The addition of the selective CDK4/6 inhibitor ribociclib to letrozole significantly improved progression-free survival (PFS) in hormone receptor–positive (HR+) advanced breast cancer. Compared with letrozole alone, the combination of ribociclib/letrozole [ Read More ]
December 2016 VOL 7, NO 11
Treating the Whole Patient: A Patient-Centered Program Integrating Evidence-Based Complementary Therapies with Traditional Cancer Care
An Interview with Stephanie Hoopes, RN, BSN, OCN, HNB-BC; Jo Weathers, RN, BSN, OCN, CBCN; and Trish Leighton, MSN, Ed OCN, Nurse Navigators from the Center for Integrative Oncology and Survivorship at the Greenville Health System Cancer Institute
Ms Hoopes is an oncology certified and board certified holistic nurse and survivorship nurse navigator with Greenville Health System. She holds a bachelor of science in nursing degree from the University of Phoenix and has experience in acute care medical oncology, stem cell bone marrow transplantation, ambulatory outpatient medical oncology nursing, navigation, and integrative therapies.
Ms Weathers is an oncology certified nurse, certified breast care nurse, cancer survivorship and Lifetime Clinic nurse navigator with CIOS Greenville Health System. She holds a bachelor of science in nursing degree from the University of South Carolina and has experience in medical and surgical oncology, breast navigation, oncology research, and outpatient infusion.
Ms Leighton is an oncology certified nurse and survivorship and Lifetime Clinic nurse navigator at Greenville Health System. She holds a bachelor of science in nursing and a master’s of science in nursing—nursing education degrees from University of Phoenix. Ms Leighton has experience in acute care, stem cell transplantation, home healthcare management, medical outpatient oncology infusion, cancer survivorship navigation, and nursing education.
The Greenville Health System Cancer Institute in South Carolina launched the Center for Integrative Oncology and Survivorship (CIOS) in 2012 for cancer survivors. CIOS is an innovative patient-centered program that integrates evidence-based complementary therapies with traditional cancer care to treat the “whole patient,” encompassing mind, body, and spirit.
Providing a holistic approach to cancer care increases quality of life and may decrease potential cancer risks. The multidisciplinary team of physicians, nurses, and other health professionals at CIOS provides both direct services and referrals for patients throughout their cancer experience as well as assistance to guide patient and caregiver choices in complementary and supportive therapies. Complementary therapies, such as acupuncture, nutrition counseling, yoga, oncology rehabilitation, massage, and music therapies, are used primarily to treat the symptoms associated with cancer and related therapies. Supportive therapies focus on emotional and physical health. Those at CIOS believe these therapies are essential for cancer survivors and their caregivers both during and after their cancer experience.
CIOS provides survivorship care plan dissemination to cancer survivors, fulfilling the mandate from the Commission on Cancer. In addition to the survivorship care plan, CIOS offers an array of programs and services to help educate and transition patients from the acute treatment phase to living well following a cancer diagnosis. Among the services offered are nutritional counseling, oncology rehabilitation, lymphedema management, referrals to integrative therapies such as acupuncture or yoga, individual counseling, massage therapy, distress screening, smoking cessation, and support groups and classes within the Cancer Support Community (CSC).
The publishers of the Journal of Oncology Navigation & Survivorship (JONS) had the opportunity to speak with Stephanie Hoopes, RN, BSN, OCN, HNB-BC; Jo Weathers, RN, BSN, OCN, CBCN; and Trish Leighton, MSN, Ed OCN, about the various CIOS clinics and programs as well as their team-driven approach to patient care. These survivorship nurse navigators each has diverse backgrounds that enhance oncology care at CIOS. What follows is our insightful exchange.
JONS Thank you for taking the time to speak with us today. To begin, please tell us about your background and your involvement in survivorship and the CIOS program.
Ms Weathers I have worked in oncology for more than 21 years and have been involved in everything from direct patient care to management. Before joining CIOS, I spent 8 years in the Multidisciplinary Center of Greenville Health System working with patients from initial diagnosis through treatment completion. I was delighted to join CIOS and work with patients on transitioning from active treatment to treatment completion. When I first joined CIOS, it was inspiring to see how the unique range of services and programs positively impacts patients’ lives. We have wonderful survivor volunteers who are part of our navigation program and philanthropically funded programs such as our music and oncology rehabilitation program. I learn something new each and every day, and I am proud of all we have to offer.
Ms Leighton I was the first survivorship nurse navigator hired at CIOS in 2012 when the program was initiated. I have worked in oncology for more than 25 years, mainly in medical oncology and stem cell transplantation.
Working at CIOS is personally rewarding. In all my years in oncology, I have watched patients fight the battles of cancer with chemotherapy and radiation and experience the toxicities, but now I’ve learned that is not the end of their struggle. I work with survivors who have made it through that journey, and it is very satisfying to know that I can help survivors through many of the issues that are occurring as a result of their treatment-related effects.
Survivorship gained attention in 2005 with a statement issued by the Institute of Medicine charging that we needed to do a much better job at taking care of cancer survivors on the back end of their cancer journey. Entering into survivorship from working in acute outpatient oncology made me realize just how important it is to offer support, education, and services once treatment is complete.
Ms Hoopes I have worked in oncology for the past 15 years, mostly inpatient oncology. I arrived at CIOS in 2013. In addition to my nursing credentials, I am certified by the American Holistic Nurses Association. Working in this program allows us to move beyond medical management and address a host of other needs. I offer an integrative oncology clinic once a month and find that cancer patients are seeking ways to manage their journey while maximizing their health.
We were the first hospital to affiliate with the CSC, formerly called Gilda’s Club, and we have a monthly calendar of activities and events offered at no charge. By way of example, a look at the CSC calendar shows the following: Clinical Trials Workshop; Real Face Time—a women’s support group on reclaiming the present moment; CSC Pacers—a twice-a-week walking club; and Create Your Own Cancer Fighting Kitchen—a cooking class series.
JONS CIOS offers several individual clinics and programs. Can you describe the offerings for patients in the Integrative Oncology Survivorship (IOS) clinic?
Ms Leighton Every patient has the opportunity to schedule an IOS appointment at the beginning of diagnosis, while in treatment, or at the completion of treatment. The purpose of the IOS visit is to introduce our services and programs and to meet compliance of survivorship care plan dissemination as mandated by the Commission on Cancer.
At the first IOS visit, the patient receives a draft of the survivorship care plan, which is printed and stored electronically in the patient’s medical record. If the IOS visit occurs before the end of treatment, the patient is given the option to return to review the care plan at the completion of treatment. During the IOS visit, the nurse practitioner collaborates with the nurse navigator to assess the patient’s individual needs and makes appropriate referrals for that patient’s situation.
For example, a patient may want to join the oncology rehabilitation program, which is philanthropically supported and offers 3 free months of exercise. We have a smoking cessation program, low-dose lung cancer screening program, an acupuncturist who provides consultations for cancer treatment–related side effects such as pain and neuropathy, referrals for cognitive rehabilitation, referrals for nutritional counseling with cooking classes offered through CSC, and individual counseling by licensed clinical social workers.
JONS CIOS also offers the Lifetime Clinic where survivors receive evidence-based, state-of-the-art cancer surveillance and preventive services. Can you elaborate on the goals of this clinic?
Ms Weathers Trish and I care for patients within this clinic, which is devoted to long-term follow-up care. Often when patients complete cancer treatment and are released by their medical, radiation, or surgical oncologist, they become primary care patients. The patient’s own primary care physician (PCP) does not always have the time or the expertise in health maintenance, prevention, and follow-up care appropriate for patients with cancer.
Once released to the Lifetime Clinic, the patient is followed according to National Comprehensive Cancer Network guidelines, and it is up to the patient to determine how long he or she wants to participate and be followed in active surveillance; the cancer institute and CIOS will follow them for life. If the patient should have a recurrence or second malignancy, the patient is then smoothly transitioned back to his or her treating oncologist.
A special GYN Lifetime Clinic is available for patients who have had a gynecologic cancer. Stephanie cares for this patient population.
JONS Can you describe the offerings in this clinic?
Ms Hoopes The GYN Lifetime Clinic operates under the same premise as the Lifetime Clinic. Patients have annual visits, PAP smears, and preventive services and are followed for life.
JONS Another subset of survivors who are served in the Lifetime Clinic program are young adults. What needs are addressed in the Lifetime Clinic for this population?
Ms Hoopes Yes, I care for the patients within the Adolescent and Young Adult (AYA) Lifetime Clinic. This clinic also operates on the same premise as the Lifetime Clinic but is specific for patients between the ages of 18 and 39 years who have completed cancer treatment. AYAs have different needs than adults. Patients have annual visits at which their long-term needs are assessed. We evaluate their health risks, financial concerns, and psychosocial issues. We also ensure that they have appropriate follow-up care. For example, if they were treated with anthracycline-based chemotherapy, they would be closely monitored for late cardiac adverse effects or events and referred to a cardio-oncologist as needed.
JONS What programs does the CIOS offer for lung cancer survivors?
Ms Hoopes I care for patients referred to the Lung Cancer Screening Program. We see patients referred within our own system as well as those referred by their PCP. Patients are screened with low-dose CT if they meet prespecified criteria: they are between the ages of 55 and 77 years, they have a 30 pack-year history of smoking, or they are a current or former smoker within the past 15 years. This program is a multidisciplinary effort by a radiologist, pulmonary physician, thoracic surgeon, nurse practitioner, and nurse navigator.
I also care for patients referred to the Smoking Cessation Program. This program involves 2 to 4 visits where patients are weaned off nicotine. We use nicotine replacement therapy and medical management. We have followed our patients at 1-, 3-, 6-, and 12-month intervals. We found high success rates at the beginning, then a dip from 3 to 6 months, but we have found that after 6 months some of the patients who relapsed were able to have success. Our take-away was that relapse may not interfere with success.
JONS It certainly appears the social and emotional support you provide survivors is just as important as their medical treatment. Thank you for sharing this important work with us and please accept our wishes for continued success.
Quantifying the Relational Dimensions of Study Staff in a Randomized Controlled Trial Among African American Women Recommended to Receive Breast Cancer Chemotherapy
Background: The Adherence, Communication, Treatment, and Support (ACTS) randomized controlled intervention study was a one-time psychoeducational intervention encouraging adherence of African American women to prescribed chemotherapy. Surprisingly, 98% of both [ Read More ]