Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA
Liana Yocavitch, Gregory D. Garber, Alison Petok, Brooke Worster, Nathan Handley
Background: Patients with cancer who engage early with palliative care may experience improved quality of life (QOL), increased overall survival (OS), and decreased acute care utilization. The Neu Center for Supportive Medicine and Cancer Survivorship (NCSMC) at Thomas Jefferson University is a program designed to identify patients who would benefit from early intervention palliative and supportive care and deliver appropriate services. After initial experience with the model in patients with gastrointestinal and head and neck malignancies, the NCSMC is expanding to patients with genitourinary cancers. Methods: A multidisciplinary team consisting of palliative care physicians, social work, psychology, and navigation conducts biopsychosocial screening (using the NCCN Distress Thermometer) and initiates a personalized care plan for each patient to clarify treatment goals and offer assistance. Prior to deploying the program, multiple stakeholders were engaged to discuss optimal screening points in the patient journey. Patients with a new cancer diagnosis are approached at a post-operative visit in the urology clinic; patients with high distress or significant barriers are discussed at a weekly interdisciplinary meeting with a team of physicians, nurses, social workers, and psychiatry. Patients are subsequently referred to services identified as potentially beneficial. Results: In the first 10 weeks of the program, 67 patients with new diagnoses of bladder (28, 41.8%), prostate (21, 31.3%), kidney (12, 17.9%), urothelial (5, 7.5%), and testicular (1, 1.5%) cancers were screened. 38 (59.4%) patients were identified as low distress; 24 patients (36%) were identified as high distress and offered NCSMC services. Two patients utilized services. Conclusions: Distress and barriers to care amongst patients with newly diagnosed genitourinary cancers are highly variable. While evaluating all patients in the immediate post-operative period is effective at identifying affected patients, the process is resource intensive. An iterative approach testing the intervention at different points in the patient journey is ongoing. As the program matures, impact on QOL, OS, and utilization will be measured.
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