1. Nalley, Catlin

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ORLANDO-Recognizing the importance of whole-person care, the LIVESTRONG Cancer Institutes created a program that flips the traditional physician-centric clinic model.

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"One of the challenges that cancer service delivery as a whole is facing is how to address the growing evidence that it really matters how you provide support to patients throughout treatment," said Elizabeth Kvale, MD, MPH, Program Leader of Survivorship, Supportive and Palliative Care, LIVESTRONG Cancer Institutes at UT Health Austin/Dell Medical School.


"For instance, we know that early, concurrent palliative care helps people live longer and live better, but we don't have systems of care that allow people to access that consistently," she continued. "Providing whole-person care not only helps people have a better experience, but it helps them utilize health care more appropriately."


Recognizing the need for a system that addresses every area of care, Kvale and colleagues developed a new approach. The CaLM-Cancer Life reiMagined-model empowers a diverse team of caregivers to serve the mind, body, and spirit of cancer patients, survivors, caregivers, and loved ones.


During the Association of Community Cancer Centers (ACCC) 36th National Oncology Conference, this program received an ACCC 2019 Innovator Award.


A New Approach to Care

Beginning in December 2018, Kvale and colleagues initiated this piloted care model, which delivers daily oncology care with help from a multidisciplinary team.


"In the traditional clinic, a patient comes into a disease treatment office and they progress through the treatment process," Kvale explained. "If the oncologist recognizes that the patient is having uncontrolled symptoms or needs additional support, such as psychosocial or palliative, they get referred to other providers.


"The CaLM model flips this approach," she continued. "Patients now come into cancer treatment through those supportive care services. The first thing we do is a whole-person assessment. What are this person's strengths as they're moving into cancer treatment? Where will we need to provide support?"


The physical and social needs are triaged through the SWAT team, which includes a palliative NP, med/onc NP, clinical social worker, and navigator. These caregivers are the anchor for patients, with the oncologists facilitating treatment planning and disease management.


CaLM includes coordinated, interdisciplinary care that involves financial and fertility navigation, nutrition, genetic counseling, pharmacy, and psychiatry, according to Kvale.


"This model is an effort to design health services that deliver the care cancer patients need," she noted. "How we approach care must continue to evolve as more patients are living with advanced disease and prolonged courses of treatment."


What's next for the program? According to Kvale, they are considering the best way to scale the CaLM model at their facility and beyond.


"If we discover that we're really changing the cancer experience and improving outcomes for our patients, how do we make this model available to people in community centers where they just don't have access to all of the resources that you would at an academic center?"


One avenue being explored is virtual health delivery, which would allow more patients to benefit from a whole-person approach. "Redesigning care to ensure that patients have access to the necessary support improves care from both the patient and provider perspective," Kvale emphasized.


Initial Impact

While the CaLM model is still in the early stages, trends in patient-reported outcomes have shown a positive impact.


"Patients who initially reported moderate to severe symptoms are improving to mild or none over time, which confirms the importance of a whole-person approach," Kvale noted. "We have also observed a positive impact on anxiety and depression among patients."


Kvale noted that the program has not been open long enough to confirm whether or not there has been an impact on overall survival.


"A whole-person approach, like the CaLM model, allows teams to deliver better care," Kvale said. "And when we're delivering care in teams, even if those are virtual teams, all of the team members are better supported.


"You can feel good about care when you know that you're delivering the very best care possible and taking care of your patient as a person, even if that's not your personal strength as a doctor," she added. "For instance, if you're a cancer scientist and what you really want to do is focus on the disease of cancer, this is a model that flexes to help support a patient who is not just the disease.


"This is a model that helps make sure that the whole person gets care, so the patient does better and providers do better because they're supported in all the really hard things that we ask our cancer treatment professionals, both nurses and doctors, to do."


Catlin Nalley is a contributing writer.