Center for Integrative Oncology and Survivorship at the Greenville Health System Cancer Institute

The Greenville Health System (GHS) Cancer Institute in South Carolina offers the Center for Integrative Oncology and Survivorship (CIOS) for patients who are cancer survivors. This unique program, which opened in 2012, is the first hospital site to become part of the Cancer Support Community, the largest professionally led nonprofit network of cancer support in the world, and is the first of its kind in the United States.

CIOS provides survivorship care plan dissemination to cancer survivors, fulfilling the mandate from the Commission on Cancer. However, CIOS goes many steps further than survivorship plan dissemination, offering an array of programs and services to help educate and transition patients from the acute treatment phase to living well beyond a cancer diagnosis.

Among the services offered are nutritional counseling, oncology rehabilitation, lymphedema management, referrals to integrative therapies (eg, acupuncture or yoga), individual counseling, massage therapy, distress screening, smoking cessation, and support groups and classes within the Cancer Support Community.

The Oncology Nurse-APN/PA (TON) spoke with 3 survivorship nurse navigators from the survivorship nurse navigation team at CIOS about the various CIOS clinics that have a team-driven approach to patient care—Patricia (Trish) Leighton, MSN, Ed OCN; Stephanie Hoopes, RN, BSN, OCN, HNB-BC; and Jo Weathers, RN, BSN, OCN, CBCN.

TON: You 3 nurse navigators bring together diverse backgrounds that complement oncology care in your clinics. Before we delve into the particulars of all of the offerings at CIOS, tell us a little about yourselves, and how you have experienced your involvement in survivorship and CIOS.

Jo Weathers: I have been working in oncology for more than 21 years, and have done just about everything, including management. Before joining CIOS, I spent 8 years in the Multidisciplinary Center of GHS working with patients from diagnosis through treatment. I was thrilled to join CIOS and work with patients after they had completed treatment, to help with their transition. It blew my mind to see how unique this department is, and the range of services and programs it offers to patients. I learn something new every day, and I literally walk around with my mouth open at all we have to offer. Some of our programs are funded by philanthropy; for example, the music program and the exercise program.

We are also blessed with wonderful survivor volunteers who are part of our navigation system, and the list goes on.

Trish Leighton: I was the first survivorship nurse navigator to be hired at CIOS in 2012, when the program was started. I have worked in oncology for more than 25 years, mainly in medical oncology and in stem-cell transplantation.

Working at CIOS is personally rewarding. In all my years in oncology, I have watched patients fight the battles of cancer with chemotherapy and radiation, and experience the associated toxicities, but at CIOS I’ve learned that is not the end of their struggle. I work with survivors who have made it through the active treatment journey, and it is very satisfying to know that I can help survivors through many of the issues that occur as a result of their treatment-related effects.

Survivorship gained attention in 2006 with a publication of a position statement from the Institute of Medicine, charging that we needed to do a much better job of taking care of cancer survivors on the back end of their cancer journey. Entering into the survivorship arena after working in acute outpatient oncology made me realize just how important it is to offer support, education, and services once treatment is complete.

Stephanie Hoopes: I have worked in oncology for the past 15 years, mostly in inpatient oncology. I arrived at CIOS in 2013, and, in addition to my nursing credentials, I am certified by the American Holistic Nurses Association. Working in this program allows us to move beyond medical management to address many other needs, for example, with our services in distress screening, music program, and diet.

I offer an integrative oncology clinic once a month, and find that patients with cancer are seeking ways to manage their journey while maximizing their health and well-being.

We were the first hospital to affiliate with the Cancer Support Community (formerly Gilda’s Club), and we have a monthly calendar of activities and events offered at no charge.

A look at our September 2016 calendar shows we had Clinical Trials Workshop, Real Face Time (ie, a women’s support group on reclaiming the present moment), Cancer Support Community Pacers (ie, a walking club that meets twice weekly), and Create Your own Cancer Fighting Kitchen (ie, a cooking class series).

TON: Let us turn to individual CIOS clinics and programs. Ms Leighton and Ms Weathers, you are responsible for patients in the Integrative Oncology Survivorship clinic. Please tell us what that entails.

Ms Leighton: Every patient has the opportunity to schedule an Integrative Oncology Survivorship clinic appointment at the beginning of diagnosis, while receiving treatment, or at the completion of treatment. The purpose of the visit is to introduce our services and programs, and to meet compliance of survivorship care plan dissemination, as mandated by the Commission on Cancer.

At the first Integrative Oncology Survivorship clinic visit, the patient receives a draft of the survivorship care plan, which is printed and stored electronically. If the visit occurs before the end of treatment, the patient is given the option to return to review the care plan at the completion of treatment. During the Integrative Oncology Survivorship clinic visit, the nurse practitioner collaborates with the nurse navigator to assess the patient’s individual needs, and makes appropriate referrals for that patient’s specific situation.

For example, a patient may want to join the oncology rehabilitation program, which offers 3 free months of exercise, and is philanthropically supported. We have a smoking-cessation program; a low-dose lung cancer screening program; an acupuncturist who provides consultations for cancer treatment–related side effects, such as pain and neuropathy; referrals for cognitive rehabilitation; referrals for nutritional counseling, with cooking classes offered through the Cancer Support Community; and individual counseling by licensed clinical social workers.

TON: Can you tell us about the Lifetime Clinic?

Ms Weathers: Ms Leighton and I care for patients within this clinic, which is devoted to long-term follow-up care. Often, when patients complete cancer treatment and are released by their oncologist, radiation oncologist, or surgeon, and they become primary care patients. The patient’s own primary care physician does not always have the time or the expertise about health maintenance, prevention, and follow-up care appropriate for patients with cancer.

Once the patient is released to the Lifetime Clinic, it is up to the patient to determine how long he or she wants to participate and be followed in active surveillance. Otherwise, the Cancer Institute and CIOS will follow the patient for life. If the patient should have a disease recurrence or a second malignancy, the patient is smoothly transitioned back to his or her oncologist.

A special GYN Lifetime Clinic is available for patients who have had a gynecologic cancer. Ms Hoopes cares for this patient population.

Ms Hoopes: The GYN Lifetime Clinic is run under the same premise as the Lifetime Clinic. Patients have annual visits, Papanicolaou tests, and preventive services, and are followed for life.

I also care for patients referred to the Smoking Cessation Program, which involves 2 to 4 visits where patients are weaned off of nicotine. We use nicotine replacement therapy and medical management. We have followed our patients at 1-, 3-, 6-, and 12-month intervals. We have found high success rates at the beginning, then a dip from 3 to 6 months, but we have found that after 6 months some patients who relapsed were able to achieve success. We learned that a disease relapse may not interfere with success.

In addition, I also care for patients who are referred to the Lung Cancer Screening Program. We see patients being referred within our own system, as well as those who are referred by their primary care physician. Patients are screened with a low-dose computerized tomography if they meet the following prespecified criteria: they are aged 55 to 77 years, have a 30-pack-year history of smoking, are current smokers, or are former smokers within the past 15 years. This program represents a multidisciplinary effort by a radiologist, a pulmonary physician, a thoracic surgeon, a nurse practitioner, and a nurse navigator.

I also run an Adolescent and Young Adult Lifetime Clinic. The needs of adolescents and young adults are different needs from those of adults. This clinic is run on the same premise as the Lifetime Clinic but is specific for patients between the ages of 18 and 39 years who have completed cancer treatment.

Patients have annual visits during which their long-term needs are assessed. We evaluate their health risks, financial concerns, and psychosocial issues. We also make sure that they have appropriate follow-up care. For example, if they were treated with anthracycline-based chemotherapy, they would be closely monitored for late cardiac adverse events and referred to a cardio-oncologist as needed.