Implementation of a novel primary care-centered clinic for survivorship care.

Authors

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Archana Radhakrishnan

Louis Stokes Cleveland VA Medcl Ctr, Cleveland, OH

Archana Radhakrishnan , Youngjee Choi , Zackary Berger , Craig Evan Pollack , Sydney Morss Dy , Kimberly S. Peairs

Organizations

Louis Stokes Cleveland VA Medcl Ctr, Cleveland, OH, Johns Hopkins School of Medicine, Baltimore, MD, Johns Hopkins University, Washington, DC, Johns Hopkins University, Baltimore, MD, Johns Hopkins Medicine, Baltimore, MD

Research Funding

NIH

Background: Patients often face challenges in transitioning to the survivorship stage of cancer care and coordinating with primary care. Prior research has highlighted the uncertainty in who provides survivorship care, leaving patients “lost in transition”. Integrating primary care providers (PCP) into cancer care offers one potential solution. Expanding traditional PCP roles to participating throughout the cancer continuum and familiarizing PCPs with cancer patients’ needs can address this gap. We describe an innovative model of incorporating PCPs to delivering primary care to cancer survivors at a large academic institution. Methods: As one part of a plan to address an identified need for improving survivorship care for cancer patients at Johns Hopkins, PCPs and cancer survivorship care experts developed the Primary Care for Cancer Survivors clinic (PCCS) in 11/2015. The clinic receives referrals from the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center and patients are seen for either a one-time consultation or can transition their primary care to the clinic. We also are creating a database of internal and external referrals to meet the specific needs identified by patients. We descriptively analyzed the utilization of PCCS from 11/2015 through 9/2016. Results: A total of 35 patients have been seen at PCCS. The average age of patients was 56.8 (SD 12.4) and 32 were female and 3 were male. 24 patients identified as white, 8 black, 1 Asian, and 2 others. Most patients transitioned their PC to the clinic (n = 30). The majority of patients had breast (n = 19) and colorectal cancer (n = 5); 10 patients had metastatic disease (3 have deceased). Commonly, referrals were made to physical therapy, including pelvic rehabilitation and lymphedema management, and nutrition counseling. Conclusions: Patients with a wide variety of cancers and at all stages of disease were seen for survivorship care in the PCCS clinic. Integrating nutrition care, psychosocial support, exercise programs, and palliative care were key early factors in meeting patients’ needs. Continuing to assess and meet survivors’ individual needs and build referral networks are important next steps in the development of the clinic.

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Abstract Details

Meeting

2017 Cancer Survivorship Symposium

Session Type

Poster Session

Session Title

Poster Session A: Care Coordination and Financial Implications, Communication, and Health Promotion

Track

Care Coordination and Financial Implications,Communication,Health Promotion

Sub Track

Models of Care/Medical Homes

Citation

J Clin Oncol 35, 2017 (suppl 5S; abstr 41)

DOI

10.1200/JCO.2017.35.5_suppl.41

Abstract #

41

Poster Bd #

D10

Abstract Disclosures

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