Against the background of continuing pandemic challenges, the Association of Community Cancer Centers (ACCC) held its 38th National Oncology Conference virtually to honor excellence in cancer care delivery. The meeting featured awards to individuals and programs for their contributions to oncology, along with educational sessions on quality and practice improvement for conference attendees.
In her welcome remarks at this virtual conference, ACCC President Krista Nelson, MSW, LCSW, OSW-C, FAOSW, said one of the chief benefits of the meeting is that it brings together health professionals from different disciplines, and when they all come together in this virtual space "we draw from this collective experience to provide the best care for our patients." She is Program Manager of Quality & Research, Cancer Support Services and Compassion at Providence Cancer Institute.
Nelson chose as her ACCC presidential theme "Real-World Lessons from COVID-19: Driving Oncology Care Forward." As previously reported by Oncology Times, COVID-19 has presented major challenges to delivering cancer care. This past August, the ACCC launched a new series to help cancer care professionals navigate changing practice requirements, "Returning to Practice in the COVID-19 Era." That series includes video podcasts, audio podcasts, and on-demand webinars featuring the COVID-19 vaccine and treatment issues.
"Not only did the pandemic lead to sharp drops in cancer screenings and diagnoses, but it interrupted the ongoing treatment of many existing patients," said Nelson. "Further, the regional impacts of the pandemic and locally based vaccination efforts mean cancer programs across the country are in different phases of recovery and trying to put in place new safeguards for their patients and staff-particularly the immunocompromised patients who are most vulnerable to infection."
As previously reported by Oncology Times, community oncologists have made a concerted effort to get people back on track with recommended cancer screenings. The Time to Screen toll-free hotline (1-855-53-SCREEN), a collaboration of the nonprofits CancerCare and the Community Oncology Alliance, was launched to encourage people to resume screening schedules interrupted by the pandemic.
ACCC Award Winners
At the ACCC national oncology meeting, the organization presented the following 2021 individual awards:
[spacing ring above] Annual Achievement Award. Lori J. Pierce, MD, FASTRO, FASCO, a radiation oncologist who is Professor and Vice Provost for Academic and Faculty Affairs at the University of Michigan; Director of the Michigan Radiation Oncology Quality Consortium; and Immediate Past President of the American Society of Clinical Oncology (ASCO).
[spacing ring above] Clinical Research Award. Richard L. Schilsky, MD, FACP, FSCT, FASCO, Professor Emeritus at the University of Chicago, where he joined the faculty in 1984; former Executive Vice President and Chief Medical Officer of ASCO; Past President of ASCO (2008-2009); and former board member of Conquer Cancer, the ASCO Foundation.
[spacing ring above] David King Community Clinical Scientist Award. B. Lee Green, PhD, Vice President of Diversity, Public Relations, and Strategic Communications for Moffitt Cancer Center, where is he responsible for ensuring that Moffitt is actively creating a culture of diversity and inclusion.
Innovator Awards
Since 2011, the ACCC has presented Innovator Awards to cancer programs that have adopted creative ways of meeting challenges in cancer care. During the past year, COVID-19 exacerbated these challenges; some of the winning programs were pilots undertaken to meet COVID-19 concerns. Recipients of these innovator awards presented their programs at this year's conference. The 2021 awards include the following practice improvement solutions to cancer care delivery challenges.
* Developing a Cancer Care and Community Paramedicine Partnership. Michele Goodman, RN, BSN, MBA, Vice President of Cancer Care Services at Presbyterian Healthcare Services, and Scott A. Kasper, MS, Vice President & Chief of Albuquerque Ambulance Service at Presbyterian Healthcare Services.
Avoidable emergency department (ED) visits add costs and-especially in the COVID-19 era-can expose patients to infection. This pilot program sought to reduce ED use and the exposure of patients to infectious disease. Health professionals identified symptoms that could be managed safely in a lower level of care setting, the patient's own home. A mobile integrated health team provided clinical interventions and checks for wellness such as hydration and laboratory values, in the safety of the patients' own homes. Throughout 2020, the care team in this pilot made 652 home visits to 169 patients with cancer, thus saving them some potential ED visits.
* Remote Monitoring of Patients With Cancer During COVID-19. Nancy Bowles, MHA, RN, OCN, CRNI, NEA-BC, CPC, CHONC, Vice President of Nursing; and Laura Matthews, MBA, MPH, Vice President and Administrator, both at Inova Schar Cancer Institute.
The pandemic has heightened cancer patients' concern about seeking medical care in clinics, especially if they test positive for COVID-19. They may fear hospitalization. This cancer program developed a remote monitoring pilot program for clinically stable patients with cancer who were positive for COVID-19. Patients were given equipment by cancer program staff, which they used to report their vital measurements 3 times a day. The patient data were captured on a password-protected dashboard and monitored 12 hours a day, 7 days a week by advanced practice providers (APPs). Physicians and APPs then worked together to make clinical decisions on next steps, documenting provider communications and clinical recommendations in the electronic health record (EHR).
* 3D Virtual Reality: Changing the Standard of Care for Patients With Cancer and Their Caregivers. Douglas Holt, MD, Chief Resident of Radiation Oncology at the University of Colorado Cancer Center, UCHealth-Oncology Services.
The scientific complexity of cancer is often difficult for patients, who are already stressed by their diagnosis. One of the big problems patients have "is trying to understand what is happening to them," Holt stated. This project recognizes the unique position of virtual reality (VR) technology to improve patient understanding of cancer and its treatments. During clinical consultations, radiation oncology personnel use a mobile VR cart to provide 3D patient-specific CT, MRI, and PET-CT imaging in order to enhance the provider and patient interaction, improve patient education about cancer, and reduce patient distress. A clinical study captured both quantitative and qualitative data on patient acceptance and the perceived usefulness of VR in cancer education and treatment.
* Oncology Capture of ED Patients with Incidental Radiologic Findings. Nicholas Garland, MS, Senior Project Manager, and Katharine "Katie" KIar, RN, BSN, Assistant Nurse Manager, both at Vanderbilt University Medical Center.
The increased use of CT scans in EDs leads to higher rates of incidental radiologic findings, including adrenal masses and pulmonary lung nodules. Klar noted that it is often difficult for patients to know what to do about these findings. In this model for follow-up care of these findings, ED professionals used the EHR to prompt oncology nurse navigators and case managers to contact patients with incidental findings. The managers of this program noted that prompt follow-up allows for earlier diagnosis and treatment-thus improving patient care, patient experience, and patient outcomes.
One case study involved a 64-year-old patient who went to the ED for abdominal pain; follow-up showed that he had a liver mass and liver metastases. Garland said about 120 patients per month were found to have incidental radiologic findings. He noted that, from a business perspective, the cancer program realized financial gains through additional patient visits, procedures, surgeries, radiology scans, and/or laboratory tests. Garland said an inpatient pilot is planned for this program, noting that its success depends in part on interdepartmental collaboration and the ongoing engagement of physician leaders.
* Implementing a Transportation Hub: A Holistic Approach to a Systemic Problem. Rachel Marquez, MPH, Director of Transportation Services at Cone Health Cancer Center.
Transportation problems are common among some cancer patients, Marquez noted; these can lead to delays in care and worse outcomes. She said data show that nearly 3.6 million Americans lack access to non-emergency medical transportation. This cancer program found in analyzing data that people living in two ZIP codes had a 12 percent and a 15 percent no-show rate, compared to the average of 2.9 percent rate across all ZIP codes. So the staff implanted a screening tool to initiate transportation discussions with patients before non-compliance with treatment became an issue, potentially threatening treatment goals and patient outcomes. The cancer program staff then began a pilot program to address identified patient needs using an online transportation platform. Using this approach to implement access to transportation decreased no-show appointments by 48 percent, and the no-show incidence from patients living in the two risky ZIP codes dropped to 1.2 percent and 1.3 percent, respectively. "We've been able to make the business case for our own vehicles," said Marquez, noting that the program has been expanded to deliver food to food-insecure cancer patients with reduced immunity.
* An APP-Physician Model Improves Risk Stratification and Palliative Care. Jia Conway, DNP, CRNP, AOCNP, Nurse Practitioner at Cancer Care Associates of York.
Recognizing that patient education about palliative care is an important component of oncology care, this practice implemented an APP-physician model to provide information about palliative care to patients. Risk-stratification assessment tools were adopted to establish baseline metrics related to deficits in the area of nutrition, psychosocial health, performance and mental status changes, skin breakdown, fall risks, incontinence risk and treatment tolerance, as well as patients' co-morbidities. Health care providers then used these outcome measurements to make patient-specific, safe treatment decisions about chemotherapy, immunotherapy, surgery, and/or radiation.
* The DISCO App: A Patient-Focused Tool to Reduce Financial Toxicity. Lauren M. Hamel, PhD, Assistant Professor in the Department of Oncology, and Lorna Mabunda, MSI, Clinical Research Assistant, Behavioral & Field Research Core, both at Wayne State University School of Medicine.
Financial toxicity-difficulty paying for cancer care costs-is a known stress and burden for cancer patients. In a pilot program, this cancer program adopted the DISCO (DIScussions of COst) app to educate patients with cancer about their potential treatment-related costs and generate tailored questions to prompt cost-related conversations with health providers.
Mabunda said that, in the pilot of 32 patients with an average age of 61.4 (mostly female and most with breast cancer), the app significantly improved patients' sense of self-efficacy for managing their treatment costs and interacting with providers, while reducing their cost-related distress. Some 84 percent of patients said it took them 15 minutes or less to use the app. In the pilot, 100 percent of video-recorded clinic visits included a cost discussion on topics ranging from patient co-pays to transportation concerns. "Overall we are very pleased with the findings," said Mabunda. Next steps include expanding the program.
Peggy Eastman is a contributing writer.