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The Cancer Supportive Care Program
A Model for Developing Integrated Patient-Centered Care

Ernest H. Rosenbaum, MD and David Spiegel, MD

Program Background
Goals Of Supportive Care
How To Develop A CSCP
Long-Term Strategies For Program Funding
Cancer Supportive Care Resources

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During the last few decades, hospitals and cancer centers have recognized the need for supportive cancer care for patients and their families. The growing number of patients diagnosed with cancer, research on the benefits of group support, advocacy by cancer survivors, surveys of the number of patients who use complementary and alternative therapies, and new emphasis on patient services - all have contributed to this awareness. Hospitals and cancer centers have established a variety of supportive programs and services over the years. However, the mix and quality of services available in each institution varies, and programs often are not funded or coordinated. Some hospital services such as support groups, physical therapy, and nutritional counseling, may not be linked into the cancer care continuum. In some cases, patients and physicians are not aware that services are available.

Program Background
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To address this need, a free Cancer Supportive Care Program (CSCP) was established in 1999 at the Center for Integrative Medicine at Stanford University Medical Center, Stanford Hospital and Clinics. Supported by private funds, grants and donations, the CSCP complements standard cancer therapies (surgery, radiation therapy, chemotherapy, hormonal therapy and immunotherapy) by integrating all aspects of healing: strengthening the body, educating the mind, and nurturing hope and courage. center could donate a few hours of staff time (medical social worker, physical therapist and nutritionist) to initiate the program.

Physicians, nurses, and other health care providers who have worked with the CSCP model agree that it improved patient care and well being. Patients also appreciate having access to a range of supportive services, and being able to choose those that best meet their individual needs. The success of the pilot program at Stanford (1999-2002) has shown that it can be used as a model that can be modified and adopted by other hospitals and/or cancer centers.

The results have showed improved Quality of Life.
1. Improved physical well being
2. Increased energy level (fatigue reduction)
3. Increased hopefulness, control and empowerment
4. Improved sleep hygiene
5. Modest control and reduction of pain
6. Improved stress reduction
7. Patients involved in their own care had improved recovery
8. Referring patients to the program saved physician and nursing time

Goals Of Supportive Care
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The goals are to provide patient care through the use of complementary supportive care programs, which may be added to existing programs at hospitals or cancer centers:
1. To improve the Quality of Life for cancer patients and their families.
2. To reduce the severity of side effects related to cancer and its treatments.
3. To provide supportive programs during the time of diagnosis, treatment and post-therapy including group support, exercise and complementary/alternative medicine (CAM) classes, and nutrition, fatigue reduction, pain management, and recreational activities (Art for Recovery).
4. To provide patients and families/friends with information and education about their illness through lectures, classes, literature, videos, and website.

How To Develop A CSCP
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1. Engage physicians, medical administrators, nurses and medical social workers in implementing a comprehensive patient-centered model of supportive care.
2. The institution's medical team and/or cancer committee selects a Program Coordinator.
3. The Program Coordinator inventories potential care services available:
location of service, contact person, service accessibility, personnel and equipment
cost of services and annual budget estimate
volume of patients needing supportive care
how patients have found or been referred to the service
4. Collect available data on the number and demographics of potential patients. Special needs of ethnic minorities, older patients, and poor patients should be considered.
5. Identify what the institution needs to develop, improve, or expand for patient-centered supportive care programs, considering personnel, facility, time, and cost requirements.
6. Identify available resources and potential sources of financial support.
7. Present findings to the medical team for selection of the supportive care programs to be initially established. Existing programs have included group support, exercise (CAM), and nutrition in both literature and class formats.
8. Develop an action plan and obtain necessary agreements and resources, such as documentation to ensure that the program will be implemented.
9. Develop methods to monitor progress through surveys and research data. Identify a validated data form (such as EORTC-QOL30) to be used to analyze the quality and coordination of services.
10. Implement the supportive care programs that the hospital elects to establish. 11. Identify volunteers (professional and non-professional) to provide and expand services, and to help reduce costs.

Long-Term Strategies For Program Funding
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The CSCP will assist institutions in the development of a patient-centered supportive care program compatible with the structure and resources of each hospital or cancer center. With initial hospital start-up support, it is hoped that the programs can be initiated, sustained and expanded by obtaining grants through the hospital, community and foundations. The Stanford Cancer Supportive Care Program has shown that with hospital support, donated funds, and corporate grants, a modest cancer supportive care program can be developed based on the institution's own resources and fund raising. Each hospital's plan will include identification of related costs and funding sources to provide this program to patients, families and friends free of cost as possible.

The program requires a part-time coordinator, and a medical social worker, nutritionist, and physical therapist for one to two hours per week. In most cases, these costs could be included in hospital budgets. As another alternative, the hospital/cancer center could donate a few hours of staff time (medical social worker, physical therapist and nutritionist) to initiate the program.

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Most hospitals that provide cancer care offer at least some supportive services. The CSCP patient-centered model is unique and flexible. It can be modified depending on the available resources to meet the needs of each hospital/cancer center in that it strives for an integrative total patient care program to improve the quality of life for both patient and family.

CSCP programs are currently implemented at the Center for Integrative Medicine at Stanford University Hospitals and Clinics, the San Francisco Kaiser Permanente Hospital, and the Oakland Kaiser Permanente Hospital. Program development is underway at other institutions nationally and internationally.

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