For a closer look at efforts to improve patient outcomes, Becker's Hospital Review asked organizations included on U.S. News & World Report's 2020-21 Best Hospitals rankings for cancer care to share changes that brought about those improvements in the last year. Read their responses below, presented alphabetically.
Editor's note: The following responses were lightly edited for length and clarity.
Jame Abraham, MD, chair of hematology and medical oncology at Cleveland Clinic Cancer Center: Under the direction of our cancer institute chairman, Brian Bolwell, MD, Cleveland Clinic streamlined cancer care delivery through cancer programming [to prioritize and structure parts of team-based care]. From diagnosis, through initial visit, surgery, radiation, systemic therapy to survivorship our disease-based teams put the patient at the center of the care delivery model. It took a concerted effort from various specialties including hematology and medical oncology, radiation therapy, surgery, radiology, pathology and community outreach. This has transformed the patient experience, contributed to shortening time to treatment and helped to improve outcomes.
Laura Crocitto, MD, vice president and CMO for cancer services at UCSF Health (San Francisco): We have implemented several strategies in the past year to improve patient outcomes. Pre-COVID, we opened a Cancer Acute Care Clinic where our oncology patients can be seen for evaluation of symptoms and management in some cases preventing a visit to the ED and in other cases hospitalizations. Post-COVID, we created an oncology- focused Respiratory Screening Clinic to evaluate patients for possible COVID in a setting away from the clinic to determine if they have COVID or disease/treatment related symptoms and then be managed appropriately (either as a COVID patient or returned to usual care).
Nancy Davidson, MD, University of Washington Medicine's head of oncology, and president of the Seattle Cancer Care Alliance: A small change we've made this year is going from virtually no telehealth providers to telehealth being a core part of our privileging. All our providers right now are telehealth enabled. It has allowed patients to receive care closer to home or at home. It has allowed cancer patients to in many cases avoid the need to leave their homes and come into a medical facility. It has also improved the quality of life for their providers. All individuals have benefited from this relationship. For example, in the Seattle Cancer Care Alliance, we had 10 providers privileged at the beginning of 2020 and now we have over 400. Across the whole University of Washington and Seattle Cancer Care Alliance, we now have over 4,000 credentialed providers.
Robert Figlin, MD, Steven Spielberg Family Chair in Hematology Oncology, and deputy director, Cedars-Sinai Cancer (Los Angeles): Augmenting its already robust Cancer Supportive Care program, Cedars-Sinai this year integrated patient and family support and wellbeing screening into the care of each cancer patient, whether newly diagnosed or dealing with advanced disease. The center's pilot screening program focuses on the patients' complete cancer journey, not just their treatments.
In addition to the cancer center’s chaplaincy, psychiatric and social work services, Cedars-Sinai Cancer's
wellness, resilience and survivorship programs offer cognitive rehabilitation, art therapy, nutrition education, several exercise classes, among other options. These programs help patients gain skills and insights to optimize their recovery and wellbeing. As one patient put it: "Thank you so very much for providing me with the incredible opportunity to be part of your exercise program! I'm feeling so much better, after numerous tests, operations, chemo and radiation. Your program has given me hope that I can move forward with strength and confidence."
Rafael Fonseca, MD, interim executive director of the Mayo Clinic Comprehensive Cancer Center (Phoenix): Very quickly we converted a large number of appointments to remote visits. While this was done primarily for safety reasons, it has greatly expanded to possibilities that this brings for patient convenience and value. Furthermore, remote visits will make tertiary centers be more available to remote populations and to patients with less capacity for travel.
Leonidas Platanias, MD, PhD, director of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University at Northwestern Memorial Hospital (Chicago): We instituted telemedicine to minimize nonessential in-person visits during our initial COVID-19 response. This allowed important patient follow-up in a safe way, minimizing potential coronavirus exposures. It also decreased potential risks for the patients who needed to come to the outpatient facilities in person for treatment by allowing social distancing and minimizing COVID-related morbidity and mortality.
Peter WT Pisters, MD, president of The University of Texas MD Anderson Cancer Center (Houston): The University of Texas MD Anderson Cancer Center developed a first-of-its-kind Hemovigilance Unit to monitor cancer patients before, during and after each transfusion of blood components. The HVU, as a centralized hub for patient monitoring, is a collaborative effort between nursing, laboratory medicine and information technology departments, bringing together cancer patient care, transfusion medicine and technology.
Transfusion reactions can be more difficult to identify in cancer patients because the side effects of cancer treatment are often similar to the warning signs of an adverse reaction to a blood transfusion. Recognizing an opportunity, MD Anderson set a new standard for preventing, detecting and responding to transfusion reactions. The HVU is staffed around the clock by a unit of nurses and advanced practice providers who remotely monitor the vital signs of every transfusion patient, allowing a practitioner to quickly be at the bedside of a patient who shows signs of an adverse reaction. These practitioners help treat the patient and offer assistance to the patient's front-line nurse, as an additional layer of safety and support.
Blood transfusions are a common inpatient procedure at MD Anderson, and therefore, the HVU monitors up to 200 patients each day. Last year, our teams transfused more than 190,000 blood products, which is about 1 percent of the nation’s total transfusion procedures. The HVU collects data from the many transfusions performed at MD Anderson, and analysis of this large amount of data facilitates new insights into transfusion medicine. The HVU's success and the data it offers has created a safer way to provide blood products to our patients.
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