Three Game-Changers in Cancer Care

When a patient has cancer, often family and friends are involved. That’s because members of a patient’s personal network will drive the patient to and from treatments or sit with the patient while they receive treatment. Still other patients will continue to work on either a full- or part-time basis. What all of these patients have in common is they have cancer and they’re seeking treatment. They also need to be able to plan their days around their cancer care.

Three years ago, Bobby Lester, director of ambulatory oncology operations at University of Chicago Medicine Comprehensive Cancer Center, one of two National Cancer Institute (NCI)-designated comprehensive cancer centers in Illinois, says he would have given his facility a “C” grade on its ability to schedule patients for treatment. For example, it was common for patients to experience delays of seven hours or more. Today, to keep patients on schedule, schedulers at the cancer center start by capturing patient’s availability.

To reengineer its scheduling for transfusion treatments, Lester’s team started by analyzing the time patients need to sit in infusion chairs, realizing that patient flow would look different on a Monday (the first business day of the week) than on a Tuesday or other days of the week. While collaborating with the cancer center’s data analytics team to crunch the historical data, Lester kept in mind that the cancer center averages 90 to 95 treatments each day; some patients are participating in clinical research trials, which includes another level of complexity, he adds.

Related: Cancer Death Rate in U.S. Sees Largest One-Year Decline

To illustrate how scheduling works today, Lester offers the example of a fictional patient named Alice, who was recently diagnosed with cancer. After an oncologist designs her therapy, which includes 12 cycles of treatment, Alice will need treatment every other week for the first four weeks and every three weeks for the remainder of her care plan. In addition, she’ll need four CT scans over the course of two months to track the response of the treatment on her cancer.

In the redesigned process, a scheduler will select a series of two-hour options in the infusion chair for this patient on these dates, and Alice can choose based on her access to transportation or the need to return to work.

“Truth in scheduling” means that patients can plan their schedules, says Lester. It also means that the cancer center can schedule staffing appropriately. Before redesigning the scheduling system, it was common for a patient to expect to leave the infusion chair at 6:30 p.m., only to leave after 8 p.m. That meant that clinical staff had to stay with the patient, which led to an increase in overtime and frustrated staff members who couldn’t manage their schedules. Today, staff engagement is improved as a result of the new scheduling process, says Lester.

The results of reengineering the transfusion treatment schedule:

• Average daily patient volume increased 17%

• Average daily infusion minutes increased 10%

• Overbookings decreased 57%

Huntsman at Home treats patients at home

Providers at the University of Utah Health’s Huntsman Cancer Institute, an NCI-designated cancer research facility and hospital located on the campus of the University of Utah in Salt Lake City, want to care for patients where they want to be. That’s at home. Going to the hospital when you’re feeling nauseous after chemotherapy is a big deal, says Karen Titchener, MSN, NP, RN, administrative director of the Huntsman at Home program, which has treated approximately 500 patients with cancer in their homes since the program’s launch in August 2018.

Patients often feel well after the first couple of doses of chemotherapy, says Titchener. But they can become violently ill later in their treatment, which often requires a trip to the emergency department. “The last thing that person wants to do is...to get in a car and keep their head in a bucket while they’re going to the emergency room,” she says.

Instead, patients who live within a 20-mile radius of the cancer center can get a referral to the Huntsman at Home program from their oncologist. That means they’ll be visited at home by one of the following: a registered nurse, nursing aide, physical therapist, pharmacist, or social worker employed by West Valley City, Utah-based Community Nursing Services, which hires these healthcare workers; Huntsman Cancer Center partners with the nursing services nonprofit and has access to a dedicated team of its clinicians for this program, says Titchener.

Registered nurses and physical therapists are the mainstays of Huntsman at Home, she adds. Nurse practitioners employed by the cancer center conduct complex visits and patient assessments; they’re also on-hand to visit patients urgently in their homes if they’re deteriorating. Otherwise, it is registered nurses employed by Community Nursing Services who do home visits. All clinicians are under the direction of a medical director at the Huntsman Cancer Center, according to Titchener.

Salt Lake City isn’t plagued by traffic. “If there are 10 cars on the road, that’s morning rush hour,” she says. Still, to make the best use of clinicians’ time, they’re organized by geographic region. That means, for example, that clinicians aren’t being sent north, east, south, and west; instead, a group of nurses focuses on patients in each region.

What sells healthcare executives on this program? According to Titchener, it’s data. For example, in 2017, there were more than 40,000 emergency department admissions, 40% of whom were among patients who were admitted to the hospital; these patients had an average length of stay of 10 days. 

The Huntsman at Home program will lead to fewer emergency room visits, fewer unplanned hospital admissions, reduced length of stay for patients, and improved patient outcomes and family experience, says Titchener. She was unable to share statistics, but her team is in the process of having the results published in a study.

Froedtert & Medical College of Wisconsin offers innovative therapy

In January 2019, Milwaukee-based Froedtert & the Medical College of Wisconsin, a regional health network that operates eastern Wisconsin’s only academic medical center, treated the first cancer patient in the United States using the MR-linac, which integrates high-field MRI and modern linear accelerator technologies. This is a history-making event because, with this technology, providers can image tissue from cancers of the pancreas, liver, and kidney more easily-that’s in addition to being able to tailor the therapy precisely for each patient’s tumor type.

Delivering this therapy entailed a 10-year journey that started with the health system’s process of strategizing about its capital equipment purchases, says Christopher Schultz, MD, chairman of radiation oncology at the health system.

Some lessons he learned:

• Recruiting physicists with experience in MR imaging, not a typical skill set for physicists, is a challenge. Once on board, the physicists helped develop a workflow to incorporate MR imaging into the radiation therapy workflow.

• Planning and patience are important. Schultz describes it as “an engineering hurdle” to put two strong electromagnetic fields next to each other in a room-one magnet in the MRI scanner and the other in the linear accelerator. Stockholm-based Elekta, a medical device company that manufactures radiotherapy solutions for cancer care and brain disorders, partnered with Amsterdam-based Philips, he healthcare technology company with global reach, to develop the platform, which received FDA approval in December 2018.

• Cross-specialty collaboration is key. At first, radiologists weren’t comfortable interpreting these images, since they weren’t in organized in the series they were used to, says Schultz. The solution? His team of physicists and physicians knew enough about MR imaging to build trust with radiologists and bring them on board. The collaboration continues in monthly meetings, mostly to coordinate scheduling; the MRI machine is also used for breast biopsies, brachytherapy planning, and sometimes cardiac imaging.
   

Aine Cryts is a writer based in Boston.