Winchester Hospital is a general medical and surgical hospital in Winchester, MA. Founded in 1912, the hospital serves the healthcare needs of the communities of northwest suburban Boston.
The Reno Center for Cancer Care at Winchester Hospital provides care for an average of 1800 patients with cancer every month. Currently, the facility employs 5 full-time hematologist/oncologists and 1 full-time nurse practitioner. In addition, the practice is supported by a part-time gynecology/oncology surgeon and another full-time nurse practitioner.
The Oncology Nurse-APN/PA spoke with Susan Sheehan, RN, MS, OCN, Nurse Manager, Reno Center for Cancer Care at Winchester Hospital, about the fatigue management program, the “pre-hab” (or prerehab) program, and her role at the center.
Your center provides a unique program to help patients with cancer deal with fatigue. Can you tell us about it?
Susan Sheehan: We were fortunate in that we found a donor to fund our ability to be STAR (Survivorship Training and Rehabilitation) certified and to initiate STAR training. The STAR programs provide oncology rehabilitation for cancer survivors. STAR-trained staff include occupational therapists, physical therapists, and nurses, along with nutrition counselors and cardiac rehabilitation experts.
First we assessed more than 500 cancer patients’ level of distress using the National Comprehensive Cancer Network (NCCN) Distress Thermometer, where patients are asked to rate their distress over practical problems (eg, childcare, housing, and insurance/financial issues), family problems related to dealing with children and partners, as well as family health issues, emotional problems, spiritual and religious concerns, and physical problems. These were patients who received chemotherapy in our infusion room.
We found that fatigue was overwhelmingly the number one concern of our patients. That information led us to address the management of fatigue. Thanks to the donor, we started a fatigue program using the STAR oncology training and rehab program for our cancer patients who are undergoing chemotherapy in our infusion room.
Now patients being given infusions are provided with the NCCN Distress Thermometer. When they fill out the form and circle fatigue as an important and distressing concern, the nurse gives them a form designed specifically to rate their fatigue from 0 to 3, with 3 signifying the most severe levels of fatigue. A score of ≥2 triggers the nurse to provide fatigue education to that patient, and information about our “fighting fatigue” exercise class. The patient or nurse can call to register the patient if he or she is interested.
Patients who sign up for the program are screened by a physical therapist to make sure they are appropriate candidates for a class, which meets every Monday and is conducted by a physical therapist and an advanced health and fitness specialist. During the class, they do exercises that can be modified to each participant’s ability, including breathing and meditation exercises. They are also given homework. The class lasts for 10 to 12 weeks, and then patients graduate to make room for new patients. The class is free to the patient, and has been well-received.
How do you assess how well the program is working?
Ms Sheehan: We give graduates a survey.
What have the surveys shown regarding satisfaction with the fatigue program?
Ms Sheehan: The feedback has been overwhelmingly positive. We have more women participants than men. Some patients are taking this class while they are receiving chemotherapy or radiation treatments, whereas others are participating posttreatment. As I stated, a patient can sign up for up to 12 weeks, and then that person graduates to make room for new patients. We have not had a statistically significant number of surveys returned yet, but from reading the ones that we received, patients are very happy with the program.
Here are some examples of comments:
- “I feel I’ve accomplished something each time.”
- “The program has helped tremendously with increased balance and stamina. It is extremely helpful to have combined exercise and PTs [physical therapists] assist to find safe alternatives.”
- “Best thing that happened to me! I was at one of the lowest points in my life, and I met the most wonderful people, including my ‘classmates.’ I learned all sorts of information that we all shared.”
- “I wish doctors had told me about it during my radiation treatment.”
How do patients continue on their own?
Ms Sheehan: If they need one-on-one physical therapy, they would either pay privately, or through insurance, or homecare services would cover it. Every situation is different.
Do you have other STAR-based initiatives at your center?
Ms Sheehan: We conduct impairment screenings during the patient’s first visit to our thoracic surgical clinic. The goal of the assessment is to identify patients who would benefit from prerehab before undergoing surgery (ie, to optimize physical health before surgery). Patients who do prerehab will have a better postoperative course.
The program has been going on in a small group of patients for a little more than 1 year, and our impression is that it is helpful. We also plan to roll it out for the patients who are slated to undergo ovarian or uterine cancer surgery.
Tell me about your role as Nurse Manager at the cancer center.
Ms Sheehan: I manage the overall operations of the cancer center. I have been in this position for more than 2 years, and I have been an oncology nurse for 28 years.
What is your biggest challenge?
Ms Sheehan: It was quite challenging to get everyone to buy in to the fatigue program—patients, physicians, and the nursing staff. Twenty years ago you could not push a patient with advanced cancer to engage in exercise, but the thinking has since changed. The evidence-based practice shows that patients with cancer do better overall with regular exercise. As our director of physical therapy says, “Doing nothing is not an option!”
What is your biggest reward?
Ms Sheehan: I find it rewarding to improve processes for patients and staff. In addition, the patients’ satisfaction with the fatigue program is quite rewarding; we are ahead of the curve in recognizing the importance of oncology rehab.