Whole-person cancer care may be more cost-effective cancer care

October 9, 2012 | by Alicia Di Rado

Photo of American flag with Health Care Reform billHealth-care reform is a hot button issue of the Presidential debates, and the high cost of health care is on Americans’ minds. “Cut costs,” the pundits cry. “Trim the fat.”

You might think the human side of health care – what we call supportive care -- would be the first to fall victim to the budget-slicing knife in times like these. There’s reduced reimbursement for psychology and no insurance reimbursement for supportive care professionals like clinical social workers, navigators, health educators or chaplains. What would be the incentive for a medical center to keep them on staff, other than an ethical commitment to our shared humanity?

As it turns out, beyond being “the right thing to do,” this care may cut health-care costs.

Take City of Hope’s Department of Supportive Care Medicine. Since 2010, its social workers and chaplains, in partnership with the intensive care unit (ICU) team, have facilitated a “family meeting” program in City of Hope’s ICU.

The goal is to get family members of dying patients to rethink their end-of-life expectations. Rather than demanding ultimately ineffective care for their loved one, family members come to understand and accept the process of dying. Supportive care staff compassionately help family members agree on palliative care steps and teach them to communicate with doctors.

Today the average ICU patient stays about four fewer days in the unit than when the program began.

Supportive care staff also help patients fill out advance directives. Together, both measures cut patients’ suffering and health-care costs.

That’s just part of how supportive care plays a part in delivering more efficient health care. It helps keep patients safe in treatment, reduces unnecessary readmissions to the hospital and frees up doctors to see more patients. When social workers help patients get the transportation they need to get to the doctor’s office, for example, that means fewer missed appointments.

Incentives for supportive care have grown so fast that City of Hope’s Matthew J. Loscalzo, L.C.S.W., Liliane Elkins Professor in Supportive Care Programs, started hearing clamoring at conferences. Other cancer centers and hospitals want the kind of comprehensive care offered at the Sheri & Les Biller Patient and Family Resource Center. But they’re unsure where to start.

So he and his colleagues at Mount Sinai School of Medicine in New York City applied for and received a $1.5 million grant from the National Cancer Institute to train faculty and staff at hospitals and centers across the country.

Health-care professionals will compete to get one of 400 spots in the program. Faculty members from several successful supportive care programs will lead 10 twice-yearly training workshops for participants, and the participants will then spread the supportive care message at their own institutions.

“The scientific evidence behind the significance of supportive care for cancer patients has been growing tremendously,” he says. “Patients and families increasingly expect these kinds of services, and institutions are starting to see their value in a competitive health-care market.”

Program leaders include City of Hope’s Marcia Grant, R.N., D.N.Sc., and Karen Clark, M.S., as well as leaders from Mount Sinai, Dana Farber Cancer Institute, the H. Lee Moffitt Cancer Center & Research Institute and others.

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