1. Eastman, Peggy

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The Association of Community Cancer Centers (ACCC) held its 47th Annual Meeting & Cancer Center Business Summit virtually against a background of rapid changes and practice transformation caused by the coronavirus. The theme of the multidisciplinary meeting was "Positive Disruption in the COVID-19 Era."

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The meeting featured speakers, panels, and "hot topic" interactive sessions on expanded use of telehealth and remote symptom management; communication outreach and cancer screening efforts to patients fearful of in-person care; meeting cancer patients' and survivors' changing needs; supporting an exhausted workforce; and strategies to help patients feel less isolated and anxious, especially if they are in assisted living centers or hospitalized and cannot have visitors.


"Oncology professionals have shown remarkable resilience and innovation in the face of extraordinary challenges," said new ACCC President Krista Nelson, MSW, LCSW, OSW-C, FAOSW, who is Program Manager of Compassion and Senior Social Worker at Providence Cancer Institute at Providence Health and Services in Portland. "Without a doubt, our community will use the lessons we've learned this past year to develop a blueprint for moving forward."


Nelson, who has served on the ACCC Executive Committee and Board of Trustees for 5 years, said her theme will be "Real-World Lessons from COVID-19: Driving Oncology Care Forward." She said the theme will focus on three priorities: 1) the role of health equity and the development of practice-based solutions to remove barriers and improve outcomes; 2) demonstrating to internal stakeholders the increased need for high-impact psychosocial and supportive care services; and 3) strengthening a culture that supports professional well-being and resilience for members of the multidisciplinary cancer care team.


In a keynote address, Kavita Patel, MD, MS, FACP, Fellow and Managing Director of the Center for Health Policy at the Brookings Institution, emphasized that "the Biden-Harris administration and the 117th Congress have a robust health agenda." President Biden will prioritize COVID-related actions to "address immediate and long-term problems," she said.


The U.S. Congress recently passed, and Biden signed, the $1.9 trillion American Rescue Plan Act of 2021, the latest round of COVID-19 relief legislation. In addition to direct payments to Americans suffering financially from the pandemic, that legislation contains money to replenish reserves of medical supplies and equipment through the Defense Production Act; track, administer, and distribute COVID-19 vaccines; and diagnose and trace coronavirus infections.


"You're going to see a really important emphasis on health equity," Patel added, and equity task forces to increase minority and gender access will be common. She said other Biden priorities will include expanding and strengthening the Affordable Care Act (ACA), expanding and strengthening Medicaid, improving rural health, and reducing out-of-pocket costs for Medicare beneficiaries.


Patel noted that, while the President will make changes via executive orders where possible, "many of the Biden Administration's proposals will require Congressional action." Currently, almost 30 million Americans lack health insurance, and President Biden has asked federal agencies to review administrative changes made to weaken the ACA during the Trump administration.


The following are some of the highlights from the ACCC annual meeting.


Lessons learned from rapid expansion of telehealth. In her keynote address, Patel said that telehealth represents "an incredible opportunity to improve oncology care." Most of the speakers at the meeting agreed-if it is provided with high quality.


"It's been very successful here; patients love it," said Chad Pedersen, MD, medical oncologist at Sidney Health Center in Montana. He said using telehealth technology is especially useful for meetings that include patients and their relatives: "It's like one big virtual conference."


"Obviously, telehealth is here to stay," said Luis M. Isola, MD, Director of Cancer Clinical Programs at Mount Sinai Health System & Tisch Cancer Institute. But he, like other speakers, noted that the rapid adoption of telehealth did not occur without major practice changes and adaptations. Isola said that Mount Sinai received a grant to buy tablet devices, which were distributed to patients who needed them for virtual medical visits.


Sibel Blau, MD, Medical Director of Northwest Medical Specialties and President and CEO of the Quality Care Alliance, described how her institution hired technology coordinators to help patients-such as those in nursing homes-who needed assistance in communicating virtually with their health providers.


Telehealth visits had to be integrated into care delivery schedules according to a time use plan, noted Jody Pelusi, PhD, FNP, AOC, NP, Oncology Nurse Practitioner with the HonorHealth Research Institute in Scottsdale, AZ. She said her organization wasn't really set up to do cancer support services online and had to gear up. But the health professionals realized that one benefit of telehealth visits was being able to remind patients of needed cancer screenings that might have been delayed.


While there is a large group of cancer patients who can be managed by telehealth, newly diagnosed patients need to be seen in person, said Adam Riker, MD, FACS, Chair of Oncology at Anne Arundel Medical Center, DeCesaris Cancer Institute, in Annapolis, MD. He, like other speakers, also noted that patient disparities meant many of those who could be managed via telehealth lacked access to Internet platforms such as Zoom and could not set up an online patient communication portal called "My Chart."


While telehealth can be a boon in rural areas for patients, some of whom don't even have gasoline to travel, the lack of access to technology and lack of consistency in telehealth devices and platforms-too many options-has been confusing for staff and patients, said Johanna Garzon, MHA, HBAT, Cancer Center Director for Central Care Cancer Center and Heartland Cancer Center in Garden City, KS. "It's very important to educate your team" about which devices and which online platform will be used."


She said her organization uses Zoom and, and added that FaceTime is the simplest platform. She also noted that the lack of consistency in telehealth platforms can be a barrier not only between patients and providers but even from hospital to hospital.


Like other speakers, Garzon said licensing reimbursements-especially across state lines-are a major issue for telehealth reimbursement.


"I do think we have to maintain the momentum here after COVID-19," she said of expanded coverage and flexibility for telehealth visits due to the pandemic, adding that she hopes for parity in reimbursement for in-person visits and telehealth visits.


Changes to in-person care delivery. COVID-19 safety guidelines have not only required mask mandates and stringent infection control procedures, but also different facility configurations for seeing patients, several speakers noted.


"We had to redesign the way we deliver ambulatory care," said Riker. The waiting room was abolished, and cancer patients wait in their cars to be called to come in for appointments. "I'm glad waiting rooms are gone," he stated, noting they were a huge source of patient dissatisfaction. Isola agreed, saying the waiting room is "a wasted experience for patients."


Opportunities for remote symptom management. The pandemic has heightened the need to recognize and address patient-reported symptoms early, said Ethan Basch, MD, MSc, Chief of the Division of Oncology and Physician-in-Chief at NC Cancer Hospital. He described a workflow model for using electronic patient self-reported outcomes and symptoms-ePROs-in oncology clinical practice.


In this model, patients send symptom alerts-such as chemotherapy side effects-to a medical practice via a Web-based, mobile, or automated telephone system. Basch noted that, not only does such a patient-driven system drive down emergency room visits, but it also fosters improvements in survival, quality of life, and physical function.


While integrating ePROs into clinical practice has been slow, Basch emphasized that implementing such a system with high patient usability has many benefits for patient management. He did say that nurses can find addressing the alerts an added burden, and the clinic workflow has to make an accommodation for responding to them.


"Clinic measures do not capture how a patient feels or functions or what they want to achieve from a treatment," said Bruno Lempernesse, CEO of Carevive Systems, Inc., which has developed an electronic system of patient-generated symptoms. Nadia Still, DNP, RN, Senior Director of Client Services for Carevive Systems, said that when practitioners commit resources to this system of receiving and evaluating symptoms remotely, it leads to cancer care team satisfaction, as well as patient satisfaction. In addition to helping patients avoid emergency room visits and hospitalizations, she said the system prompts also enhance the evaluation of patient treatment usage, adoption, and compliance.


Other sessions at the meeting covered the following topics:


* Mobile screening vans can be used to improve cancer screening rates by taking screening to the people. Renea Austin-Duffin, MPA, described the "Prevention on the Go" program of the Mary Bird Perkins Cancer Center, which takes cancer screenings and education on-site to workplaces in Louisiana and Mississippi. Employees pre-register for cancer screenings, said Austin-Duffin, and "It has worked extremely well."


* The pandemic has forced hospitals to get creative with cell phones and Zoom calls for visits with cancer inpatients. Not having visitors was a huge source of dissatisfaction, said Mary Miller, MSN, RN-BC, OCN, Nurse Manager at Franciscan Health Center in Indianapolis. Miller noted that social isolation is devastating for patients, and that visits are important to the healing process. Pelusi agreed. "We forget that the isolation is huge," she said. "I think there's more for us to do in terms of support."


* It is important to collect data on telehealth to document its efficiency and efficacy in care delivery. Some policy makers are still reluctant to embrace telehealth, said Mei Wa Kwong, JD, Executive Director of the Center for Connected Health Policy.



So they will need data to convince them. Agreeing was Frank Micciche, Vice President for Public Policy and Communications at the National Committee for Quality Assurance. "We really need data, and we need to be impartial about the data, he said. "Data wins the day." One concern is that telehealth could exacerbate health disparities because of a "digital divide" due to differences in patients' accessibility to the Internet and online access tools.


* Staff members, who are exhausted by the demands of the pandemic, need mentoring and support. Miller said she started a video chat program to communicate with her nurses, which worked very well. "We've learned a lot this year, and I hope we don't go back to our old ways," said Miller, pointing out the need for constant innovation in cancer care delivery. Isola said staff members need reassurance to combat their fear of an unknown virus. "We're in a better place now," he said, because the biology of COVID-19 is better understood. But, he noted, employees are "showing the strain."


* Changes made during the pandemic can have beneficial effects on transforming U.S. health care delivery as a whole to make it more equitable, effective and efficient. Keynoter Kavita Patel, MD, MS, FACP, said that just focusing on COVID-19 without looking at the broader picture will never improve the health system. Conversely, lessons learned during the pandemic can strengthen and improve the infrastructure of the nation's health system going forward.



Peggy Eastman is a contributing writer.