Jason King, RN, BSN, OCN
One of the first of its kind in the United States, the Prisma Health Cancer Institute provides a holistic approach to cancer survivorship, with a focus on increasing quality of life and decreasing potential cancer risks, according to Jason King, RN, BSN, OCN, assistant nurse manager at Prisma Health Cancer Institute’s Center for Integrative Oncology & Survivorship (CIOS) and Center for Cancer Prevention & Wellness (CCPW) in Greenville, SC.
At the AONN+ 13th Annual Navigation & Survivorship Conference in New Orleans, Mr King took a deep dive into the vast array of survivorship services provided by CIOS and CCPW and emphasized their focus on a whole-person approach to survivorship care encompassing mind, body, and spirit.
“We like to take the whole being, not just cancer, into account,” he said.
What’s in a Name?
CIOS is a group of clinics and services designed to assist patients in navigating their unique cancer experience across the continuum. Their multidisciplinary team of physicians, nurses, and other healthcare professionals focus on maximizing health, cancer surveillance, and prevention through all stages of cancer and to providing direct services and referrals for patients throughout the cancer journey (from “previvorship” through posttreatment).
CCPW began as an extension of CIOS in 2017 and has grown as new clinics and services have been introduced in recent years. Their prevention clinics provide ongoing specialized medical support and health surveillance for patients with a higher-than-average risk of developing cancer. CCPW staff actively navigate patients to appropriate screening to proactively decrease their cancer risks.
From Survivorship Care to Integrative Oncology Survivorship
At CIOS, what is now the Integrative Oncology Survivorship (IOS), a visit began as the survivorship care plan visit. According to Mr King, this shift was largely due to patient feedback.
During the IOS visit, nurse practitioners address questions from cancer survivors about integrative and complementary therapies, supportive services, and connections to other survivors. Unique needs are assessed, questions about survivorship health are answered, and patients are navigated to support services based on their individual needs, all the while keeping the emphasis on wellness, healing, and prevention.
In addition to addressing symptom management (physical, emotional, and psychosocial), the team educates on late- and long-term side effects, facilitates referrals to hospital and community resources, assesses familial cancer risk (and refers to cancer genetic testing as appropriate), makes referrals to integrative and supportive services, and promotes educational strategies for cancer prevention and healthy lifestyle behaviors. Many of these visits are virtual, and the patient can be referred back at any time.
“This visit type actually works as a feeder of sorts for other services within CIOS,” he said. “We actually worked with our IT department to have referrals autopopulate when a treatment regimen is entered on a patient, so we typically try to see those patients after cycle 1 or 2 of treatment.”
Additional CIOS Support Services
Nurse practitioners at CIOS are available to provide additional support for patients living with an ostomy. Oncology rehabilitation/exercise navigation services are provided to support patients to live physically active lifestyles and to combat cancer-related fatigue, and the Lymphedema Management Program helps patients with lymphedema to maintain a good quality of life.
To address an array of psychosocial needs, the team provide counseling and distress management services. A licensed counselor is on staff to support patients through the oncology diagnosis with one-on-one psychosocial counseling. Issues that can be addressed in psychotherapy counseling include cancer distress, anxiety, or depression in response to a cancer diagnosis; fear of cancer recurrence; and family issues related to diagnosis. Patients are screened for distress at each provider visit, and screened for depression annually. Social workers manage patients with higher distress scores, as well as those with suicidal ideations; these patients are automatically referred to a social worker through the electronic medical record (EMR). To support the spiritual needs of patients and family members through the cancer diagnosis, chaplaincy services are also provided.
The Lifetime Clinic offers patients ongoing survivorship support after the completion of treatment.
“Many cancer-related issues require long periods of surveillance, so I want our patients to have an oncology home,” Mr King said. “Our primary care physicians were overwhelmed with conditions like hypertension, routine health maintenance, and diabetes. So, in 2013 we started our Lifetime Clinic.”
According to Mr King, the Lifetime Clinic is an innovative model of long-term follow-up care for cancer survivors, where patients receive recommended surveillance according to national guidelines for recurrence of new cancers. They provide services such as specialty referrals for posttreatment issues, screening for delayed toxicities, and survivorship research opportunities as available (concerning research topics like quality of life, integrative therapies, etc). The Lifetime Clinic has now expanded from general oncology to include GYN oncology, genetics management, and special services to assist with the transition from pediatric to adult oncology care.
At CIOS, the Sexual Health Evaluation visit is tailored to females and addresses sexual health issues in both cancer survivors and high-risk individuals.
“We’ve always addressed sexual health issues with our patients to a degree, but in 2017 we decided it was time to create a type of visit specifically for women,” noted Mr King.
And the list goes on: CIOS provides personalized nutritional counseling (complete with a malnutrition screening tool linked to the EMR), a smoking cessation program (including pharmacological management as a component), and genetic counseling/testing (which is offered both onsite and virtually).
The Center for Cancer Prevention & Wellness
With 3 of their providers board-certified in lifestyle medicine, CCPW provides patients with evidence-based approaches to promote lifestyle modifications as a method of primary prevention. According to Mr King, CCPW also navigates patients in secondary prevention methods through enhanced cancer screening and surveillance.
CCPW boasts a Genetic Management Clinic that optimizes cancer screening and surveillance methods for people who test positive for hereditary cancer risk. Their Breast Cancer Prevention Clinic (BCPC) provides patients with higher-than-average risk of developing breast cancer with the information needed to make informed decisions about early detection, screening, and risk-reduction measures. Mr King noted that providers can refer patients to the BCPC, but patients can also self-refer based on factors such as family history or previous chest radiation therapy. Findings from this visit determine if a patient moves on to their High-Risk Breast Lifetime Clinic for long-term surveillance.
CCPW also offers a lung cancer screening program, screening and referral to large clinical trials, as well as a large research department currently offering their own research study. Started in 2018, this longitudinal research study (Prevent Cancer-Greenville) aims to reduce individuals’ cancer risk through free wellness evaluations and suggested lifestyle modifications. Currently, about 800 individuals have enrolled.
“The aim of Prevent Cancer-Greenville is pairing information about one’s behavioral and environmental risk factors with their genetic information to better understand their predisposition for cancer,” he explained. “The more diverse participants are in gender, race, and health status, the more telling the data may be in identifying patterns applicable to the community as a whole.”
According to Mr King, CIOS and CCPW have a strong community presence and have continued to develop relationships with numerous internal and external partners. They have also been involved with philanthropic efforts for over a decade, allowing them to fund many of the services and free programs they provide to patients.
“Part of a successful survivorship program is finding the resources and talent that exist within your community, and seeing how you can work together—or what you can offer one another—to meet the goals of those affected by cancer,” he said.
Finally, Mr King pointed out the importance of evaluating a survivorship program through patient and departmental surveys.
“Patient comments have really helped us over the years to evaluate patient needs, and to determine how we need to alter our programs,” he said. “Building a survivorship program takes time, but start with what you know—the strengths of your staff and the needs in your community—and just go from there.”
