Founded in 1974, the Association of Community Cancer Centers (ACCC) represents more than 23,000 oncology care providers in the United States from more than 2000 hospitals and cancer care centers.1 The ACCC estimates that 65% of cancer patients in the United States receive their treatment at a hospital affiliated with the organization. The ACCC hosts five meetings annually, in addition to multiple webinars and information sessions held throughout the year.
The ACCC held their 34th National Oncology Conference in Nashville, TN, from October 18 to October 20. The meeting highlighted advances in the treatment and care of patients with multiple different types of cancers, as well as issues germane to practice within the community oncology sphere. At the conference, Barbara L McAneny, MD, FASCO, MACP, president-elect of the American Medical Association, was honored with the Annual Achievement Award. “It is a great honor to receive this ACCC award,” said Dr McAneny in her acceptance speech. “This is an organization that brings together thousands of specialists from all areas of cancer care, from cancer centers and hospitals to private practices and academic centers. All of us have a common cause, which is taking care of cancer patients. So, to receive an award from an organization that has so many great people to choose from is one of the greatest honors of my life.”2
Duke Cancer Institute Launches Community Partnership Program
Duke Cancer Institute has developed a community health program focused on minimizing cancer disparities and improving overall health. Nadine J Barrett, PhD, MA, MS, director of the Office of Health Equity and Disparities at Duke Cancer Institute (Durham, NC) presented on the initiative.
“Part of the Office of Health Equity and Disparities is to really start thinking about what are some of the key needs in our community,” Dr Barrett said in a video supplied by ACCC. “African Americans, Latinos, and other disenfranchised groups tend to have worse outcomes compared to their white counterparts, or those who might be wealthier. So what we really wanted to focus on is how we ensure that people have the right information to act upon—the education component. The other part is outreach: How do we as an institution partner with community organizations to ensure that we are doing the appropriate outreach.”
Community partnerships have served as the basis for the creation of the program. Local organizations, faith initiatives, community liaisons, and representatives from state and local bodies comprise the program’s advisory council. Outcome measures, research, and partnerships have also been designed to refine and spread the program’s messages, and to help achieve the program’s goals.
The program’s advisors focused on three distinct areas: community engagement and outreach, bringing diversity to clinical trials and research, and educating practitioners on health disparities in research and practice.
Since its implementation, Dr Barrett conjectures that the program has reached more than 5000 community members, resulting in more than 1500 cancer screenings. The majority of screened patients were uninsured, and approximately 35% were undocumented. Twelve percent reported having no primary care provider.
Screenings resulted in the initiation of follow-up care for 52 community members.
Further goals of the program, which was funded in part by the National Cancer Institute, include outreach to racial and ethnic minority groups; individuals living in underserved and rural communities; and individuals in the lesbian, gay, bisexual, transgender, and queer community.
“When we think about the challenges that really prohibit people from getting access to care, it’s not just the issue of the system,” Dr Barrett said. “It’s also a challenge in terms of people having fear and concerns about navigating this complex health system. It’s really important to eliminate those fears and break some of those myths.”
Lay Navigators Improve Quality of Cancer Care, Reduce Costs
Integrating lay navigators into a cancer care network reduced hospitalizations by 8% per quarter and accounted for $19 million in savings for Medicare.
The Patient Care Connect program, which is implemented in the University of Alabama at Birmingham (UAB) 12-institution cancer network, is designed to help patients make appropriate treatment choices, reduce the use of ineffective therapies, and maximize the appropriate use of health care resources. The health care systems are encouraged to achieve the tripe aim.
The lay navigators’ role in this program involves empowering patients to identify resources, recognize clinical symptoms, understand their disease, and engage in end-of-life discussions with their providers, as well as connecting patients to providers to address symptoms and coordinating care between multiple providers.
“We really wanted to encourage patients to take an active role in their health care,” said Gabrielle B Rocque, MD, assistant professor, division of hematology and oncology, UAB School of Medicine, during her presentation. “Navigators can fix problems for patients, but we wanted to focus on the concept that of empowering patients to learn how to use the system and the resources that are available.”
From March 2013 through December 2016, Patient Care Connect helped navigate approximately 10,000 patients. Individual navigators had an average of 152 patients per quarter.
Long-term results of the program showed a 6% reduction in emergency room visits, 8% reduction in hospitalizations, and 10% reduction in intensive care unit visits per quarter among navigated patients compared with matched controls.
This improvement in health care resource utilization resulted in approximately $19 million savings for Medicare across the health system during each year of the program. Additionally, researchers reported that patients engaged in advanced care planning had lower health care utilization at the end of life and lower chemotherapy use.
Researchers acknowledged that navigator-led distress screening identified a few non-treatment-related issues, such as fatigue, scheduling concerns, and transportation concerns.
“Navigation will be a key element of future patient-centered, value-based health care redesign,” commented Dr Rocque.
Cancer Survivor Offers Insights for Oncologists, Care Providers
Brianne Joseph, LPI, a cancer survivor and author of Punk Azz Cancer: How Dare You! How to Turn Your Pain into Power After a Cancer Diagnosis, presented on the levels of support provided by clinicians and other care team members.
A private investigator by training, Ms Joseph was diagnosed with ductal carcinoma in situ at the age of 38 years. Her presentation touched on her experience as she navigated the complicated world of cancer treatment.
“All I was interested in was if I was going to die, when I was going to die, and how much time I would have with my babies,” Ms Joseph said.
Her initial doctor did not appear equipped to handle her emotional state. “My doctor was an excellent doctor and he was very professional, but he wasn’t very emotionally supportive of me, and he was very robotic in his explanation,” she said. “Perhaps if my doctor had given me a hug, or at least told me that everything would be okay, it would have made a world of difference in that moment.”
Ms Joseph’s experiences, as well as conversations with other cancer survivors, inspired her to write and speak about ways that care providers can be supportive of their patients during treatment.
“You are some of the most intelligent people on the face of the earth, but it’s important that you remember to be a human being first,” she said. “Everyone can see the scars we bear from our mastectomies or our lumpectomies. The scars that are the hardest to heal are the ones you cannot see.”
Ms Joseph encouraged providers to view the concerns that patients have about their treatment as part of the overall experience, particularly in regard to younger patients.
“It’s equally important that we are given resources to support the emotions we are feeling, so that we can become empowered,” she said. “Empowerment is simply about giving us tools we need so that we can become advocates for our own health.”
Cancer Hospital Pilots Free Texting Service to Update Patient Families
Van Elslander Cancer Center (Detroit, MI) has developed a free text messaging service to keep the families of patients undergoing surgical procedures informed. This move came as a way to improve analog surgical updating systems, such as a basic surgical board.
“When we asked families for their feedback about their experiences, they said ‘nobody tells us anything,’” Anthony Pappas, MHA, gastrointestinal oncology coordinator at Van Elslander Cancer Center, said during a presentation. “Surgeries can last anywhere from 6 to 14 hours. We wanted to develop something that would allow family members to get updates every couple of hours during surgery.”
The service is provided through an app called TEXT NOW, on which family members can create accounts for text message updates. A designated family member provides a cell phone number to a staff member, who uses the app to issue an update every few hours.
Data shared through the app are encrypted, and the messages sent through the app do not contain specific medical or personal information. Family members can use the app to ask questions of the care team.
The pilot program has been used in more than 80 surgical cases since its inception last year. All families who used the service have been given surveys, of which 30 have been returned. Survey results have shown an average score of 9 out of 10 with regard to patient satisfaction.
“Patients and their families know they are in good hands when they come to us,” Mr Pappas said. “We hope this can catch on across the surgery department and in the hospital. Patients don’t want it to stop.”
References
1. About the Association of Community Cancer Centers. Association of Community Cancer Centers website. https://www.accc-cancer.org/about/. Accessed October 27, 2017.
2. Association of Community Cancer Centers honored medical oncologist and AMA president-elect Barbara L McAneny with National Award. Association of Community Cancer Centers website. https://www.accc-cancer.org/mediaroom/press_releases/2017/ACCC-Honored-Medical-Oncologist-and-AMA-President-Elect-Barbara-McAneny-with-National-Award-10.26.17.asp. Published October 26, 2017. Accessed October 27, 2017.
