This past April, Albert Einstein Cancer Center was selected to join the National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP), which, in the words of William J. Tester, MD, FACP, medical director of Einstein’s Cancer Center, offers “an opportunity to bring more resources to our patients.”
NCCCP is designed to create new research opportunities across the cancer care continuum from screening and treatment to followup and survivorship care. NCCCP cancer centers are also tasked to reduce healthcare disparities and improve the quality of care at community hospitals.
Reducing disparities
With its mission of delivering high-quality care, Albert Einstein Cancer Center (Einstein) has already been working to overcome those barriers that contribute to healthcare disparities. Located in north Philadelphia, Einstein serves a diverse population that includes large African-American, Hispanic, and Asian subpopulations. In this urban setting, Einstein delivers care to patients from multiple socioeconomic groups, some of whom are uninsured or underinsured.
But the staff believes they can do better. For example, radiation oncology “has advanced radiation treatment equipment for patient care,” Lawrence J. Solin, MD, FACR, FASTRO, chair, Department of Radiation Oncology told The Oncology Nurse. “It is extremely important to make sure that our patients not only have access to treatment, but that we provide them with the support services to complete their prescribed therapy.” To help patients do that, Einstein plans to expand its nutrition, dietary, and social services for patients undergoing radiation oncology.
These expansions will go well beyond radiation oncology. “For those patients that are starting chemotherapy for the first time, we have developed what we call a patient teaching appointment. The patient comes in and has one-on-one time with a social worker, a treatment nurse, and a dietician,” said Tiffany Raroha, MSW, one of two oncology social workers at Einstein. The center’s plan is to reach every patient starting a new cancer treatment, expanding social services not only to radiation oncology patients but also to surgical oncology patients. “We plan to be more proactive with doing psychosocial assessments up front with newly diagnosed patients as well as being able to do continuous follow-up of their psychosocial needs,” said Raroha. Einstein also plans to add patient navigators to help patients get through the system more easily.
Enhancing quality
For more than 20 years, Einstein has employed site-specific multidisciplinary cancer programs. For most disease sites, physicians and support staff meet and discuss all new cases as well as cases where a problem has arisen or a patient has a recurrence. These groups include more than just the medical, surgical, and radiation oncologists. In addition to these oncologists, for example, the lung cancer program has regular attendance by its thoracic surgeon, its pulmonologist, a research nurse, social services, and a pathologist, according to Tester. In the breast health program, 15 to 20 people meet every Wednesday, including representatives from breast surgery, medical oncology, radiation oncology, radiology, pathology, plastic surgery, genetics, and rehabilitation. “This is a great way to involve all the experts, so when a patient returns for her 1-week checkup after completing her surgery, and I tell her that she needs to see the medical oncologist, that physician has already fully reviewed her case. I can tell the patient what the medical oncologist plans on giving her and which trials will be available to her,” said Lisa Jablon, MD, FACS, a breast surgeon who is director of the Breast Health Program. At present, Einstein has multidisciplinary programs in breast cancer, lung cancer, gastrointestinal cancer, and hematologic malignancies, and hopes to develop an active urologic program with the NCCCP funding.
To integrate care further, Tester has one initiative he has been thinking about and is excited about the possibility of implementing now that Einstein is an NCCCP cancer center. “What we could do with NCCCP support is bring the patient into the multidisciplinary conferences. We have always discussed cases, reviewed pathology, radiologic imaging, and clinical trials that would be appropriate, but we have never actually brought the patient into the discussion room. Multidisciplinary care is an initiative that is important to the NCCCP, and we are planning and want to make that work. At the very least, we want to have a multidisciplinary clinic that meets after the tumor board meeting where the patient could actually meet three or four of the clinicians involved in his or her care. The presence of the patient will show him or her that our approach is truly multidisciplinary, and that his or her personal issues and input are considered in making final treatment decisions.”
In addition, Einstein plans to incorporate more survivorship services. “Our plan is to offer survivorship strategies to all patients at the time of diagnosis and continue that through and beyond treatment,” said Tester. The NCCCP grant allows Einstein to hire a coordinator to run survivorship services. Jablon provided an illustration of how this would work in breast health: “We do have an active cancer program and social workers. Plus, different organizations like the American Cancer Society offer a lot of programs that are integrated with our local hospital, such as Reach to Recovery and Look Good…Feel Better. We would like to make survivorship even more of a focus for our patients after they have passed through their primary treatment. For example, I just got back from a conference where they talked a lot about how we don’t integrate improvements in exercise or weight control into our cancer population. Even though we tell our patients that they need to lose weight, we offer no specific, active programs for them to go out and do that. One of my thoughts is to go out into the community and organize walking groups of cancer survivors and people interested in cancer prevention to integrate exercise into the community practice.”
Clinical trials and biospecimen research
Einstein has been active in clinical trials since it was originally funded by the NCI in 1972. “We have always had a strong commitment to offering patients state-of-the-art clinical trials, and I think that is exemplified by the array of clinical trials we offer through the Eastern Cooperative Oncology Group (ECOG), the Radiation Therapy Oncology Group (RTOG), and the National Surgical Adjuvant Breast and Bowel Project (NSABP),” Solin said. “One of the things we would like to do is enhance access to clinical trials for our population through the NCCCP grant.”
Biospecimen collection, however, will be something new. “We have done a lot of clinical work at Einstein but not as much in the basic science arena,” said Tester in an interview with The Oncology Nurse. “But with the NCCCP to support our collection of biospecimens, we are going to be creating our own tissue bank, and we are going to be able to be involved in more translational research activities.” For example, Einstein currently works in collaboration with Thomas Jefferson University, which has a strong basic science program and translational research. Tester believes that Einstein’s involvement in those types of research “could increase as we put aside tumor specimens and ship them for special molecular studies, and then tie that into clinical trials where we are going to evaluate the effect of certain new targeted therapies on patients according to which molecules are expressed by their tumors. With the assistance of Corrado Minimo, MD, and our pathology department, we plan to
develop a strong biomarker program this summer.”
To the future
“Cancer affects not just the patient but the entire family as a unit. So our hope is to expand our program to meet the needs of not just the patient but the family unit. We are hoping we can provide a bereavement program for families of those unfortunate patients who lose the battle to cancer and, possibly, some programs that will meet the needs of children whose parents have cancer,” Raroha told The Oncology Nurse.
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