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Embracing Multidisciplinary, Centralized Cancer Care in Oncology

May, Brandon

doi: 10.1097/01.COT.0000542451.62827.70

Caring for the cancer outpatient relies on real-time communication between physicians of multiple specialties, yet this communication is often delayed due to physical distance between specialists. The idea of multidisciplinary and interdisciplinary care in cancer is nothing new as represented by the multitude of research demonstrating the efficacy of this care strategy for improving the patient's perception of care, as well as survival outcomes (BMC Health Serv Res 2017;17(1):218, Ann Thorac Surg 2016;101(2):495-502, discussion 502-3, PLoS One 2015;10(5):e0126547, BMC Cancer 2015;15:686).

Cancer can often involve complex treatment regimens that necessitate thoughtful discussion among specialists, making an interdisciplinary and multidisciplinary outpatient team environment essential for improving communication and fostering greater collaboration across team members. Currently, there is a need for oncology specialists of varying disciplines to provide outpatient care under one roof in an effort to streamline physician-to-physician communication and create ease in the patient's treatment experience.

The Cleveland Clinic is meeting this need with its relatively new Taussig Cancer Center, a 377,000-square-foot, seven-story outpatient cancer center that provides outpatient cancer treatment services in one location.

“In an age where cancer care is getting more and more complex and includes new drugs, new side effects, new technologies, and greater focus on very important aspects of the medical experience such as cost and social and mental aspects, multidisciplinary care works better under a single roof,” said Pauline Funchain, MD, a medical oncologist at the Cleveland Clinic.

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Care Strategy & Treatment Teams

Rather than having to travel to multiple offices and clinics for chemotherapy, imaging tests, or even nutrition and counseling sessions, cancer patients at the Taussig Cancer Center can receive their outpatient care services from members of their treatment team, all of whom practice on the same floor.

“The foundation was to form a building based on multidisciplinary disease care, and we accomplished this by enhancing the number of multidisciplinary clinicians and placing them in one location,” Shannon Faulhaber, Director of Strategic Growth at Cleveland Clinic, told Oncology Times.

When the Taussig Cancer Center first opened on March 6, 2017, it was one of the first innovative efforts to bring together genetic counselors, medical and radiation oncologists, surgeons, and nurses into a shared space. Ultimately, the goal was to facilitate greater interdisciplinary communication and multidisciplinary care, greater ease of care access among patients, and improved outcomes. Since its opening, there have been close to 14,000 new consults and over 80,000 established visits from cancer outpatients.

“Cancer programming [is] at the focus,” said Brian Bolwell, MD, Chairman of the Taussig Cancer Institute at the Cleveland Clinic Main Campus. “The space is designed for collaboration within our team because working collectively as a team promotes optimal clinical care and research opportunities.

“People coming to see us are scared, they want to get better, and they need our help,” Bolwell continued. “We set out to design a building that was patient-centric. While working with the architects...we sought input from patients, nurses, doctors, support staff, and everyone in between. We know this is a cancer center, not a museum, but we did anything we could do to help create a calm, bright, and efficient environment for our patients.”

Prior to opening the center, outpatients had to travel to four different buildings to receive their required and desired outpatient services. Now, patients can make and attend their appointments in one location, reflecting the innovative move toward integrated and localized care.

“The idea is to reduce the number of hoops a patient has to jump through to get complete, multidimensional cancer care,” explained Funchain.

Each floor of the center is based on the type of cancer diagnosed, further specializing and optimizing the care each patient receives. “Our model is designed in that each floor is disease-based, so patients can go and see their specialists while never having to go to multiple locations,” said Faulhaber. “Our goal is that, when patients walk on their floor, they see their home-based care team in the same environment.”

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Construction Concepts

For the construction of the building, the Cleveland Clinic kept the patient in mind. “The one thing that stands out from the design perspective was that we asked ourselves, What does the patient need right there in front of them to make the patient process easy?” noted Faulhaber.

Likewise, Bolwell explained that the totality of cancer isn't just about the treatment the patient receives. “Waiting in lines, trying to park, ordering lab tests, receiving radiation and infusion [therapies], and interaction with other patients—we took that into account and created a bright, light-filled, high-ceilinged space filled with art.”

On the first floor, the center has full glass walls to let in the natural light and “brighten up” the ambience in an effort to make specialized service centers fully visible. “A lot of patients don't realize the support services that are available to them,” stated Faulhaber, “so we collected all of those services and placed them on the first floor behind glass so patients can see the different services right in front of them.”

A total of 126 exam rooms and 98 treatment rooms are found in the Cleveland Clinic Taussig Cancer Center. Additionally, the north side of the center features private chemotherapy infusion suites with floor-to-ceiling windows, and there currently exists a dedicated space for clinical trials research, particularly phase I trials.

Additionally, there are three valet lanes that can hold a total of 14 cars, which expedites the entrance and exiting process for patients, particularly for those patients with physical mobility issues. Also, all labs are placed on the first floor for easier access.

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Speciality Services

A few of the outpatient services offered by the Taussig Cancer Center on the first floor growing in popularity are the complementary therapy and personal care services, including nutritional counseling, yoga, a salon/spa, art and music therapy, and even a wig boutique. As these services are now more accessible and visible to cancer patients, they're being utilized by patients at an increasing rate. Since the center's opening, close to 500 wigs have been distributed and over 500 music therapy appointments have been made.

Reiki therapy, a complementary and alternative medicine approach that consists of laying the hands over the body to promote relaxation with “healing” psychic energy, is also offered and has been growing in popularity among patients. While some patients are seeking this therapy in its specialized location on the first floor, many patients are also asking for this complementary therapy at the bedside or while undergoing testing or receiving infusion therapies.

Mind-body complementary services have become more prevalent in outpatient cancer care, particularly for their effects on relieving the psychological distress associated with conventional therapy. Whether these therapies exert any real effect on a patient's physiology or course of disease has yet to be verified, but its ability to reduce stress and shift the patient's mindset from fear to hope makes it an undeniably helpful adjunct to have available.

Sara Davenport, founder of the UK-based charity Breast Cancer Haven, which offers free counseling services to breast cancer patients and survivors, believes the mind-body services to be one of the most important complementary approaches offered by the Taussig Cancer Center.

“Complementary therapies, including acupuncture, Emotional Freedom Technique, and kinesiology [may] reduce the physical side effects of conventional cancer treatment...relieving psychological strain in the process,” she noted. “The side effects are often reported as more unbearable than the cancer itself, and so therapies that reduce them are extremely valuable to a patient's state of mind and body.”

Excessive stress, when unaddressed, can often compromise care quality as well as outcomes (Curr Oncol Rep 2014;16(12):417). Stress may be associated with chronic inflammation and dysregulation of the immune system, consequently resulting in a subsequent increased disease progression and reduced survival (Brain Behav Immun 2013;30 Suppl:S41-7, Bonekey Rep 2015;4:693, Pancreatology 2016;16(3):423-433).

“Complementary therapies deal with many of the unseen difficulties that come with cancer and are not addressed by conventional treatment,” stated Davenport. “Fear of dying, fear of surgery and treatment, fear of leaving your loved ones behind, and fear of the cancer returning—these fears are endless...and many who have used complementary therapies value the relaxation and the human touch that [they] offer.”

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Impact on Patient Care

The center's centralized approach to care makes it a unique offering in the treatment of cancer. “There is a distinct emphasis on reducing time to treat,” added Funchain. “The building is built specifically with this mission in mind. Spatially centralizing as much of the care as possible means less wait time, less transit time, fewer places to navigate, fewer schedule items to keep track of, less chance of getting lost, and more precious time and mental capacity that can be spent outside of cancer care.”

Additionally, the multidisciplinary aspect of care, which was infused in the very framework of its construction, drives home the importance of its value in treatment strategy and outcomes.

“The care from a provider perspective becomes equally less complex with a building specifically designed for multidisciplinary care. With all care providers, such as radiation oncology, surgery, psychology, and medical oncology, seeing the same patients on the same floor in the same workroom [makes] multidisciplinary care infinitely easier,” explained Funchain. “Turning your chair to ask about possible surgical dates, rather than hours and sometimes days playing pager tag, is an incredible gain of precious time for both providers and patients.”

In the future, Funchain and her Cleveland Clinic colleagues at the Taussig Cancer Center hope that the efforts put forth will ultimately decrease the time to treat, which may subsequently result in earlier therapeutic intervention and improved survival.

“As a cancer center, we have already published the results of multiple retrospective studies on how decreased time to treat impacts cancer outcomes, and I would expect to see more prospective studies that quantify this effect in more detail,” Funchain concluded.

Brandon May is a contributing writer.

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