long. I’ve been part of support groups. I’ve journeyed it with my own family. My son-in-law and then my sister were diagnosed [with cancer]. We lost her a few years ago.  We had so many contacts with people who were in the cancer journey; the more I learned about their battles, the more I realized what I had at Lacks Cancer Center and especially with Dan was not the norm. It’s not what was done at a lot of cancer centers. I just realized what a blessing it had been to me, and that there really is this need [for these types of services]. It’s a need; it’s not an option. There’s just way too much to handle when you’re dealing with cancer. If you can get the financial challenges off your plate, that’s a huge help because that’s what sinks you. If the disease doesn’t get you, the finances will.

ACCCBuzz: Any final thoughts that you want to add?

Scott Steiner:  Financial navigation doesn’t just help the patient. It helps the cancer center or the hospital. They are helping themselves [by reducing write offs and bad debt].

I think hospitals [and] cancer centers need to understand that these services need to be part of their care for their patients—just like they help by connecting us with psychological help when we need it, or transportation, or support groups. Financial assistance is just as important, if not more important, than all of those other services they offer help with.

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Oncology financial navigator Dan Sherman, MA, LPC, serves on the Advisory Committee for the ACCC Financial Advocacy Network (FAN). Learn more about resources and training for financial advocates available through the ACCC Financial Advocacy Network.

Snapshot of a Case-Based Financial Advocacy Network Workshop

By Joseph Kim, MD, MPH, MBA

Hands-creating-circle-of-supportACCC recently held its first Financial Advocacy Network (FAN) Case-Based Workshop of 2016.  Attendees representing a wide range of professionals working in financial advocacy joined in lively discussions across the continuum of cancer care in the community. Even today, many cancer programs do not have enough dedicated financial advocates providing support and assistance to cancer patients who struggle to pay for their care. As a result, social workers continue to shoulder the bulk of the responsibility of identifying financial resources and assisting patients with the process of completing online applications and forms for patient assistance programs.

Solving Real-World Scenarios

At the May 23 workshop held in Cleveland, Ohio, participants jumped right into dynamic case-based discussions, drilling down into specific scenarios that required them to uncover clues and develop customized plans for patients based on the unique circumstances presented case by case. Throughout the day, several key themes emerged:

Medicare:  Discussions touched on improving health insurance coverage for patients who are on Medicare. There is clear need to educate both providers and patients about the complexity of Medicare and the different options that range from Medicare Advantage, Medicare Supplement (Medigap), Medicare Select, Medicare Savings Program, Medicare Low Income Subsidy (Extra Help), and much more. Some cancer programs hold dedicated education and outreach events around the Medicare Open Enrollment Period so that patients understand their options.

Improving Communication: Another issue that resonated with most attendees was the need to improve communication about patients’ financial concerns across all the members of the cancer care team. Since this information is often not clearly documented in the patient’s chart, it may be difficult for nurses, and medical oncologists to truly understand the total impact the costs of treatment may have on a patient’s life. Improving those lines of communication could lead to creative and innovative ways to reduce the financial burden placed on cancer patients.

Tracking Savings: Almost every cancer program helps patients find various drug assistance programs, but many may not be effectively tracking their savings across their entire financial advocacy department. Attendees remarked how they were using manual spreadsheets to record the direct amounts received from patient assistance programs, drug replacements, and donations from foundations and other charitable organizations. Some track how their hospital-based charity programs are helping cancer patients with their costs of treatments. There are also savings that can be measured when financial advocates help patients improve their insurance coverage options, but these savings are not frequently being tracked.

Growing Need for Financial Advocacy: Throughout the workshop, attendees agreed on the need to strengthen and grow their financial advocacy programs. The complexity of cancer care is rising and the out-of-pocket costs are becoming significant burdens that may impact how patients receive care.

If you missed the FAN Workshop in Cleveland, be sure to mark your calendars for the upcoming FAN Workshops in Dallas, Texas, on August 17, 2016, and in Philadelphia, Pennsylvania, on September 29, 2016. Learn more and register here.

In the meantime, check out the resources available to financial advocates on the ACCC Financial Advocacy Network section of the ACCC website.

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Guest blogger Joe Kim, MD, MPH, MBA, is serving as the facilitator for the 2016 ACCC FAN Case-Based Workshops.  Dr. Kim is President of Xaf Solutions.

 

 

 

Navigation Documentation Tools Can Support Compliance with Commission on Cancer Standards

By Tricia Strusowski, MS, RN

ThinkstockPhotos-180686516Documentation by oncology patient navigators can play an important role in your cancer program’s efforts to comply with the new Commission on Cancer (CoC) Standards that became effective in 2015.  This blog reviews documentation-tool compliance—in other words—how your documentation tools can help you demonstrate compliance with CoC Standard 3.1 Patient Navigation Process and Standard 3.2 Psychosocial Distress Screening.

Let’s start with a review of key elements of these standards:

Standard 3.1: Patient Navigation Process

A patient navigation process, driven by a community needs assessment, is established to address health care disparities and barriers to care for patients.  Resources to address identified barriers may be provided either on-site or by referral to community-based or national organizations.  The navigation process is evaluated, documented, and reported to the cancer committee annually.  The patient navigation process is modified or enhanced each year to address additional barriers identified by the community needs assessment . . . .

Prior to establishing the navigation process, the Cancer Committee conducts a community needs assessment to identify the needs of the populations served, opportunities to improve cancer health disparities, and decrease gaps in resources. This assessment reoccurs at least once during the three-year survey cycle.

Standard 3.2: Psychosocial Distress Screening

The Cancer Committee develops and implements a process to integrate and monitor on-site psychosocial distress screening and referral for the provision of psychosocial care . . . .

The psychosocial representative on the Cancer Committee (oncology social worker, clinical psychologist, or other mental health professional trained in the psychosocial aspects of cancer care) is required to oversee this activity and report to the Cancer Committee annually.

Timing of screening: Patients with cancer are offered screening for distress a minimum of one time per patient at a pivotal medical visit to be determined by the program. Some examples of a “pivotal medical visit” include time of diagnosis, pre-surgical and post-surgical visits, and first visit with the medical oncologist to discuss chemotherapy, routine visit with a radiation oncologist, or post chemotherapy follow-up visit. Preference is given to pivotal medical visits at times of greatest risk for distress, [emphasis added] such as at time of diagnosis, transitions during treatment (such as from chemotherapy to radiation therapy), and transitions off treatment.

Method: The mode of administration (such as patient questionnaire, clinician-administered questionnaire) is to be determined by the program.

Tools: Preference is given to standardized, validated instruments with established clinical cutoffs; however, facilities may use a measure of their choice.

The complete CoC Cancer Program Standards: Ensuring Patient-Centered Care  (2016 Edition) is available on the CoC website here.

Navigation Tools & Reports Can Support Compliance

Here are five tips for creating your navigation tools and reports so that they support CoC standard compliance:

  • Ensure that the fields in your tools are specific to the standard. Many navigation programs tend to over collect information that is not needed to be compliant with the standard, resulting in additional work for the staff and/or patient and possible confusion about what information needs to be reviewed at cancer committee.
  • Keep your documentation tools and reports simple. Be sure to define your documentation fields on your tools and reports; this will ensure that the navigators are collecting the information in a consistent manner.
  • Create evidenced-based tools. For compliance with the CoC standards, tools should be evidence based. For distress screening, examples include the NCCN psychosocial distress screening tool or the FACT (Functional Assessment of Cancer Therapy) tool.
  • Use your EHR or an Excel file. Since the navigation program needs to be reviewed at the cancer committees on a yearly basis, using your EHR or an Excel file makes it easy to aggregate information for these presentations.
  • Make the most of your Community Needs Assessment (CNA). Your CNA is essential because it helps identify your population of patients and their specific needs and barriers. The CNA can also be used to identify performance improvement activities for your program.  Further, it provides an excellent review for the navigators, as well as all cancer program support services, to more fully understand their patients.

Community Needs Assessment (CNA): A Valuable Resource

Cancer programs are not as familiar with creating Community Needs Assessments; however, there are great resources to help you identify the data you will need. For example, the information and data needed for your CNA can come from:   American Cancer Society Facts and Figures, American College of Surgeons Commission on Cancer, Academy of Medicine (formerly known as Institute of Medicine), the Centers for Disease Control and Prevention Cancer Data and Statistics, U.S. Census Bureau, State Health Department and Internal Revenue Service, and National Cancer Institute Surveillance Epidemiology and End Results.

As you develop your tools:  Make sure they work for YOU, and that you are NOT working for your tools.  

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Guest blogger Tricia Strusowski, MS, RN, is a consultant with Oncology Solutions, LLC.

ACCC Members Bring Sun Safety Awareness to their Communities

by Amanda Patton, ACCC Communications

453142595May is designated as Skin Cancer Awareness Month and the National Council on Skin Cancer Prevention has named today “Don’t Fry Day” to encourage sun safety awareness.

As we head into the summer, community swimming pools open, families and friends gather for picnics and barbecues, and thousands head to beaches and lakes for fun in the sun. Recent statistics from the American Academy of Dermatology (AAD) make clear the critical need to keep sun safety on everyone’s radar screen:

  • Estimates are 1 in 5 Americans will develop skin cancer in their lifetime
  • 8,500 people in the U.S. are diagnosed with skin cancer every day
  • Melanoma rate in the U.S. have doubled from 1982 to 2011

This month and throughout the year, ACCC Cancer Program Members and their staff play an important role in educating their communities on skin cancer prevention, early detection, and screening. For example:

In Delaware, Christiana Care Helen F. Graham Cancer Center schedules free Skin Cancer Screening Awareness programs just ahead of the Memorial Day weekend. The evening education sessions—offered in both English and Spanish—include information on self exams, risk factors, and how to protect yourself and your family. The programs use AAD materials and also promote a Delaware state skin cancer education and awareness program.

In Maryland, at Atlantic General Hospital, Regional Cancer Care Center, skin cancer awareness activities during the month of May include a digital display slide on hospital lobby TVs calling attention to the need for farmers to stay skin safe; Facebook posts with sun safety tips and resources; and free skin checks by Atlantic General Dermatology at the Annual Ocean City Health Fair.

In Idaho, St. Luke’s Mountain States Tumor Institute, developed the POOL COOL program to bring sun safety education to community swimming pools.

Each year, Skin Cancer Awareness Month serves as a call to action, an opportunity to spread the message on sun safety and skin cancer prevention. ACCC thanks all of our member programs and their multidisciplinary care providers for their efforts in May—and throughout the year—promoting health in their communities through education on prevention, screening, and early detection.