Patient and Family Support Services

Podcast Transcript

Dale Shepard, MD, PhD: Cancer Advances, a Cleveland Clinic podcast for medical professionals, exploring the latest innovative research in clinical advances in the field of oncology. Thank you for joining us for another episode of Cancer Advances. I'm your host, Dr. Dale Shepard, a medical oncologist here at Cleveland Clinic overseeing our Taussig Phase I and Sarcoma Programs. Today I'm happy to be joined by Dr. Melanie Robbins on the physician lead for patient and family support services here at Cleveland Clinic. She's here today to talk to us about these supportive services. So welcome Melanie.

Melanie Robbins-Ong, DO: Hi, thank you very much for having me.

Dale Shepard, MD, PhD: Absolutely. So maybe just start off, tell us a little bit about your role here at Cleveland Clinic. What do you do here?

Melanie Robbins-Ong, DO: Sure. I am a palliative care physician, so I do all inpatient or hospital based palliative care at the Cleveland Clinic for our palliative care consult service.

Dale Shepard, MD, PhD: All right. So clinically you've focused more on inpatient, but tell us a little bit of... Give us an overview about what kind of services we have here at Cleveland Clinic.

Melanie Robbins-Ong, DO: Yeah, absolutely. So the Taussig Cancer Center actually has a really incredible and robust support service setup for patients and loved ones. And so I, within the palliative department get to not only take care of patients from a symptom standpoint, communication standpoint from my palliative role, but I'm also as the physician lead for the patient and family support services can really help make sure that we have well thought out, robust, accessible ways to help people have better quality of life while they're receiving treatment. Because we know that if you feel better, you do better. So Taussig Center has a whole list of things that are available, probably one of the most important ones, because it's the center for how to get to all of them is the Scott Hamilton & Helen McLoraine Patient Resource Center. That is really the center of where all of our information is.

We have a wonderful healthcare liaison named Bria, who sits down there and can answer any questions from patients and loved ones about what's available, provide pamphlets, calendars of activities, and really guide people if they feel like they know they need something, but they're not sure what. And then each of the individual types of services we have, we have art therapy, which can be on in the studio or in a private session, can also be done in the infusion suite while people are receiving therapy. We have music therapy, which is also often done in the infusion suite. So while people are receiving chemotherapy, they could actually have a therapy session that would distract them from what's going on or help them with coping and symptoms. We have my mindfulness meditation. We have what we call the reflections wellness program. They do Reiki guided imagery, reflexology. We also have facials and skincare available because we know chemotherapy does a lot to your body, including your skin.

And if we can help you feel better about your skin and how you're looking, we know that also is a huge part of your overall care. We also have licensed oncology massage therapists that can really help with symptom management for our patients and a couple other things that we do, we have yoga classes. We also have a wig boutique that offers complimentary wigs to our patients, private appointments, individualized fittings, lots of different colors and styles.

So again, if chemotherapy makes you lose your hair, that can be really emotionally challenging and really make this journey feel much harder. And that's the last thing you need. So if we can help you feel better about yourself and have a semblance of normalcy, we want to do that. Finally, we also have yoga classes and we work with the incredible national program, the 4th Angel Program which partners, patients and caregivers with trained volunteer mentors that are people who've gone through situations just like them. So other caregivers, care partners, other patients with similar diagnoses, similar age, they do a really nice job of matching them so that you have someone to lean on who knows what you're going through.

Dale Shepard, MD, PhD: And if people want to know more about the 4th Angel component, we actually had a preview is Cancer Advances episode on 4th Angel Program. So people might want to go back and listen. So you mentioned the access to the Resource Center, which is really important. And I'm happy that in our building, it is like the focal point of the building. So right in the middle, in our previous building was actually, you had to know it was there, but it is right there for everyone to use. So that's outstanding. Now, there are a lot of other services. How do patients learn about them? How do we get them involved?

Melanie Robbins-Ong, DO: That's a great question because it's tough we want to make sure that our patients don't have to seek these things out. So we try really hard not only is the Resource Center, like you said, it's very visible. It's right there on the first floor. You really can't miss it. Because when you walk straight in it's there, there's not really a door. It's a big open area it's labeled, Bria is there. So we do try to make that very accessible. We do some advertising with rack cards and other signage around Taussig. So that way patients can see it.

But we also try really hard to work with the infusion suite nurses, with the physicians, nurse practitioners in Taussig, to help make sure they know what's available and really can rely on some of their expertise too. So if you're seeing your patient in your clinic and you're getting the sense that we might be having a coping issue or I really think they could benefit from non-pharmacologic management of pain or anxiety. We actually have a prescription pad that Bria came up with where you can check the boxes of the services you think might be helpful, or even just write a little note to Bria saying, "Hey, I've got this concern," and you give that to the patient and they take it to the Resource Center and then Bria can help connect them to the things that might make the most sense.

Dale Shepard, MD, PhD: That's great. And so that's certainly, and a lot of the things you mentioned are available both inpatient and outpatient, is that correct?

Melanie Robbins-Ong, DO: Yes. Yeah. Now a lot of them like the wig boutique and yoga, those are outpatient, but art therapy, music therapy, Reiki, there is a healing services components on the inpatient side with aroma therapy and some other things. So we do have services that cross both sides.

Dale Shepard, MD, PhD: Yeah, no that's excellent. Now one thing I wanted to make sure we touched on is that we see patients in clinic and all the attention is usually on the patient, understandable, but they have caregivers that have needs as well. And I think that way too often that's ignored. Sometimes I make a point of starting my conversations, talking to the caregiver instead of the patient just because no one else ever does. So tell us about the support we've put in place to help bought with caregivers?

Melanie Robbins-Ong, DO: Yes. I'm glad you brought that up because you're right it's often overlooked. And when someone gets a cancer diagnosis, they're not the only one impacted by that diagnosis, their loved ones, whether that's family or chosen family are often part of that, whether that's helping with transportation or just being another set out of ears in an appointment, or even helping with pill boxes or even 24 hour care, it can be a very complex, layered, and sometimes overwhelming role to be a caregiver and or what we sometimes refer to as a care partner. So we worked really hard with the social workers in Taussig and with some of our caregivers in the community and did a survey to see what needs do you feel as a care partner that you have that are maybe not being met by the current system, by your oncology appointments alone or by the resources that you know are available?

And so we sent out the survey and also did a lot of literature research to determine what are the resources that are commonly needed by caregivers? What are the benefits? How can we better support them? And we developed a program called caring for the care partner, which really focuses on bringing a lot of these incredible resources that we have for patients to be available for their loved ones, for families, for care partners. Because we know that if we can help them have less stress, less anxiety or feel like they've got the resources they need to answer some of the tough questions overall, everyone's going to do a lot better and feel better about it as they do it.

Dale Shepard, MD, PhD: So what are some of the components of the program?

Melanie Robbins-Ong, DO: So we have in the current caring for care partner, we're in the process of rolling out a bunch of different services. At this point in time, we have dedicated support from our art therapist, music therapy, meditation, Reiki, yoga, as well as a really strong component of social work support, which includes counseling, education, resource referral, support groups. And the 4th Angel Program already has a really nice setup to work with care partners. So those are the current services available. And then in the future, we're planning on rolling out of availability for people to work with reflexology and do some of the other reflections wellness program activities.

Dale Shepard, MD, PhD: So it sounds like we have a lot of these services that we're providing with our own providers and our own services. How do we interact with places like the gathering place and other communities sources? Do we make referrals to those resources?

Melanie Robbins-Ong, DO: Yes. That is a great question. We do try to partner really closely with some of our external resources. Social work really helps with a lot of that. They can do a social work assessment to determine what resource needs there are, whether that's lodging, finances, psychosocial support and then connect to these outside resources like the gathering place, or even if it's just working with a patient to get hotel access or just some other resource to help them be in the area and have care be smooth, social work works with them on that.

Dale Shepard, MD, PhD: So I think one thing that might be of a concern to patients, if you start talking to about these services, is are they covered or is there a cost to them and things like that? What are those sorts of issues and how are we being able to provide those services to patients?

Melanie Robbins-Ong, DO: You're right. That is always a concern, especially when you're already going through really intensive medical therapy. One of the really beautiful and wonderful things about the Taussig Cancer Center is we have incredible philanthropy support and we are able to offer all of these service complimentary services. So our patients and their care partners don't have to worry about costs. They can receive the support on us, let us help.

Dale Shepard, MD, PhD: That's great. And I think that the more we can do by encouraging them to get those services and reassuring them of that, that's probably best because I think there might be a hesitancy from that standpoint.

Melanie Robbins-Ong, DO: Yeah. Agree. Or they might just not really understand how it could help them or might not understand if you ask someone, "Hey, do you want such and such service?" They might not know what they're signing up for and have hesitancy with that.

Dale Shepard, MD, PhD: I'll ask a question's that'll cause trouble.

Melanie Robbins-Ong, DO: Go for it.

Dale Shepard, MD, PhD: You've talked about a number of ways patients might be able to know what's available. See the Resource Center, infusion nurses, social work might make some recommendations. And then of course there's the doc and APP sort of component. How do most people get to the services and who needs the most education about what's available? Because I think I know that I'm probably in the category that that needs the most help.

Melanie Robbins-Ong, DO: I think you might be right. It is a mix of walk-in referrals from people who've seen the clinic or seen the sorry, the Resource Center as well as a nice mix with the prescription pad that's available that has the list of services you can checkbox. We do get referrals through that. So I would say it is a pretty good mix of both. I do think continuing education for the providers of what's available within the center is the biggest way to get people connected, especially because we know the patients and care partners here are here for world class care and they build really strong relationships with their oncologists. And I think they really trust that relationship too.

So it's a really meaningful referral when it comes from someone they know and trust. If their oncologist is the one to say, "Hey, we're going to do such and such treatment. I also think you would do really well seeing this provider because I think it's going to help support you from a symptom standpoint or just, I think you'll tolerate your treatment better. How about you check it out?" That goes a really long way when you've got an established relationship.

Dale Shepard, MD, PhD: Yeah. Makes sense. So COVID, it seems has-

Melanie Robbins-Ong, DO: Oh, boy.

Dale Shepard, MD, PhD:... impacted about everything.

Melanie Robbins-Ong, DO: Yes.

Dale Shepard, MD, PhD: How has it impacted the ability to give supportive services? Did you make some ways to adapt to do more virtual or hands off types of things and what's been the impact and is that coming back around?

Melanie Robbins-Ong, DO: Yes. Like all things, COVID has impacted patient services. Absolutely yes. In the heart of it. And in the beginning we did temporarily pause a lot of the services moved a lot towards virtual, our art and music therapists were able to do some virtual appointments. Yoga was able to use some internet channels for videos to help still connect. Fortunately, at this point in time, we are able to open, I think almost all the resources are back to their normal capacity. The primary precautions at this point is we are still requiring masks, just we are following the Cleveland Clinic policy. We require masks. We are still trying to social distance. A lot of the services are typically private appointments anyway. So we can still maintain some level of distance with that. And obviously sanitation and just taking precautions of screening. If you're coming in the building, there's an expectation that you'll be screened for COVID symptoms and we'll reschedule if we need to. And we'll work with you on that.

Dale Shepard, MD, PhD: I think we found that clinically there was actually some benefit to the move toward virtual and some of these services going to remain virtual and maybe have a little better access for patients in some settings.

Melanie Robbins-Ong, DO: That's a really interesting question. It's something that we've talked about in the background. I think we have found at this point in time that a lot of the services we're offering, because there's so much therapeutic value in the actual face to face interaction for these type of services, our preferences to maintain in person, we do recognize that having video yoga instruction and some of the other video availability does increase access, but it's not quite the same therapeutic benefit. So I'm not sure where we're going to head with that at this point in time. But I think it's definitely a question that's on our minds of what do we need to continue doing outreach wise? And is there a role for that in the future in a more permanent basis?

Dale Shepard, MD, PhD: So what are the gaps, what would you like to see us be able to do that we're not able to do currently?

Melanie Robbins-Ong, DO: That's a good question. It's one that I think in my role as the physician lead part of my job is to constantly be assessing what we're offering and to also look to some of the other top cancer centers in the country and see what's available through them and start hopefully building a collaboration with them to see are there things we could build together, are there things that they're doing that we would love to do? Are there things that we are doing that we could help them build? I suspect there are gaps, what they are is something we're still looking into. Unfortunately COVID squashed some of those opportunities and the ability to even reach out and collaborate. So I'm hoping that something we can do more of in the future is really collaborate more and see, and also just listen to our patients and our care partners to see what gaps they feel like they're experiencing.

Dale Shepard, MD, PhD: Yeah. And as we think about gaps, there may be people who have listened in and they've heard about the services we might be able to offer and they might be thinking, "Hey, maybe we should do that." So any advice to people who might be listening, that might be wanting to set up services in their own institutions, where to start, what to do, what to focus on, what's highest impact?

Melanie Robbins-Ong, DO: Yeah. I think a lot of it's going to be based on a needs assessment, starting with a needs assessment in your own area of what are the things you are currently providing? And what's going to be the lowest hanging fruit as far as who do you have available? Are there maybe small things that you're already doing that just aren't being advertised very well, starting with that? And then looking into the community to see if you can start bringing in some licensed partners for things like art therapy, music therapy work with local entities. We are also absolutely happy to communicate with anyone interested in learning more about our programs and how we're running and what we're doing. And you can definitely contact the Resource Center and you would actually reach Bria-

Dale Shepard, MD, PhD: Excellent.

Melanie Robbins-Ong, DO: ... and that would be a great way to at least connect and get a sense of what we've got going on at the time. And Bria can help filter you either to me or to one of our individual providers if there's a specific service you're interested in.

Dale Shepard, MD, PhD: That's excellent. Well, Melanie, you've provided some great insight for us today. Is there anything else that we've missed?

Melanie Robbins-Ong, DO: I'm really excited about these services. I know our patients really appreciate them. And as we've started the caring for care partners, we've heard a lot of really positive feedback. So I think there's great value in offering these types of services. So anything we can do to help people know what's out there.

Dale Shepard, MD, PhD: Very good. Well, thanks for being with us today.

Melanie Robbins-Ong, DO: Thank you very much.

Dale Shepard, MD, PhD: If you'd like more information on our patients support services, you can call (216) 445-2273. That's (216) 445-2273.

This concludes this episode of Cancer Advances. You'll find additional podcast episodes on our website, clevelandclinic.org/canceradvancespodcast. Subscribe to the podcast on iTunes, Google Play, Spotify, SoundCloud, or wherever you listen to podcasts. And don't forget you can access real time updates from Cleveland Clinics Cancer Center experts on our Consult QD website at consultqd.clevelandclinic.org/cancer. Thank you for listening. Please join us again soon.