CANCER BUZZ

Isolation is a common concern among caregivers. Studies show that 40% to 70% of family caregivers experience clinical symptoms of depression. The lack of social interaction and stimulation from individuals other than their care recipient, especially when cognitive impairment is present, can be an undeniable trigger for loneliness. Addressing isolation is critical and any way that caregivers can connect with peers, professional support, and friend/colleague support networks is a priority.

CANCER BUZZ spoke to Allison Applebaum, PhD, Psychologist, Memorial Sloan Kettering Cancer Center in New York City, NY. Listen as Dr. Applebaum discusses combatting the feeling of isolation among caregivers.

"…Inevitably all caregivers will experience isolation."

"Many caregivers have it together, they're on top of everything. They are organized, they are experts at this, but they are falling apart inside. You aren't going to know if you don't ask."

Allison Applebaum, PhD

Psychologist

Memorial Sloan Kettering Cancer Center

New York City, NY

Resources:

American Cancer Society

Cancer Support Community

Memorial Sloan Kettering Cancer Center

National Alliance for Caregiving

This project is supported by EMD Serono.

Adding a clinical trials navigator to this practice team required a business case that demonstrated return on investment. After a successful onboarding, this navigator is now the point person to help identify patients appropriate for clinical trials and to help busy clinicians with enrollment criteria and trial selection.

Guest:

Carrie Friedman, BSN, RN, OCN

Clinical Trials Navigator

Virginia Cancer Specialists, PC

"The number of physicians across all our sites that are referring patients for clinical trials has increased…we easily take over 100 referrals a month. Looking forward, we may even need a second navigator who can replicate my role."

This podcast is part of an ongoing series from ACCC's peer-related journal, Oncology Issues. For a deeper dive into this content, read Friedman's article, Increasing Clinical Trial Accrual Through Implementation of a Clinical Trials Navigator. ACCC members can access the complete Volume 38, Number 4 issue online.

Resources:

Just ASK! How One Healthcare System is Operationalizing This Implicit Bias Program to Ensure Equitable Access to Clinical Trials

The ASCO-ACCC Joint Initiative to Increase Diversity in Clinical Trials

Virtual Navigation to Clinical Trials

New Legislation Expands Access to Clinical Trials

Older Adults with Cancer & Clinical Trials

Lipson Cancer Institute adapted the University of Washington's Collaborative Care model to embed counseling services into oncology and palliative care across 6 clinic locations. This model allows patients with cancer to receive counseling for depression, anxiety, and other psycho-social concerns while in active treatment and survivorship, eliminating many barriers to care. Counseling is provided in-person or virtually, ensuring that critical support and mental health care are accessible to all, including patients in rural areas and those who are homebound.

Guest:

Earon Lehning, LMSW, Collaborative Care Therapist

Rochester Regional Health – Lipson Cancer Institute

Rochester, New York

"When our social work team meets with patients…and identifies a mood concern, they are able to put someone on my schedule within the next 2 days for an intake, compared to [services] in the community where it might take months to connect with a mental health provider."

This podcast is part of a special series with the 2023 ACCC Innovator Award winners. For a deeper dive into this and other content that will help your team reimagine how care is delivered at your cancer program or practice, register today for the ACCC 40th National Oncology Conference, Oct. 4-6, in Austin Texas.

Resources:

Collaborative Care: A Solution for Increasing Access to Psychosocial Care in Cancer Programs and Practices

Oncology Leaders Issue Urgent Call for Mental Health Support Improvements

[Podcast] Cancer Care Team Mental Health: Normalizing Helpers Seeking Help

Delivery of Psychosocial Cancer Centers Care in Oncology Summit

AMCCBS Psychosocial Summit Pre-Read

[Blog] Psychosocial Care in Oncology: Advocating for Policy Changes that Improve the Culture of Care

[Blog] Psychosocial Care in Oncology: The Impact of Social Determinants of Health

Supportive Oncology in Lung Cancer: Program Development for Patients and Care Partners

Providing Psycho-Education to Combat Fatigue

Every day caregivers face emotional, physical, and logistical challenges caring for their loved ones. But what about the toll on the caregivers themselves? Ensuring empowered caregivers involves educating and informing them, engaging them in planning and decision-making, and reassuring them that their role is manageable and worthwhile. Any steps providers can take to combat the invisibility of caregivers is important. This can range from simply acknowledging the caregiver's presence in medical appointments to routing them to caregiver-specific support and services.

CANCER BUZZ spoke to Allison Applebaum, PhD, Psychologist, Memorial Sloan Kettering Cancer Center in New York City, NY. Listen as Dr. Applebaum discusses practical tips providers can use to support caregiver empowerment.

"I think it is quite important for ALL members of the health care team to be able to identify signs and symptoms of distress in caregivers and should know what resources are available in their unique cancer center so they can refer these caregivers or make a suggestion that they speak to a social worker."

"The number 1 tip, is to acknowledge the caregiver's presence."

Allison Applebaum, PhD

Psychologist

Memorial Sloan Kettering Cancer Center

New York City, NY

Resources:

American Cancer Society

Cancer Support Community

Memorial Sloan Kettering Cancer Center

National Alliance for Caregiving

This project is supported by EMD Serono.

While next-generation sequencing is recommended by the National Comprehensive Cancer Network for biomarker testing for all patients with advanced non-small cell lung cancer (NSCLC), uptake among community oncology programs and practices is suboptimal. To standardize comprehensive biomarker testing in patients with NSCLC, Oncology Hematology Care, Inc., developed and implemented a 1-year quality improvement (QI) project that included custom data reports and monitoring dashboards to ensure practice-wide adoption and sustainability across multiple clinic sites. After increasing biomarker testing rates from 68% to 92.7%, this QI project is now being scaled across the country through the US Oncology Network, McKesson as a best-practice initiative.

Guest:

Molly Mendenhall, RN, BSN

Director of Quality and Compliance

Oncology Hematology Care, Inc. (OHC)

Cincinnati, Ohio

"[On average] biomarking testing for patients with cancer is less than 50%. But with a shift towards personalized medicine, if we can implement and standardize this testing across the nation, we could provide targeted therapies, which have been shown to improve overall survival and quality of life."

This podcast is part of a special series with the 2023 ACCC Innovator Award winners. For a deeper dive into this and other content that will help your team reimagine how care is delivered at your cancer program or practice, register today for the ACCC 40th National Oncology Conference, Oct. 4-6, in Austin Texas.

Resources:

[Video] Optimizing Advanced NSCLC Biomarker Testing, Treatment, and Management Virtual Summit

Biomarker Testing in Patients with Non-Small Cell Lung Cancer

NSCLC Biomarker Testing Roadmap Infographic

[Video] Optimizing Biomarker Testing through Precision Medicine Stewardship

A Financial Advocate's Guide to Biomarker Testing

Paying for Biomarker Testing

[Podcast] Financial Barriers to Biomarker Testing

[Podcast] Biomarker Testing Advocacy

The rapid evolution of cancer care delivery toward multi-agent regimens, oral and/or combination therapies, and at-home treatment administration has made cancer caregiving extremely complex. The Caregiver Clinic at Memorial Sloan Kettering provides support to people who are having difficulty coping with the demands of being a caregiver. The purpose of this clinic is to help individuals maximize their ability to provide care to loved ones while attending to their own self-care, needs, and other important responsibilities. Caregivers can receive individual, group, couples, and family therapy sessions, as well as medication management as needed.

CANCER BUZZ spoke to Allison Applebaum, PhD, Psychologist, Memorial Sloan Kettering Cancer Center in New York City, NY. Listen as Dr. Applebaum discusses the programs and practices in place at Memorial Sloan Kettering Cancer Center to support caregivers.

"We talk a lot about sitting with uncertainty. So many caregivers struggle with the fact that they can't plan… they can't plan for a vacation in six months, they actually can't plan for the next day sometimes and that is exhausting and quite difficult for caregivers over the long term."

"For many (caregivers) they feel there is so much support around patients, but so very little support for them, and they feel left out (and alone)."

Allison Applebaum, PhD

Psychologist

Memorial Sloan Kettering Cancer Center

New York City, NY

Resources:

American Cancer Society

Cancer Support Community

Memorial Sloan Kettering Cancer Center

National Alliance for Caregiving

This project is supported by EMD Serono.

Between 4% to 15% of patients with cancer who are treated with a class of medications called immune checkpoint inhibitors experience immune-related adverse events (irAEs), including hypothyroidism, hyperthyroidism, and insulin-deficient diabetes. Delayed access, diagnosis, and management of irAEs are often causes of preventable hospital admissions in cancer patients.

At Duke Cancer Institute, the implementation of electronic-consults for patients experiencing endocrine irAEs improved patient access and reduced healthcare utilization. Time to appointment and hospitalizations were reduced from 61 days to 39 days and from 11% to 2%, respectively. To propel integration and scalability, the next step is to ensure adequate reimbursement from payers for these types of e-consults.

Guest:

Afreen Shariff, MD, MBBS

Director, Duke Endo Oncology Program

Associate Director, Cancer Therapy Toxicity Program, Center for Cancer Immunotherapy

Duke Cancer Institute

Durham, North Carolina

"I've been a strong advocate to fix the effort and reimbursement mismatch because these are very different from traditional e-consultative services…the acuity of patients is different. The level of expertise that is needed to triage and give recommendations to patients is different…the reimbursement we get through third party-payers is what I call the 'coffee and bagel' consult because it really doesn't do justice to the kind of service we provide."

This podcast is part of a special series with the 2023 ACCC Innovator Award winners. For a deeper dive into this and other content that will help your team reimagine how care is delivered at your cancer program or practice, register today for the ACCC 40th National Oncology Conference, Oct. 4-6, in Austin Texas.

Resources:

Managing irAEs into Post-Treatment Survivorship

Working with Rheumatologists to Manage irAEs

Adverse Event Management in the Community-Based Immuno-Oncology Clinic

Virtual Toxicity Team Cleveland Clinic

Perspective on Managing Immune-related Adverse Events

Working with Rheumatologists to Manage irAEs

Many patients with small cell lung cancer (SCLC) have a high symptom burden, poor prognosis, and adherence challenges due to treatment-related adverse events, stigmatization, and emotional distress. Multidisciplinary care coordination and timely diagnosis are critical to achieve positive health outcomes for this patient population. Nurses play an important role in the direct care of patients. CANCER BUZZ spoke to Robin Atkins, RN, Symptom Management Triage Nurse, Virginia Oncology Associates in Gloucester, VA. Listen as we discuss nursing's role in the care of patients with small cell lung cancer (SCLC).

"What the patient experience means to them is what the nurse should be listening for, just hearing a list of side effects, hearing a list of concerns, doesn't really translate into patient-centered care because the nurse becomes very task oriented. Rather, we need to interpret that for the patient in a way that they understand what the interventions mean to them."

Robin Atkins, RN

Symptom Management Triage Nurse

Virginia Oncology Associates

Gloucester, VA

Resources:

Cancer Support Community

Go2 for Lung Cancer

LUNGEVITY

Lung Cancer Research Foundation

For several years, this healthcare system struggled to find a sustainable program to perform outreach to patients with outstanding orders for lung, breast, and colon cancer screenings. A financial analysis of associated expenses, reimbursement, payer mixture, and downstream revenue of these screening efforts demonstrated positive net return on investment, allowing for expansion and implementation of the Population Health Support Services team to perform this task. In 2022, 12 outreach specialists scheduled visits that accounted for 38% of completed lung cancer screenings and 15% of completed breast cancer screenings for this healthcare system.

Guest:

Michael Gieske, MD

Medical Director, Lung Cancer Screening

St. Elizabeth Cancer Center

"We've demonstrated through a financial analysis of our screening programs that colon, breast, and lung cancer screening definitively have a net positive revenue. There's a return on investment for every lung cancer screen we do, for every mammogram we order, for every colon cancer screening we do. The more [screening] you do, the more volume is generated, and the better business case you make for supporting a screening program."

This podcast is part of a special series with the 2023 ACCC Innovator Award winners. For a deeper dive into this and other content that will help your team reimagine how care is delivered at your cancer program or practice, register today for the ACCC 40th National Oncology Conference, Oct. 4-6, in Austin Texas.

Resources:

ACCC Spotlights Critical Lung Cancer Screening Needs in Appalachia

Appalachian Community Cancer Alliance: Who We Are and What We Can Accomplish

PCP Insights Needed to Improve Cancer Screening in Rural Appalachia

Oncology Capture of ED Patients with Incidental Radiologic Findings

Leveraging a 3D Lung Nodule Educational Tool to Reduce Patient Distress

The Role of Population Health Navigators

Population Health Navigators: An Innovative Approach for Supporting Underserved Patients

Caregivers experience higher levels of financial, emotional, and physical health difficulties than non-caregivers and are more likely to suffer from depressive symptoms and mental health problems. The Caregivers Clinic at Memorial Sloan Kettering Cancer Center is the first of its kind and provides comprehensive psychosocial care to family members and friends of patients who experience significant distress and burden because of their caregiving role. CANCER BUZZ spoke to Allison Applebaum, PhD, Psychologist, Memorial Sloan Kettering Cancer Center in New York City, NY. Listen as Dr. Applebaum discusses the development and dissemination of psychosocial interventions for cancer caregivers, as well as understanding the impact of caregiver psychosocial wellbeing, prognostic awareness, and communication skills on advanced care planning.

"So many caregivers feel like they weren't given a choice to become a caregiver, and often feel disempowered in their caregiving journeys. Through discussions on attitude taking, we can help caregivers connect to the ways in which they can choose to respond to the limitations and losses they face."

Allison Applebaum, PhD

Psychologist

Memorial Sloan Kettering Cancer Center

New York City, NY

Resources:

American Cancer Society

Cancer Support Community

Memorial Sloan Kettering Cancer Center

National Alliance for Caregiving

This project is supported by EMD Serono.