Following a lung cancer diagnosis, patients typically embark on a dizzying journey that takes them from one waiting room to another, as they follow their treatment plan from the medical oncologist to the surgical oncologist to the radiation oncologist and back again. Coordinating these visits imposes yet another burden on the patient and often leads to delays in care. Six years ago, St. Joseph Mercy Cancer Center in Ypsilanti, Michigan, decided to simplify life for their patients by opening a multidisciplinary lung cancer clinic.
“They can come in the morning and see everybody and come out with a plan,” explained Philip J. Stella, MD, the clinic’s medical director and medical oncologist. The multidisciplinary approach seems to be working. Not only has the program shaved more than two-thirds off the time between when lung cancer is suspected to initiation of a treatment plan, “We have very high rates of satisfaction from the patients and their families,” said Stella.
Patients are not the only ones who appreciate St. Joseph Mercy’s efforts. Primary care physicians in the region have shown their satisfaction with the program by referring more patients to the lung cancer clinic. “We try to make it easy for them, so [that] when they have a patient with lung cancer, they don’t have to call 3 different offices. … Just 1 call will get the patient seen in a timely fashion,” said Stella.
The lung cancer clinic’s reputation continues to spread. Stella said the positive reception for the multidisciplinary approach has led to patient referrals from physicians outside the St. Joseph Mercy system and the need to expand.
A Model in the Making
Like other multidisciplinary clinics at St. Joseph Mercy, the lung cancer clinic is spearheaded by an advisory committee, which consists of physicians and other providers who tend to patients at the clinic and participate in tumor boards. Vita McCabe, MD, a cardiothoracic surgeon, chairs the committee and helps steer the program.
McCabe described her philosophy of care: “When you are a cancer patient, you need to feel that you are in a highend department store, that you are completely cared for from every direction— [that] this is not a discount-shopping situation.” Department stores claim to operate according to the principle that the “customer is always right.” Although the patient might not always be right at St. Joseph Mercy, the lung cancer clinic’s multidisciplinary team factors the patient’s perspective into each decision.
In developing the program from the perspective of the patient, it became clear that it would be important to assign each patient to a nurse navigator. The navigator serves as the point person for arranging visits and facilitating communication between the patient or the patient’s caregivers and the individuals on his or her care team. This is useful for coordinating not only anticancer treatment, but also support services. Along with medical oncologists, surgeons, and radiologists, many patients meet with researchers, social workers, and nutritionists at the clinic.
Lara Blair, RN, is one of the program’s nurse navigators. “Even if someone just has a small question, when you have a team of 3 or 4 different doctors and other specialists, that can mean 20 phone calls,” said Blair. “One of my biggest jobs is cutting that process down and streamlining it for [the patients].”
Benefits of this system are that “patients don’t have to wait for care, nor are they confused,” said McCabe.
The clinic strives to stay at the forefront of lung cancer care, offering an array of advanced surgical and radiotherapy techniques. To handle growing demand, a second surgeon was recently added to the staff. With 2 surgeons onboard, the clinic has been able to expand the number of minimally invasive approaches available, to include video-assisted and robotic surgery and thoracoscopic procedures.
St. Joseph Mercy became the first hospital in Michigan to offer the CyberKnife system for stereotactic body radiation therapy. As a result, “Medically inoperable patients are being treated for their lung cancers with a high degree of success and with minimal complications and side effects,” said Walter M. Sahijdak, MD, a radiation oncologist at the clinic.
As a member of the Community Clinical Oncology Program (CCOP) network for the past 20 years, St. Joseph Mercy has actively recruited patients with cancer for a number of clinical trials. The CCOP affiliation allows patients treated at St. Joseph Mercy, including those seen in the lung cancer clinic, to enroll in trials conducted by major national research groups, such as the Mayo Clinic and the M. D. Anderson Cancer Center. The lung program currently has patients enrolled in several innovative studies its researchers are conducting, including trials comparing outcomes with CyberKnife versus standard resection in patients with solitary lung nodules.
The lung cancer clinic recently moved into new space, which houses a nurse navigation office and the advisory committees for each of St. Joseph Mercy’s multidisciplinary clinics. Stella said the lung cancer program has been so successful he expects it to serve as a model for future multidisciplinary clinics focused on other tumor types.
Success Paves the Way
The success of the lung cancer program no doubt factored into last year’s decision by the National Cancer Institute’s Community Cancer Centers Program (NCCCP) to designate St. Joseph Mercy as one of only 30 NCCCP sites in the nation. The NCCCP initiative seeks to develop a network of community hospitals tasked with re - searching ways to improve the quality of cancer care and prevention, as well as to reduce disparities in access to care and outcomes.
An accompanying $2.5-million grant will allow St. Joseph Mercy to add several cancer specialists to its staff and develop new programs. In a press release announcing the designation, Stella, the grant’s principal investigator, said, “This program allows St. Joseph Mercy Ann Arbor to accelerate the tempo of scientific research and advancement of cancer care. … St. Joe’s is already recognized for our cancer research; this contract allows us to take our program to the next level and expand other areas of research and care. It underscores our dedication to providing our patients with the latest and most state-of-the-art care.”
The NCCCP contract calls for St. Joseph Mercy to develop a tissue bank. Stella said while St. Joseph Mercy typically submits tissue from patients in its clinical trials for translational research, the center will now be preserving tumor tissue samples for all their patients with cancer. “We are going to…be able to provide that to investigators at academic centers around the country that want access to fresh tissue or paraffin-embedded tissue to do their translational work,” said Stella. “This is a very important part of this grant and the network as a whole,” he explained. “So much of what we are going to be learning about cancer is going to be through translational research.
Other plans include hiring a geneticist to counsel patients and evaluate those considered high risk and expanding outreach efforts to underserved communities. This will require hiring a minority coordinator to reach out to ethnic minority populations and adding a financial counselor to the staff to help low-income and indigent patients with obtaining oncologic care.
“There is no way in this economic environment that the hospital would ever be able to provide these positions,” Stella said. “If it had not been for this grant, we absolutely would not be able to provide many of the services that I think we should be doing as a cancer program.” And had it not been for the stellar multidisciplinary lung cancer clinic at St. Joseph Mercy, it might have taken the NCCCP longer to recognize just how determined the center is to ensure that people with cancer have the best care possible