Comprehensive Cancer Care: Bridging the Gap Between Treatment and Support: Addressing the Challenges Faced by Cancer Patients In A Complex Environment

Brianna Abbott's recent WSJ article, 'Cancer Care Is Getting Personal. Local Doctors Can't Keep Up,' published October 22nd, has given me much to think about

The overall message of the article is that cancer care is becoming more personalized with an increasing number of new drugs and changing treatment guidelines. It is also reasonable to say that local doctors are struggling to keep up with the rapid pace of change. This complexity is leading to a divide in how patients fare depending on where they go for treatment. Oncologists at magnet cancer centers have the expertise to develop personalized treatment plans for patients, but most people get treated locally to be near home and jobs. Local oncologists, faced with a range of cancers, may not be able to stay up-to-date on everything. This can result in patients receiving suboptimal care.

However there were several excellent points made in the WSJ Opinion section today entitled “Oncologists Diagnose Their Industry’s Issues: Care delivered in rural communities shouldn’t be undervalued.”??

Miriam Atkins, President of the Community Oncology Alliance, Clifford Hudis, M.D. CEO, American Society of Clinical Oncology and Wade T. Swenson M.D a rural Minnesota Oncologist highlights the following themes.

• Quality of care: There is no evidence to suggest a significant quality gap between independent community oncology practices and hospital systems. Second opinions are common practice and can lead to changes in treatment plans, even within the same institution.
• Access to care: Administrative burdens, such as prior authorizations, and workforce shortages are contributing to diminished access to care. Rural communities face unique challenges, as patients often have to travel long distances to receive specialized care.
• Collaboration and support: Collaborative efforts between community oncologists and tertiary care centers are essential to ensure that rural patients receive high-quality care. Organizations like the American Society of Clinical Oncology are working to support clinicians in all settings and improve access to care.

Overall, the statements emphasize the importance of recognizing the valuable role of independent community oncologists in providing high-quality, personalized cancer care. By addressing administrative burdens, improving access to care, and fostering collaboration, we can ensure that all patients receive the best possible treatment, regardless of their location.

A critical aspect of comprehensive cancer care often overlooked is the disruption to patients' support systems. When individuals and their caregivers must leave their communities to seek treatment, they are disconnected from invaluable resources like family, friends, and local support organizations. This displacement frequently incurs significant financial burdens, including travel, lodging, and potential loss of income. Moreover, many essential supportive care services, such as those offered by Cancer Support Community or cancer rehabilitation centers, are primarily localized. As Director of Program Development at the Cancer Survivorship Provider Network, I can attest to the challenges faced by NCI-designated cancer centers in providing comprehensive supportive care to geographically distant patients. The costs and operational complexities associated with replicating these services for a dispersed patient population are substantial.

Comprehensive cancer care involves a multifaceted approach that addresses not only the physical aspects of the disease but also the emotional, psychological, and social well-being of patients and their families. While precision medicine and advanced treatments are crucial, supportive care plays a vital role in improving quality of life and overall outcomes.

The Importance of Supportive Care

Supportive care encompasses a range of services designed to alleviate the side effects of treatment, manage pain, and address the emotional and psychological impact of cancer. These services may include:

• Psychological support: Counseling, therapy, and support groups can help patients and their families cope with the emotional challenges of cancer.
• Pain management: Effective pain management strategies can significantly improve quality of life.
• Nutrition counseling: Proper nutrition can help patients maintain their strength and energy during treatment.
• Physical therapy: Physical therapy can help patients regain strength and mobility after treatment.
• Financial counseling: Financial counseling can help patients navigate the complex financial challenges associated with cancer.

The Benefits of Survivorship

Cancer survivorship refers to the period of a person's life after a cancer diagnosis, treatment, and recovery. Survivorship care focuses on long-term health and well-being, including:

• Monitoring for recurrence: Regular check-ups and screenings can help detect cancer recurrence early.
• Managing late effects: Addressing long-term side effects of treatment, such as fatigue, heart problems, and secondary cancers.
• Promoting healthy lifestyle: Encouraging healthy habits like regular exercise, a balanced diet, and stress management.
• Psychological support: Continuing to provide emotional support and counseling as needed.

The importance of comprehensive supportive care is highlight in NCCS’s 2024 Survivorship Survey which was released this week and the slides can be accessed through the NCCS website.? Here are some key findings.

• Cancer patients experience a high burden of side effects that often continue beyond treatment.
• In addition, caregivers are also struggling with physical, emotional, mental health and practical issues.
• Most importantly, our cancer programs are overwhelmed and lack a payment model for supportive care.? The number of patients that are seen for a one time post treatment visit for their Survivorship Care Plan is shockingly low.

The lack of focus on creating a structured and intelligently designed supportive care programs is prolonging the suffering and harm of those receiving treatment.? I highly recommend that you listen to these presentations from the 2024 Northwestern Survivorship Conference.??

• All Together Now: Building a Learning Health System to Facilitate Team-Based Comprehensive Cancer and Survivorship care Catherine Alfano, PhD Vice President, Cancer Care Management and Research Northwell Health Cancer Institute Presentation Slides: unavailable Presentation Recording
• Team-Based Survivorship & Personalized Follow-up Care Sheetal Kircher, MD Medical Director, Cancer Survivorship Institute Mita Sanghavi Goel, MD, MPH, FACP Professor of Medicine & Medical Education Division of General Internal Medicine Presentation Slides Presentation Recording

Here is the recommended model of comprehensive supportive care starting at time of diagnosis managed by a team of highly trained experts.? Every patient should be demanding this level of care.?

Catherine M. Alfano et al., Engaging TEAM Medicine in Patient Care: Redefining Cancer Survivorship From Diagnosis. Am Soc Clin Oncol Educ Book 42, 921-931(2022). DOI:10.1200/EDBK_349391

I’ve recently come to appreciate the immense potential of the Cancer Survivorship Provider Network as an online professional community. The power of peer-to-peer collaboration has already inspired innovative ideas and accelerated progress. I hope that every healthcare professional dedicated to supporting cancer patients and their caregivers will consider dedicating a small amount of time each month to join us in addressing the challenges we face daily.

The Cancer Survivorship Provider Network (www.TheCSPN.org) started in 2014 by 3 Seattle area nurse practitioners, The CSPN now has over 900 members in every State in the US as well as Canada, the UK, Australia, and more. What began as a grassroots gathering of providers sharing resources has become a network connecting hundreds of survivorship providers across the globe, 24/7, through a secure on-line platform. With monthly educational meetings, expert speakers, free contact hours, library of research-based resources and working groups the CSPN is leading the way to address key barriers that impede the implementation of high quality supportive care from day of diagnosis. Here are a few of the ongoing initiatives:

• ?Clinical Supportive Care Mapping and Toolkit. Mapping supportive care from time of diagnosis through the cancer journey for BMT/Cellular Therapy survivors.? Our diverse membership provides a multidisciplinary team that can work together on synthesizing recommendations through a peer to peer process.
• Creation of operational survivorship resources. Development of Survivorship SOP Template and database based on the NCI National Survivorship Care Standards, CoC and NAPBC and ASCO Certified requirements.
• Understanding ROI and business case for survivorship and supportive care.?
• Educational resources.? Development of clinical onboarding resources for new survivorship clinicians, mapping of comprehensive competencies for onco-generalists and supportive care along with free oncology nursing credit hours.?

We are the only provider-facing Survivorship-focused network connecting professionals in ALL fields of healthcare. The Cancer Survivorship Provider Network supports professionals in clinical, research, and supportive practices through education, advocacy, and peer Networking.

Our members include physicians, advanced practice providers, researchers, nurses, social workers, psychologists, rehabilitation specialists, integrative health providers, administrators, support; retreat program leaders, and more. The CSPN vision, that every cancer survivor will receive comprehensive, equitable, high-quality survivorship care from providers who understand their unique health risks and needs, guides our organization at every decision point. We have provided this service at no cost to members. Learn more about us, become a member at www.TheCSPN.org.

If you are interested in leading peer to peer work through the CSPN, please email me at [email protected].