11 Trends in Hospitals' Cancer Programs

With advancements in technology and treatment, more cancer patients are surviving and are living longer, creating a greater need for cancer services. Many hospitals are expanding oncology offerings or creating new centers for cancer care to cater to this population. Here, oncology leaders at some of the country's top hospitals share 11 trends in hospitals' cancer care.

Theresa Franco is executive director the cancer program at The Nebraska Medical Center.
Theresa Franco
1. More outpatient care.
Most cancer care at hospitals is now delivered outpatient, as most treatments do not require hospitalization. Many surgical interventions are becoming less invasive, and some may also be delivered outpatient, according to Terry Tsue, MD, physician in chief of The University of Kansas Cancer Center in Kansas City.

2. Focus on patient-centered care. As with hospital care in general, cancer care at hospitals is becoming more patient-centered. For example, when Durham, N.C.-based Duke Medicine planned its cancer center, which opened in February 2012, it conducted focus groups of patients and their families to elicit feedback on what the new center should offer.

Some amenities at the center that originated from those focus groups include the rooftop terrace garden, where somepatients can receive infusion treatments outdoors, and living room-style seating with natural light in waiting areas, according to Tracy Gosselin, PhD, RN, assistant vice president and associate CNO for Duke Cancer Institute, which includes the Duke Cancer Center.

3. Personalized medicine. Personalized medicine — using genetic analysis to determine which drugs will target a patient's specific cancer — isanother growing trend in hospitals' oncology services. "We're able to customize their therapy to the cellular makeup of cancer rather than treating all breast cancers the same and all lung cancers the same," Dr. Tsue says.

This individualized approach, which aligns with a patient-centered culture, also reduces side effects and improves symptom management.

4. Greater awareness of cost. The cost of cancer care treatment has been a long-time
Dr. Tracy Gosselin is assistant vice president and associate CNO for Duke Cancer Institute.
Dr. Tracy Gosselin
challenge for healthcare providers and patients alike. As the industry puts more pressure on organizations to reduce cost, hospitals are including financial counselors in their cancer programs to help patients manage the costs of treatment and opportunities for savings. For example, financial counselors can determine patients' eligibility for patient assistance programs. "These patients have so much going on already, let alone the complexity of trying to apply and get coverage for certain aspects of care," Dr. Tsue says.

In line with the enhanced focus on patient-centered care, cancer care providers are also taking more time to ensure patients understand the costs and benefits associated with different treatment options. Some drugs may be very costly but may not significantly improve the quality of life, for example.

"We want to make sure patients fully understand the treatment plan and agree with the plan. If treatment is not going to cure [the cancer], discussion should take place between the physician and patient to make sure everyone is in the same place in terms of the goals of care," says Terry Langbaum, chief administrative officer of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Medicine in Baltimore.

5. More focus on outcomes.
Healthcare reform is requiring all areas of hospital care to be more accountable for quality by adhering toevidence-based practices, and cancer care is no exception. Theresa Franco, executive director the cancer program at The Nebraska Medical Center in Omaha, suggests that while standards of care currently do exist, cancer programs will begin to focus more on defining standards for cancer care outcomes. "I think that there's going to be some very significant benchmarks that are going to be put in place that we're going to have to meet in relation to defining the quality of cancer care," she says. Moreover, as physicians align more closely with hospitals, oncology practices may become more standardized, she says.

Terry Langbaum is chief administrative officer of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Medicine.
Terry Langbaum
6. Care coordination through technology. Technology is playing a larger role in hospitals' cancer services as hospitals implement electronic health records. "Having access to information and an integrated health record where everyone who touches the patient can see what's going on is going to be the new way of treating cancer patients and will lend itself to greater efficiency and effectiveness in cancer care," Ms. Franco says. Accessing patients' records through an EHR can help providers coordinate care. In addition, providing cancer patients access to their records via a patient portal helps engage patients in their care.

7. Complementary services.
Another growing trend in hospitals' cancer care is offering services that complement their treatments, such as social, psychological, spiritual and dietary services. "I think supportive services and complementary care are going to continue to be something that patients are going to ask for and want in addition to their traditional cancer care program," says Ms. Franco. "We're getting a better handle on what kinds of things make a difference in the cancer experience as far as [fewer] complications [and] a better quality of life."

These additional services are part of creating a patient-centered cancer program, as they recognize that patients have diverse needs. "The non-medical aspect of patient cancer care is being addressed in a more rigorous fashion," says Dr. Tsue. "We're not just treating the patient, but the whole person." For example, The University of Kansas Cancer Center makes fertility experts available to female patients who are considering having children after treatment. Treatment can affect a patient's fertility, so addressing patients' plans for children before treatment enables healthcare providers to meet patients' needs as both cancer patients and future parents.

8. Coordinated cancer services. In addition to offering more complementary services, hospitals' cancer care programsare also working to coordinate their services more effectively. Cancer centers are bringing providers of their complementary services together with the main clinical providers in a multidisciplinary team-based approach. The team may include a medical oncologist, surgical oncologist, radiologist, pharmacist, dietician and rehabilitation professional, and would develop each patient's care plan in consultation with one another to ensure they are treating the whole patient.

Ms. Franco suggests mid-level providers, such as nurse practitioners and physician assistants, may play a larger role in cancer care in the future as the shortage of cancer specialists grows. "The numbers of physicians in the critical cancer care specialties, whether radiation oncology, medical oncology — those numbers are dwindling, and the demand is gong to exceed supply. We're going to have to figure out more strategic and creative ways to take care of patients," she says.

Hospitals' cancer programs are also coordinating care by centralizing services in one location. In Duke Medicine's new cancer center, the patient
Dr. Terry Tsue is physician in chief of The University of Kansas Cancer Center.
Dr. Terry Tsue
resource center, boutique and outpatient pharmacy are all on the facility's entry level. In addition, the new facility centralized the lab draw area instead of having separate lab areas in each clinic. Centralizing resources not only makes accessing these services more convenient for patients, but it also reduces the chance of errors from miscommunication between different areas.

Care transitions
Besides coordinating care during patients' treatment, hospitals' oncology programs are also coordinating care for patients post-treatment, as they transition to survivorship programs and return to their primary care physician. At Johns Hopkins' Kimmel Cancer Center, cancer care providers communicate the patient's post-treatment plan with both the patient and his or her primary care physician. The provider reviews the patient's diagnosis, the treatments he or she received and the surveillance schedule for after treatment. The cancer center also established a hotline for primary care physicians so they can ask questions about the cancer patient to an advanced nurse practitioner at Johns Hopkins. For example, a primary care physician may want to know which post-treatment symptoms are normal and which should be followed up on, according to Ms. Langbaum.

9. Enhanced survivorship programs. As cancer care advances, more cancer patients are surviving and are living longer, creating a need for survivorship care. Hospitals' oncology programs are meeting this need through survivorship services such as rehab and psychiatry services. Survivorship programs address both physical and emotional long-term effects of cancer.

Survivorship programs also involve education of patients and their families. Johns Hopkins' cancer center defines a cancer survivor as any patient post-cancer diagnosis, including patients currently under treatment. Ms. Langbaum says the center educates patients on their treatment, their surveillance schedule post-treatment and the late effects of treatment. "We try to bring patients and caregivers in for these programs so the entire support system for that patient is well educated in terms of what we can learn to make treatment easier and the quality of life better," she says.

10. Palliative care services. Beyond survivorship programs, hospital cancer programs are also offering palliative and end-of-life care for cancer patients. Palliative care involves the management of symptoms such as nausea and vomiting and focuses on improving cancer patients' quality of life. Palliative care providers take an empathetic approach to caring for patients, ensuring both their physical and emotional needs are met.

Dr. Tsue says many cancer patients confide in palliative care providers more than in their oncology physicians when discussing the effects of treatment. "They're worried the oncologist will turn off the therapy, so they sacrifice a lot and hold a lot of things in when they're talking to the treating physician," he says. Communication between palliative care providers and oncologists can help improve patients' experience of treatment without discontinuing it. For instance, Dr. Tsue says providers can offer counseling and pharmacologic intervention for a patient suffering psychological distress, which can relieve the patient of stress without affecting the actual treatment.

11. Many educational opportunities.
Ensuring cancer patients are educated about their diagnosis and treatments is a continuing trend in hospitals' oncology programs. "There's a trend toward providing more information so patients feel comfortable, well-informed and educated about what's going to happen to them," Ms. Langbaum says. For example, the Kimmel Cancer Center offers a chemotherapy course before patients begin treatment so they know what to expect about the process and side effects.

Dr. Gosselin suggests educating patients through multiple mediums, such as via the Internet, videos, iPad applications and written documents, to emphasize important information.

Hospital cancer programs also educate patients' families about their risks of getting cancer, as many cancers have a genetic basis. "It's important to determine [patients'] genetic profile and predisposition to develop other cancers as well as get relatives tested to see if they're at risk," Dr. Tsue says. "We can save a lot of lives by determining their risk profile and intervening before cancers develop."

Furthermore, cancer providers educate the community about the importance of screening for cancers and making health decisions to lower the risk of getting cancer. "We have an obligation to prevention and screening," Ms. Franco says. Cancer centers' focus on preventive care may increase as hospitals try to manage population health, one of the goals of healthcare reform.

More Articles on Hospital Oncology:

The Oncology Service Line in the Coming Year: 4 Developments
Considerations for Community Cancer Centers Exploring a Clinical Affiliation

Beloit Health System in Wisconsin Plans Cancer Center

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