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Nurse Navigator Perspective

Patient Assistance Profiler December 2014

The Christiana Care Health System has delivered cutting-edge cancer care to the Delaware tristate area since 1940, when it opened Delaware’s first cancer clinic at the Memorial Hospital. Memorial was eventually integrated with 2 other hospitals, Delaware Hospital and Wilmington General Hospital, in 1965 to become Wilmington Medical Center, and later the Medical Center of Delaware. The newly named Christiana Care Health System in Newark, Delaware, opened its doors in 1985. The hospital system now comprises 2 hospitals, suburban Christiana Hospital and urban Wilmington Hospital. National Cancer Institute (NCI) Community Clinical Oncology Program (CCOP) funding for Delaware/Christiana Care Health Services was initially obtained in 1987, followed by the establishment of the Bone Marrow Transplant Program in 1990 and the Breast Center in 1999. (NCI CCOP has since been replaced in August 2014 by the NCI Community Oncology Research Program.)

The Cancer Care Management Department was formed in 2001 and consists of disease-specific oncology care coordinators (also known as oncology nurse advocates [ONAs]). The department has recently branched out to form the independent Genetics-Oncology Nutrition & Psychology Department, which consists of health psychologists, social workers, registered dietitians, and administrative staff. A major goal of these departments is to follow patients with cancer throughout the continuum of their care.

The Helen F. Graham Cancer Center & Research Institute, one of the initial 14 NCI Community Cancer Centers and one of the top in the nation for clinical trial accruals, officially opened its doors in 2002, immediately establishing disease-specific Multidisciplinary Centers (MDCs). The Community Oncology Private Practices, Radiation Oncology, Christiana Care Thoracic Practice, Pain and Symptom Management, and Cancer Research offices presently house themselves within the cancer center, along with several medical offices and ancillary services. In addition to seeing patients in these offices, the medical, radiation, and surgical oncologists, along with ancillary services, work hand-in-hand with ONAs in the MDCs to ensure that a comprehensive treatment plan is followed in a timely fashion.

Hematology patients are treated by 3 private oncology practices within the MDC, one of which is dedicated solely to hematology and stem cell transplant. The ONA follows this population and sees those initially referred to the Lymphoma MDC, which is open to any patient with a hematologic malignancy. He or she works closely with the entire cancer center to ensure comprehensive and timely care, with collaboration regarding novel programs and patient resources, such as the Onyx Pharmaceuticals 360TM (Onyx 360) program for patients prescribed Kyprolis® (carfilzomib). This program is a team partnership consisting of the physician, the medical assistant, and the billing staff working together with an ONA to make sure that patients are offered every available resource.

The hematology-specific practice noted above sees approximately 40 patients with multiple myeloma (MM) per month and presently has 4 patients being treated with Kyprolis. Per M. Chambers, billing specialist at the hematology office, each patient is immediately enrolled into Onyx 360, with the understanding that patients are the first priority with this program: “[Onyx 360] is used as a safety net. We want to make sure that this program is in place in case future needs arise.” Another oncology practice sees approximately 50 patients with MM per month. Although there are currently no active Kyprolis-treated patients at this practice, the medical assistants are aware of the Onyx 360 program and would not hesitate to utilize its services to avoid wasting precious office time on tedious insurance coverage issues as well as to assist patients with resource availability. The transportation coordinator at the cancer center is also well aware of this program and plans to access it at every opportunity.

The beauty of Onyx 360 is its unique holistic approach to advocating for patient needs. Individuals receive not only financial services but social and educational assistance as well. The ONAs can serve as catalysts to raise patient and professional awareness of available resources and to ensure enrollment. They also remind patients to access educational information regarding their disease and its treatment, to supplement the education provided by the cancer care team. One patient voiced interest in discussing possible distant family support groups to accommodate her out-of-town children. Other patients have expressed great satisfaction regarding the availability of this additional resource. In general, the Onyx 360 program can lighten the load for the cancer care team and provide peace of mind to the patient, knowing that one major barrier—transportation—has been addressed. I think that all pharmaceutical companies should consider utilizing this approach to allow treatments to be given in a timely manner without the risk of missed appointments and the use of additional patient/staff support.

At the time of this interview, Tina Scherer, RN, MSN, OCN, was employed by Helen F. Graham Cancer Center & Research Institute, Cancer Care Management Department; she is now employed by a healthcare manufacturer.

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