Caring for the Whole Patient: Two Cancer Programs, Two Approaches

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

The pivotal 2013 Institute of Medicine* report, Delivering High Quality Cancer Care: Charting a New Course for a System in Crisis, effectively outlines what those of us working in the cancer setting inherently know: More than 1.6 million patients are newly diagnosed with cancer annually; a number that is expected to rise to 2.3 million by 2030. The same report notes that by 2022, there will be 18 million cancer survivors in the U.S.

Cancer is indiscriminate. The newly-diagnosed are old, young, rich, and poor; fathers, mothers, daughters, sons, and siblings; they are single, married, bisexual, and gay; some are working, retired, on disability, or collecting social security. Two things these patients have in common are (1) they are people who are performing the activities of daily living—whatever that may be—and (2) cancer has changed their lives forever.

On a positive note, achievements in clinical science and treatment have led to earlier detection of many cancers, significantly increased life expectancy, and cured many of the disease. However, these same people may face other challenges often not detectable by the untrained eye: they are scared, anxious, depressed, and often suffering from considerable physical impairment that may dramatically impact their daily lives. As the 2008 IOM report Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs notes, these emotional, mental, and physical symptoms may be an exacerbation of issues the patient had prior to the cancer diagnosis.

The March/April edition of ACCC’s journal Oncology Issues includes feature articles that detail how two cancer programs have dramatically improved the lives of their patients (and patients’ caregivers) by instituting psychosocial distress screening and support programs. In their article, “Building a Navigation and Psychosocial Support Program from the Ground Up,” Lori McNulty, RN, and Faye Flemming, RN, BSN, OCN, describe how the Southside Regional Medical Center implemented a newly-developed patient navigation program as the foundation of their psychosocial support services. As with many cancer programs, Southside Regional Medical Center, though committed to furnishing these services, couldn’t justify the financial outlay needed to hire additional staff. By partnering with a local community organization, Southside Regional Medical Center was able to facilitate a patient-centered—and financially sustainable—approach to providing these vital services to their patients. Additionally, its support program was established in such a way that the cancer program was able to meet many of the accreditation standards set forth by the Commission on Cancer.

The Norton Cancer Institute in Louisville, Kentucky, embedded a psycho-oncology program in its center to more effectively meet the needs of its patients’ psychosocial needs. Noting that psychological distress is common among cancer patients and often goes unrecognized, this ACCC member program developed the Norton Cancer Institute Behavioral Oncology Program (NCIBOP). As described in their article “Building Bridges, Breaking Down Barriers: An Embedded Psycho-Social Program Improves Patient-Centered Care,” NCIBOP is “a comprehensive, embedded psychiatric program with an emphasis on integrating high-quality psychiatric care to medically complex patients.” The program offers a multitude of group and individual therapy services and consultations in both the inpatient and outpatient setting. Staffed by three advanced practice RNs, a psychiatrist, a part-time social worker, a nurse, and two administrative staff, the team addresses the needs of approximately 800 patients per year. NCIBOP’s evidence-based, patient-centered approach has allowed many patients to experience a dramatic improvement in the quality of their lives.

Two cancer programs with two different approaches to meeting the cancer patients’ needs—these articles illustrate the complexity of oncology care delivery. At the same time, these divergent approaches also highlight the opportunity individual programs have to develop a programmatic structure designed to meet the needs of their unique patient population. The result? Patient-centric care models that meet the needs of the whole patient, just as the IOM report recommends.

*Note: On March 15, 2016, the division of the National Academies of Sciences, Engineering, and Medicine (the Academies) that focuses on health and medicine was renamed the Health and Medicine Division (HMD) instead of using the name Institute of Medicine (IOM). For more information, visit www.nationalacademies.org.