Studies have shown that providing supportive oncology services for people with lung cancer improves quality of life and, in some cases, can increase survival. However, misinformation about what supportive care entails combined with limited access to healthcare providers means many patients forgo this potentially beneficial care. A pilot program at NYU Langone Health’s Perlmutter Cancer Center—Sunset Park is using telemedicine to match eligible people with lung cancer with supportive care physicians at Perlmutter Cancer Center in Manhattan to fix this.
Supportive care at Perlmutter Cancer Center can include determining the patient’s goals for their care; assessing and managing pain and other symptoms; and providing nutrition services, emotional counseling, integrative health, advance care planning, and mind–body services.
“We know for a fact that early supportive care intervention in cancer, and especially lung cancer, is better for patients and leads to better outcomes,” says Abraham Chachoua, MD, director of the Lung Cancer Center. “With this pilot program, we are trying to bridge the digital divide that exists for our medically underserved patients and provide the opportunity for them to receive supportive oncology services that might otherwise not be available to them. Underserved patients are particularly affected because of poor access to care and technology.”
People with cancer often assume that supportive care is synonymous with end-of-life hospice care, says Akash Shah, MD, clinical instructor in the Department of Medicine at NYU Grossman School of Medicine and a member of Perlmutter Cancer Center’s supportive care team.
“We strive to help people with cancer understand that supportive oncology is not the same as hospice,” Dr. Shah says. “The goal of supportive care is to help patients with their quality of life while they are having treatment, including managing their symptoms and discussing their goals of care.”
“The care that we provide is aimed at enabling people with cancer to live well regardless of whether they are getting cured or if they are on a longer path in their cancer treatment,” says Arum Kim, MD, director of Perlmutter Cancer Center’s Supportive Oncology Program.
Dr. Chachoua, the Jay and Isabel Fine Professor of Oncology in the Department of Medicine at NYU Grossman School of Medicine, recognized a need for supportive care among his patients at Perlmutter Cancer Center—Sunset Park, which does not yet have supportive care physicians on-site. Telemedicine visits with the Manhattan-based team can be challenging, Dr. Chachoua says, because as many as half of his Sunset Park patients do not have the ability to connect with the supportive care team remotely through a smartphone or a computer.
Working with Dr. Kim, also assistant professor in the Departments of Medicine and Rehabilitation Medicine at NYU Grossman School of Medicine; Victor Wong, BSN, RN-BC, nurse manager at Perlmutter Cancer Center—Sunset Park; and staff at NYU Langone’s Medical Center Information Technology, Dr. Chachoua and his colleagues developed a plan to leverage the time that patients spend receiving chemotherapy infusions in Sunset Park to talk with supportive care physicians in Manhattan via video visit.
“Patients with lung cancer in Sunset Park are getting virtual supportive care because we provide iPads for them during their chemotherapy treatments,” Dr. Chachoua says. “Nevertheless, we hope to have supportive care doctors on-site in the next year.”
“People in Brooklyn choose Sunset Park for their oncology care. Unfortunately, the majority of them are underserved,” says Akilah Bryant, DNP, a nurse practitioner at Perlmutter Cancer Center—Sunset Park. “Providing these patients with an extra layer of care can lead to positive outcomes.”
A system was established that enables Dr. Chachoua or Dr. Bryant to refer those who present with lung cancer symptoms for supportive care during the initial consultation. These patients often have a more serious diagnosis with potentially life-limiting conditions, Dr. Kim says.
For patients who have consented to supportive care, Wong and nurses provide an iPad that links to either Dr. Kim or Dr. Shah during an infusion visit. Patients and their caregivers are supplied with disposable headsets to ensure privacy during the conversation, and the physicians are in contact with nurses via a separate chat platform to alert staff of any patient needs.
“We are trying to optimize the time that patients are receiving their chemotherapy and avoid the need for a separate visit for supportive care,” says Wong. “We are saving them a lot of time, and I think they see the value in that.”
Since the pilot program launched in April, more than 50 people have spoken with a supportive care physician. Plans are underway to expand telemedicine access to other services that are not yet available in Sunset Park, including psychiatric services.
“People receiving care at Sunset Park generally do not have a lot of resources. For us to be able to help them get supportive care through telemedicine has been nothing short of a transformative leap in terms of symptom control, discussing advance care planning, and overall addressing their quality of life issues,” Dr. Shah says. “I think most patients I have worked with have really appreciated it, and they look forward to the next video visit.”