Levine Cancer Institute brings supportive oncology services together in one location

Cancer treatment is often focused on the immediate goal of curing or managing the disease.

In recent years, however, greater attention has been paid to so-called “orphan services” — aspects of care that aren’t as highly prioritized. These include areas such as psycho-oncology, survivorship care, support groups, patient navigation, senior oncology and nutrition.

At Levine Cancer Institute, these orphan services have found a home — all under one roof.

“Many cancer centers have some of these services — or maybe all of these services — but we brought them together into a single department with its own administrative structure,” Declan Walsh, MD, a HemOnc Today Editorial Board member who serves as chair of the department of supportive oncology at Levine Cancer Institute, told Healio. “Patients may or may not need them at a later point in their illness, or they might need them from the very first day they are diagnosed. Our belief is that this menu of services should be provided in an organized, structured way. All of these services are important, and our patients should have access to them.”

Walsh, who developed the first palliative care program in the United States, spoke with Healio about his current program at Levine Cancer Institute, the various services offered and how other cancer centers can develop similar programs.

Healio: How did you become involved in this program?

Walsh: During the establishment of Levine Cancer Institute, part of the vision for the new center included a commitment to the concept of survivorship. Another important part of that vision was that all these services would be delivered close to the patient. I had been involved for many years with the development of palliative medicine services for patients with cancer, so as they were bringing this concept together, they contacted me.

Healio: Can you describe the services your department provides?

Walsh: We have eight Clinical Sections in the department. They include:

Survivorship: This provides long-term monitoring of cancer survivors. It also offers cardio-oncology services in collaboration with our heart and vascular institute. We’re also developing a survivorship clinic for young adults who have lived through cancer and cancer treatment.

Cancer navigation: This consists of RNs specially trained in cancer care who act as a patient’s navigator. A newly diagnosed patient can connect with the navigator, who will guide the patient through the process and offer support to the patient and their family.

Cancer rehabilitation: This is done in collaboration with our rehabilitation institute. We have a rehabilitation gym that includes physiatrists, physical therapists, speech therapists and occupational therapists. There are specialist clinics that address things like lymphedema in patients with breast cancer and pelvic floor disorders for women with gynecologic cancer.

Nutrition: We screen patients for nutritional status, and if the screening mechanism suggests that they are experiencing malnutrition, we can refer them to a specialist dietician who is cancer-specific.

Senior oncology: This is for older patients who may have numerous comorbidities. At our specialty clinic, patients can be assessed for comorbidities and receive a risk score for developing toxicities from treatment. We are also developing a “prehabilitation” program for patients who will undergo surgery to get symptoms under control, stop smoking or improve nutritional status. The hope is that this will improve the surgical outcome.

Research: This is devoted to supportive oncology research. We look at issues that cut across cancer types and tumor sites. These include pain, nutrition, fatigue and toxicities. Cancer-related fatigue, malnutrition and database research are among the focus areas.

Integrative oncology: This combines traditional physician encounters with complementary medicine. It incorporates holistic approaches like acupuncture and massage with a focus on treating the whole patient, not just the tumor site.

Psycho-oncology: This service offers a combination of psychiatrists, psychologists and social workers. Among patients with metastatic disease, about 40% experience some degree of depression, and anxiety is very common.

Palliative medicine: This service is cancer-specific for symptom control. It offers quick access and management for patients who are in severe pain. This enables the patient to avoid unnecessary trips to the ED and hospital admission.

Support groups: This offers weekly classes on yoga, music and movement therapy, tai chi, knitting and more.

We have also set up a small education group, with the idea of developing physician training fellowships in these disciplines. This year, we are starting a cancer rehabilitation fellowship.

Healio: What advice would you offer to other cancer centers wanting to develop a similar supportive oncology program?

Walsh: I think it is important that the institutional leadership shows a commitment to the idea that all these services are important and should be provided in one location. Derek Raghavan, MD, PhD, FACP, FRACP, president of Levine Cancer Institute, deserves great credit for recognizing that this would be an important part of cancer care in the 21st century. Other centers have made major commitments to aspects of this, such as City of Hope, Memorial Sloan Kettering Cancer Center and The University of Texas MD Anderson Cancer Center. So, it’s not that nobody else is doing this — I just think LCI has taken it to the next level.

Healio: What is next for your program?

Walsh: It is very much a work in progress — we’re finding the best ways to provide these services. However, the referral rates to the service are increasing by double digits each year. So, it would appear that there is a big demand for these services. They have the potential to have a major impact on patients’ quality of life and can improve their caregivers’ ability to deal with this complicated and difficult illness. We think this is an idea whose time has come.

For more information:

Declan Walsh, MD, can be reached at Levine Cancer Institute, 1021 Morehead Medical Drive, Charlotte, NC 28204; email: declan.walsh@atriumhealth.org.