Your Care Team

Your Care Team transcript - 10.27.25

Participants:

Lori Bumbaco, MS RDN, CSO, LDN, Endeavor Health, Cancer Wellness Center

Callee Brooks, PharmD, BCOP, Vanderbilt University Medical Center

Matt Christopher, MD, PhD, Barnes Jewish Hospital, Washington University

Eric Hanson, MSW, LICSW, Massachusetts General Hospital

Dawn Urbanovsky, RN, BSN, OCN, MD Anderson Cancer Center

Morgan Zaranec, PT, DPT, University of Chicago

Lindsey Whyte, Leukemia Research Foundation (Host)

 

 

Okay, thank you everyone for joining us and we're very excited to have this panel today, the Leukemia Research Foundation special webinar Your Care Team. In a moment, our guests from various institutions will introduce themselves. In the meantime, my name is Lindsey Whyte and I am the Director of Programs & Partnerships at the Leukemia Research Foundation. And we're so happy that everyone has joined us today. I would like to take a moment to thank our supporters of this program, Autolus, Cycle Pharma, Johnson & Johnson and Novartis, and we're very grateful to them for their support of this program.

 

The Leukemia Research Foundation's mission is to cure leukemia through innovative research funding and through support, providing support to patients and families. And we do that in several ways. The Foundation has raised almost a hundred million dollars in support of its mission since our founding in 1946 and has funded research grants to over 750 investigators worldwide, including one of our guests today [Dr. Matthew Christopher]. Our support programs for leukemia patients and their loved ones include information and resources on our website education programs like today's, a small financial assistance program and a directory of other helpful organizations. And we also have a peer support program and all sorts of other information on our website.

 

So for today's program we are going to have everyone on mute and we will invite guests to put your questions into the Q & A box at the bottom of your screen. Given the focus of today's program, we ask the questions are focused on the topic of managing your cancer care, who to direct questions to and how to ensure that your care team understands your perspectives, values, and challenges so that you have a productive conversation with your care team about you or your loved one's care. When you submit a question, please make sure that you check the box of to make your question anonymous, otherwise your name may show.  So there's a box when you, in the Q & A, when you submit the question, just click that box to be anonymous. And if you've already submitted a question through the registration, we have those questions and we'll do our best to go through them all.

 

I'm showing again the sponsors of today's event. Again, thank you so much to those companies for sponsoring today's program and after the program we will send a brief evaluation through email and look forward to feedback from anyone on how we can improve our programs in the future. So we invite everyone to fill that survey out.

 

Okay, so first we're going to go around the panel and invite each speaker to tell us a little bit about themselves and what their expertise is, the environment where they work and how their team functions at the hospital or clinic that they're in. And I'd like to start first with Dr. Christopher. So Dr. Christopher, if you could take yourself off mute please and answer just a few basic questions about what you do and how things operate at your hospital.

 

MC: Sure, thanks. Thanks Lindsey. So my name is Matt Christopher (MC) and I work at Washington University in St. Louis affiliated with Barnes Jewish Hospital in St. Louis, Missouri. So we're usually one of the ninth or 10th busiest transplant hospitals for hematopoietic stem cell transplant. So we see a lot of patients with blood cancers who then go on to get transplant, a big referral center here in the Midwest. I'm a Assistant Professor of Medicine and like most academic doctors, I split my time between doing research- I have a basic science lab in which we do, we research new treatments for AML and the rest of my time I spend taking care of patients. So that consists of some time in the hospital working every year on our transplant floors as well as I'm actually finishing a clinic today. That's where I'm wearing my, my fancy white doctor coat. So that's me.

 

- Callee, would you like to go next? Thank you.

 

CB: Hi everyone, my name is Callee Brooks (CB) and I'm the Clinical Pharmacist on the Leukemia Care team. I work at Vanderbilt University Medical Center and that is a large academic medical center in Nashville, Tennessee. Here we treat patients basically on standard of care chemotherapy and also enroll patients on clinical trials. In terms of my background, I did participate in specialized residency training after I received my Doctor of Pharmacy degree and that allowed me to obtain a board certification in oncology pharmacy, specifically. So in my role as the Clinical Pharmacist on the care team I do rotate between our inpatient services and our leukemia clinic. So just to tell you a little bit about what I do on each of those settings. On the inpatient side, I do participate in rounds daily with the interdisciplinary team. So with a lot of the different members that will introduce yourself on this call participate in rounds typically at our institution, and this happens Monday through Friday, that the pharmacists are there. I do review the patient's medication list each day to evaluate for appropriateness of all their medications, ensure that there are no changes needed to dosing or the medication itself for drug interactions or for changes in their organ function. I'm also heavily involved when patients have a new leukemia diagnosis or if there's a change in their treatment plan, whether that's for a relapse or just moving on to the next phase of treatment. Because we do collaborate very closely with our attending physician once they make that decision for a specific treatment plan. So once a decision is made, we do enter all chemotherapy orders for the physician's review into the patient's chart. We discuss dosing plans at that time, recommend appropriate monitoring and are relied upon to kind of ensure that patients are receiving the supportive care that they need. And so that can involve antibiotics to help prevent infection if patients need continuous IV fluids to flush out that chemotherapy and if they need any kind of other medications such as a growth factor medicine to help boost up their good infection fighting cells after chemo. So we're very involved with a lot of those things. We also review the patient's discharge medicines when it's time for them to leave and we make sure that all their, you know, specialty medicines such as maybe oral chemo are covered by their insurance and are at an affordable cost that's manageable for the patient so that they can continue that once they leave the hospital. We really do similar things in the outpatient setting. So in the clinic we're doing a lot of those same functions and we sit in the team workroom with all of our providers and the other members of the care team to be available to discuss cases and collaborate to really develop a chemotherapy plan that's safe and appropriate for the patient, you know, that we have at hand and their specific diagnoses and their specific life circumstances. And then we help with entering those treatment plans and making sure all those other supportive care things are in place as well. And throughout patient's treatments we're always available to come to from the providers or patients themselves if questions come up related to chemotherapy or other things that they have going on related to their medicines.

 

- Wonderful, thank you so much. That is great. And I'm going to ask Dawn, who is a nurse at MD Anderson in Houston, to go please.

 

DU: Hi, thank you Lindsey. My name is Dawn Urbanovski (DU) and I am an Outpatient Treatment Nurse Navigator in the leukemia center at MD Anderson Cancer Center in Houston, Texas. We are a large cancer research institute and I'd like to tell you a little about our navigation program. Our goal for the navigation program is to provide a highly reliable, high quality, equitable experience for all patients seeking care and receiving care. Our navigation program provides support from initial patient referral through the entire patient care journey, including hospitalization and outpatient treatment. We have four navigation teams that work together to ensure that the patient has continuous support. Starting with our pre- intake navigation team who provides initial assistance for initial insurance related challenges, they help guide the patients who are uninsured or underinsured to make sure that they receive the care they need. We then have intake nurse, nurse navigators who provide clinical expertise and one-on-one support to the patients prior to their first visit. They assess for early barriers to care like lodging, transportation, health literacy and things like that. They connect the patients with resources or referrals. They ensure that the patients have access to the right care through the right specialist and they help patients understand what to expect when they come for their first visit. Then the treatment nurse navigators take over and they provide support to the patient through their, throughout the continuum of care. They'll guide the patients and serve as their primary point of contact through the treatment journey. They address any changing barriers to care, provide education, advocate for the patients, help them to make decisions that align with their personal goals of care. And they also support the patients through key transitions like change in diagnosis, staging treatment, et cetera. We also have an inpatient case management navigator position that provides support to the patient from admission to post-discharge. They serve as the patient's primary contact while they're in the hospital. They coordinate with the inpatient care team to help the patients plan for a safe discharge from the hospital. And they also provide follow up and support for patients with high risk needs like home healthcare, IV antibiotics. Our outpatient navigation partners, they partner with a variety of the interdisciplinary teams to coordinate the patient care on an outpatient basis. The clinical team consists of the physician, the advanced practice provider, which is usually a physician assistant or an advanced practice nurse and a clinical nurse. They're supported by all the various departments, pharmacy, lab, social work, physical therapy, et cetera. And as navigators what we do is educate the patients on what to expect and connect patients with the appropriate resources. For example, patients should contact the medical team for symptom management questions and contact the nurse navigator for assistance with housing or transportation or coordination of their care. Planning of the patient's care is done in a variety of different ways through tumor board meetings, clinic huddles, reviewing the patient chart and collaborating across teams. As an outpatient treatment navigator, I use both telephone and patient portal account to communicate with the patients and caregivers and I proactively reach out to the patients at specific time points to provide support and education while continually reassessing the potential barriers to care. And I'm available also to respond to any questions that they may have in between. So my day is usually spent at the computer, by the telephone, communicating with patients, team members, and any other support people, usually by email or telephone. And so that's a basic overview of our program.

 

- Wonderful, thank you so much. And next is Morgan Zaranec (MZ) who is from the University of Chicago. Morgan is a physical therapist and she's going to tell us a little bit about what she does in the unique program that she's a part of at University of Chicago.

 

MZ: Yes. Hello everyone. Like Lindsey said, my name's Morgan. I work at University of Chicago Medicine in Chicago, Illinois. We are a comprehensive cancer center, similar to what others have mentioned, a lot of research and academic study going on within the hospital system here. And I work primarily in an outpatient setting. I spend most of my day meeting with patients. However, we are also opening a new outpatient freestanding cancer pavilion in 2027. So I've been really lucky to help with some of the planning for physical space, supportive services, things of that nature that we will have there. In addition to treating patients and working here, I also frequently present at national and state level conferences. I've been involved in writing curriculum guidelines for physical therapy schools so that students can have a better understanding of oncology rehab. I'm also really heavily involved in student mentorship and I teach within the residency programs here at University of Chicago. And I also assist with teaching medical students so that they can have, again, a better idea of what we do here in oncology rehab. I specifically am a board certified clinical specialist in oncology physical therapy. And I'm also a certified lymphedema therapist, so I can treat patients with chronic swelling most often from cancer treatment, but also other non-cancer reasons like venous insufficiency. I did this training at Ohio State, so it was a year long program. And then I took a board specialization examination similar to how Callee mentioned for her pharmacy board specialization. In terms of my involvement with patients with leukemia, we're really involved with the care team, both pre- and post-transplant. So specifically for our older adults, we do pre-transplant assessments to make sure that patients are strong enough to go through transplant. We see patients while they're going through chemotherapy to optimize them for transplant. And then we also coordinate closely with our inpatient physical therapists to let them know about our patients coming into the hospital, whether that be for chemotherapy or transplant, to give them a heads up that someone's coming in that they need continued care- and then we continue to see them outpatient. We also work closely within our AYA adolescent and young adult clinics. So many of those patients have leukemia going through potential transplants. And so similarly we see them pre and post and and during. Additionally, we've hosted some trainings for caregivers on things like basic body mechanics and how to stay strong as a caregiver and to make life a little bit easier as you're helping out to your loved ones. You're muted again, Lindsey.

 

- Thank you. Wonderful. Okay, we have Eric next. Eric is a social worker at Massachusetts General Hospital in Boston.

 

EH: Hi everybody. My name's Eric Hanson (EH), Clinical Social Worker at Mass General Hospital in downtown Boston, an academic teaching hospital large in size. And I am an inpatient BMT leukemia and cellular therapies clinical social worker. And I've been in this position for 16 years. Prior to this I was out in Seattle, Washington at the Fred Hutchinson Cancer Research Center and I had the opportunity in addition to my clinical roles here on the inpatient floor is I participate in supervising new MSW social workers. We have a hundred of us throughout the hospital and also participate in the learning for residents who are on their oncology rotation as well as new nursing staff. I've also done some teaching at Bridgewater State University as an Adjunct Professor. So with respect to my role, I'll definitely focus on the inpatient part of this. I work in a 32 bed unit. I'm working with people in most situations who are new into leukemia diagnosis into treatment and are coming to terms with this, are coping with this, with this news, with the decisions that must be made. And also helping people to understand the structure of the clinical team as they're on the hospital floor, coming in frequently doing psychosocial assessments, working as best I can to understand their living situation, social supports, mental health history, professional lives. As much as I can determine from their backdrop I'm gathering that and then helping them in real time to understand who it is that's going to be coming to see them throughout the day. And many people, especially those who haven't had much exposure to medical settings, really benefit from understanding just soup to nuts. Okay, what's an attending physician? What's an APP? Might that be a nurse practitioner? Might that be a medical resident to their clinical nurse? Then to all the various disciplines who may be involved to see them knowing not everybody is going to see every everybody, but there could certainly be involvement from PT, from OT, from, you know, our dietician, spiritual care pharmacy, and then on and on with the consulting services. I participate in the rounding process frequently, although it has much to do with my timing and how I can best use rounds to determine what cases I should be involved with, as well as coming into rounds and sharing details that I think would be useful to the medical team based on work that I've done with a family that I've just come to meet. But to come back just for a moment to the fact that I work in an inpatient setting, there's in many people's minds just a concern about, okay, how am I going to know that this outpatient longitudinal oncologist that I work with and the nurse and the nurse practitioner are up to speed with what's happening during these weeks and days, weeks and sometimes months that I'm in the hospital? So I use my position and my vantage point frequently to provide continuity and communication and sometimes transmit information, just reassurance to these families that the right hand really is talking to the left. That there's a lot of communication and you may not be seeing the team visually on a daily basis, but we are highly attuned to making sure that people are getting the communication that they need and bringing, you know, family meetings together whenever would be useful for folks to see the people that they're most currently involved with. But really I think what it comes down to, more than anything else, it's just a ton of communication, reassurance, helping people to ask questions if a name tag is flipped over to say, no, it really would help me a lot to know who you are and what your role is. And then identifying what their, what their learning style is and coming up with questions involving other family members and participating in their own care. And we do our, do our best to promote that idea.

 

- Great, thank you so much. And we have Lori Bumbaco (LB) from Kellogg Cancer Center in Highland Park, Illinois, who is also affiliated with Cancer Wellness Center, who's going to talk a little bit about what she does.

 

LB: Hello everyone. Last but not least right? Thank you, Lindsey. So yes, I am a registered dietician. I've been in practice for 21 years and I'm board certified as a specialist in oncology nutrition. I'm originally from New Jersey and I worked in a small community cancer center there where I managed the nutrition program and I relocated out to Highland Park, Illinois, or I located, sorry, out to Highland Park, Illinois 11 years ago. And this primarily where I work is at Kellogg Cancer Center, which is in Highland Park. And the best way to describe it, we are an academic institution, but we are a small community hospital. So it feels very much like a small community center. I work in the ambulatory care center, so I work primarily with all cancer types, receiving their active treatment. I have a lot to share. So I'm going to start, I'm going to stay with Kellogg for a moment. What I do at Kellogg is I sort of describe myself as working on the front lines. So I'm the only dietician at our location and I receive consults from all different members of the interdisciplinary care team. But we do have a screening tool in place. So if anyone triggers for our malnutrition screening tool, they're also sent directly to my inbox where I have to decide who deserves my time and attention first and foremost for that day. And I meet with individuals and I provide a comprehensive thorough assessment and then a nutrition intervention and then I monitor that accordingly. And a little bit of my work on the front lines is following individuals across their cancer treatment continuum. And very often that requires that I'm communicating with the oncologist, the treatment nurses. We have what we call collaborative nurses and nurse navigators. So I'm really coordinating my nutrition intervention alongside their care. I also work at Cancer Wellness Center, as you see behind me. And this is a nonprofit in Northbrook, Illinois. And I work here very part-time. But we offer free services for anyone who has been affected by cancer. And we have essentially like psychosocial services here and a lot of complimentary type of modalities like reiki and acupuncture, but a lot of licensed counselors who offer one-on-one counseling sessions. We have a childcare specialist, I can go on and on. We have pet therapy, we have a lot of educational programs and workshops who are really available to anyone across the country to attend virtually. So I'm really excited to be able to be a part of the team here as well. We have a demo kitchen here, so it's sort of like the fun creative side of nutrition where I get to offer some practical recommendations for anyone, again, during the continuum of their cancer care. I only work outpatient, I'm making sure I'm answering all the questions. And primarily what I do for those who I work with is not only offer that nutrition assessment and intervention, but I would say the bulk of my time spent with patients is addressing and clarifying the information that they received from a variety of different sources. A lot of my patients are motivated and their caregivers are motivated, then they might do an online search or they might be on social media scrolling and they may come across some what we call nutrition misinformation. And they falsely assume that they need to eat a certain way or that a certain food or a dietary supplement is necessary during their, cancer treatment. And so I help them navigate a lot of that and help them clarify what makes sense for them because we do see that that is very prevalent where I am in practice.

 

- Great. I'm not muted this time. Excellent. Okay, thank you so much everyone for your introductions and for talking a little bit about what you all do and how your organizations function. And in the spirit of, you know, this webinar, the idea here is to really share how different hospitals have different kind of team kind of atmosphere, if you will. And each organization works with patients and caregivers in a different way. So part of what we hope patients and caregivers can take away from this program is it's really what you make of it and a lot of it is just understanding what resources are available potentially to you and/or your caregiver or family. So I'm going to go through a couple of questions and some of these questions I'm going to address to each member of the panel and some questions will be directed at specific panel members. So, and some of you may have already addressed this question, but if you wouldn't mind just, you know, kind of briefly touch on it. So other than the clinician who meets the patient during the initial encounter, either at diagnosis or a transfer from a different hospital. Dawn, I know that you talked a little bit about what you do in the triaging and so maybe if you could just kind of share, you're not in the room most likely when the patients come in for the first time, but maybe you could just talk about how that works at your hospital.

 

DU: Yeah, so our navigation all takes place prior to the patient arriving at the clinic for their first appointment and for their subsequent appointment. So when the patient's there in the clinic, they're meeting primarily with the clinic team, which would be the doctor, the advanced practice provider, and the clinic nurse. And we also have medical assistants that the patients would interact with there in the clinic. And then the navigation is done before and after the visit in the clinic. So we're available to answer questions, make clarifications, assist them with getting in touch with any resources that they think about after they find out, you know, they've met with the team and find out the plan. So as navigators we don't actually accompany the patient or meet them in person. It's all done via telephone.

 

- Got it. Okay. Callee, how about at, and Callee, you're primarily in inpatient but say there's a new patient or maybe you're doing, spending some time in an outpatient role. Can you talk a little bit about how kind of the initial introduction to Vanderbilt works?

 

CB: Yeah, I can say kind of depending on the acuity of the patient, of course you might be presenting to the clinic and able to see your primary oncologist at that time and then you would also meet their nurse navigator if that was the case. You wouldn't necessarily meet the pharmacist face-to-face at that time, but we would be available in the background and there to give you any kind of information if that was needed. And then if the patient is more acute and coming into the hospital for their diagnosis at initial kind of touchpoint at Vanderbilt, you would be seeing an attending provider. This person may or may not end up being their primary oncologist just depending on what kind of specialty that provider works in within the blood cancer space. And then usually you would meet the pharmacist, you know, the next day on rounds we would be able to come in and introduce ourselves as well. And you would also meet the case manager and the social work team as well at that time.

 

- Great. Speaking of case managers or social workers, Eric, do you want to take that question for Mass General?

 

EH: Yeah, certainly. One thing I frequently will do when I'm meeting somebody is ask if they've worked with a social worker before. Certainly there's many different settings that we're placed in, but there are many hospitals where the social workers have a more of a case management role or a less clinical role, such as not the case at MGH. We've got on every inpatient floor we've got what's called a nurse case manager whose, whose job very specifically is with respect to discharge planning and that is to say I'm collaborating on, you know, daily and sometimes hourly basis with our case managers and doing my best to kind of transmit information that I've got about the family, about the living situation or questions that have been raised in my assessment to the case manager. And, I think also looking at where we can speak to, you know, gaps in learning or understanding that a family may have about, you know, nursing facility or a rehab facility or levels of care or, or what it could mean for a person's functioning to be too good, which would then change the discharge options that exist to them. Or you know, identifying that this is now a point where the family's asking questions about home care, elder services, VNA, home hospice, these kinds of things. I would seek to really bring the case manager in pretty swiftly.

 

- And when, so when a patient is first coming into the hospital, then who are they meeting with on that first encounter?

 

EH: If that question is still to me, I would say my answer mirrors almost perfectly Callee's answer. Okay. And, and that if people are coming into the hospital through the outpatient setting, say if they're, they're coming in to establish care here or be considered for a bone marrow transplant, then the assessment's going to be done by our outpatient team, soup to nuts. The workup will be. Social work is very much a part of that team. Everyone who comes in for bone marrow transplant or CAR T-cell therapy would have a social work assessment done on the outpatient. And I would then be notified of this and made aware of any points of psychosocial support would be beneficial. If there's more of an acute transfer, people are coming to the floor, that's when the assessment, the history and physical is done by our APP generally, nurse practitioner or medical resident. And then other disciplines are coming in. I will say that I don't meet absolutely every new patient in my role, but rather there's a very, very low threshold that my colleagues have for consulting me early if there are concerns about coping, about supports, living situation, safety concerns, any of these things that I'm, that I'm brought on board, but I'm listening pretty closely from the point of their arrival.

 

- Great, thank you. Okay. And you mentioned, you brought up the concept of communication and so that's a big question that I think a lot of patients have and caregivers have. And so I wanted to talk briefly about that. But I, before I do that, Dr. Christopher, do you have anything that you wanted to add in terms of how things operate at your hospital and how do you actually sit in on primary encounters with patients? Sometimes say for example, if they're transferred in or maybe they are coming in, I'm just not sure how things work for you on a day-to-day basis.

 

MC: I'm sure it's very similar to what's been described, described at Vanderbilt and at Mass General and all of the other places where you, where you guys work. You know, one of the things that's hard for leukemia patients I think is that while most people know someone who's had breast cancer or lung cancer or colon cancer, most people are not prepared for how complicated these blood cancers can be. And you know, some of the other panelists have alluded to, there's a lot of inpatient, you know, if you have breast cancer, you can go through your whole cancer journey and never get hospitalized. Hopefully that's what happens. But with the blood cancers, there's these prolonged hospitalizations and that leads to, you know, issues with communication between the outpatient team and the inpatient team as Eric said earlier. So a lot of patients are diagnosed, they first hear about their diagnosis in the hospital. A common story is, for a patient with acute leukemias, I was feeling fine three weeks ago and you know, I went on a bike race, you know, and then after that I noticed I was feeling a little more tired and I got all these bruises and then I went to my doctor and they did some blood work and they said, you need to get to the emergency room right away. And next thing you know, you're in another city. And since some people are talking to you and telling you that you have this diagnosis and you're going to be in the hospital for the next six weeks. So it's a terrible, it's terrible whiplash that patients get. So at WashU, just like everywhere else, the first people you meet are some doctors and nurses who come in and then the nurses really do a lot in terms of, of education because oncology nurses, as you guys all know, it's a calling and those, a lot of our nurses have been doing this, have been doing their job for decades. And one of the things they love and one of the reasons that keeps 'em coming back is to patient education and to help patients through these things. Because the doctors blow in and blow out, you know, in a few minutes, but the nurses are there for the whole shift. So those are those are the people who first meet the patients, but all of the ancillary staff, the dieticians and the therapists and the pharmacists are behind the scene. I don't think patients really realize how much pharmacists do to, really take care of them because these treatments are incredibly complicated. I can't think of any other branch of medicine. If you have a heart attack, you go and you get your cardiologist. But in blood cancers, if you come in for a stem cell transplant, all of the different pills that you're on, all of the different infusions that you get, you couldn't possibly do this without pharmacists. So, so it's cool that you're having this, gathering of all of the branches of the care team. But yeah, so the people really do want to hear from the doctors and so when I'm inpatient, I always make it a point to try to see them not long after they come in and then when they're outpatient, yeah, just like Callee said, at WashU, also sometimes the doctor you see inpatient isn't the person who you get assigned to in their outpatient clinic, but if I'm assigned a patient and I'm not on service, I'll also drop by during their admission to introduce myself. So that's how things work here.

 

- Very good, thank you so much. Okay. So, and Morgan, I see you there, but I think you're probably going to say that things are similar to how it works at other places. And Lori? So I'm going to move on to the next question, which focuses on communications. And so, you know, a lot of hospitals and clinics now are using electronic or digital means of communication, but at the same time we know that a lot of the patients that we're working with are maybe not as savvy with, you know, computers, cell phones or you know, apps, that kind of thing. So how do you work with patients to figure out what's going to work best for them in accessing help when they need it from an outpatient standpoint primarily, but then also if someone's in the hospital and maybe needs to access a specialist or something like that. So Dawn, do you want to start with that? Just talk about it from your perspective since you're primarily outpatient focused and then we can kind of talk a little bit more about the in-patient perspective.

 

DU: Yeah, sure. So one of the first things that we educate the patients on is how to use our patient portal account, which is MyChart, which is part of Epic. So we have pre-printed instruction sheets that kind of give them tips and pointers on how to quickly navigate through it for those who want to do it. One of the other things we do is we assess what's going to be the most comfortable way or their preferred method of communication so that everybody knows it upfront and then we can mark it in the chart. And so that way we're giving the patient their communication in the method that they're most comfortable with. But we educate them from the very beginning so that we can get them comfortable with it because the MyChart is, it's a very useful tool for the patient and for the rest of the team members because then we can see every communication that's gone on. So that's how we do it on the outpatient.

 

- Great, thank you so much. And let's see, how about, oh, let's go to Eric.

 

EH: Very, very similar to how Dawn described her hers. On the inpatient we don't communicate, I'm not actually findable on, our portal, which is called patient gateway, but it's used very, very commonly on the outpatient. Certainly there are some patients who are more challenged in adopting new technologies. I might meet a patient who's got a flip phone and will tell me to my face that there's no way that he or she are ever going to use an online portal. And I think we can be, you know, we can hang in there with them, we can speak about email, we can brainstorm and getting back to the communication piece, do our level best to understand their preferences and, and tailor our communication that way. It is worth mentioning that I am required to send all my emails in an encrypted status, which can be a barrier in some cases, especially for people who don't own a laptop or PC because creating a password on a smartphone is not always so easily done. So I have to be, I would say, extra mindful in how I encourage people to identify their best way of communicating with me electronically. But I would say patient gateway is highly used on the outpatient and there's a really quick link off the demographic page that can send emailed instructions to a patient on how to set up a gateway account.

 

- Okay. Callee, do you want to, you're again primarily in inpatient, but do you have anything to add or to contribute on the communications side?

 

CB: I don't know that I have too much to add. I think it can be, we have resources both a telephone number as well as some online resources to try to help patients get set up with their portal at Vanderbilt. To Dr. Christopher's point, some of these regimens and the follow-up is very, very complicated. So we do our best to give patients, get all their appointments in place at the time that they leave the hospital. So it's on their discharge paperwork, but not always, it's not always possible for everything to be in place and they might be changes that happen after the fact. So, you know, our nurses help by calling the patient and making sure everything is in place, but we really try to encourage our patients to utilize the kind of telephone phone number or the resources online to get that portal set up just to make kind of their process through the continuum as as smooth as possible and so that they can have all that real time information on their appointments and other things.

 

- Great. And Morgan, so how do patients find you and are they, I apologize if I don't recall, but you work with primarily inpatient but also some outpatient, is that right?

 

MZ: Opposite, mostly outpatient, some inpatient.

 

- Okay. So how do we schedule with you or how do we come to you with a question if there's a question?

 

MZ: Most of the time providers place a referral and let me know that they've placed the referral so I can help coordinate scheduling. And we also have dedicated schedulers for outpatient oncology scheduling. Similarly on the inpatient side, those therapists will recommend outpatient oncology rehab and help facilitate the scheduling as well. And similar to how Eric said, I'm not findable in our system for patients to send a MyChart message and it's not something that's supported by our IT department. So patients can't message me directly. So I depend a lot on email or patients calling to our office and leaving a message, which isn't always the most ideal because if you're with patients all day, it's obviously hard to return phone calls. So I try to encourage email as much as possible, but then when I have cancellations or no shows, then I call patients back.

 

- Okay, great. And then I love to hear Lori's perspective on this, because I think Lori also works quite a bit with out-patients.

 

LB: Yeah, so I don't really have much more to add. We definitely, we use Epic so we encourage using MyChart. I, when I meet with my patients, I ask them, you know, how do they prefer I communicate with them and the majority of them understand that the team, collectively, can communicate best with patients when we're, you know, using the same portal to Dawn's point, I really appreciate that. So that's that. I think that's all I have to add.

 

- Great. Okay. Alright. So we've talked about communications and we've talked about, you know, what everyone does and what their role is. I'd like to just try to get into how do you work with patients to make sure that they get the best possible care that they can through their experience with the hospital. And there's a concept called shared decision making and I know that everybody kind of strives toward that to, and for those who are listening who aren't familiar with this concept of shared decision making, I think it'd be great if each of you could just kind of talk about what is it, what does it mean at your organization and how do you kind of work with your colleagues to, you know, make sure that the team understands and factors in the specific needs of patients and caregivers in your kind of engagement with them. Whether it's, you know, treating them, helping them with accessing services, or medications, that kind of thing. So I think you could each maybe take a little bit of your own perspective on it. Dr. Christopher, do you mind if I ask you to start?

 

MC: Yeah, so to me the phrase shared decision making sort of suggests this way of taking care of patients where we're sort of all in it together and it's their illness and it's not like some doctor or some nurse is going to tell you, we're going to do this, just, you know, go over there, go over there and, and get this IV placed. It's really trying to educate the patients about why they're feeling crummy. Because usually that's, you know, what brings them to medical attention is you feel poorly where you have some other medical problem trying to educate patients about, about that and what we recommend as a treatment for that, but also to educate patients about what we don't know, which is a lot, including the future. What's going to happen if we try this treatment? What might happen if we don't try this treatment? Helping patients understand that there's a lot, there's a lot of unknowns and a lot of uncertainty as we go through this. There are also often, as complicated as our treatment plans sometimes are, there are a lot of bumps in the road or a lot of unexpected complications that can lead to having to change plans. So where, while a lot of patients want to know where they're going to be on Thanksgiving, sometimes things come up, so the best we can do is make a good guess about what, you know, the timeline of their treatment's going to be. So I think shared decision making is helping them have confidence in us, not a false confidence that we're going to handle everything and make everything better forever, but that we're in there with them and we're going to do everything we can with all of the knowledge and experience that we have to try to get them feeling better.

 

- Wonderful, thank you. Let's see, how about Lori?

 

LB: I have to keep unmuting. Yeah, no, I think when I hear shared decision making, I think collaboration, I think it's also transparency, you know, so like to Dr. Christopher's point, like this unknown, which often happens and that's a challenging thing for I think practitioners to be able to navigate with within a conversation with patients. But I think it's so important and necessary and I think it's very well received when that happens and I think that's really helpful in the long run to build that rapport and that and that trust in one another.

 

- Great. Eric?

 

EH: Yeah, I would say so many of the components that have already been raised. I really view shared decision making in our patients feeling that they can be educated about their illness, yet not feel pressured to go one way or the other. You know, or judged. That they would, you know, ask is it reasonable were I to pursue this versus that or is it reasonable to say that, you know I am motivated to do everything that I possibly can because there are some people who will say that I will fight until there's nothing left to possibly gain. And our job is to listen, to draw on their perspective, to build their trust, to invite their questions and to make them feel that it is okay to be in this position or it's okay to feel indecisive. But part of it, too, I find is helping people to identify their learning style and to ask about where's good to do my own reading? If I am so inclined to go online to answer my questions, well let's at least direct people on what are good places to go versus not good places to go. But I would also say, going back to what I had initially said in my introduction is shared decision making really benefits too with people understanding the arena of care and how it might look and feel different if they're in the clinic, if they're in the hospital.

 

- Great. Okay. Anybody, Callee, Morgan, Dawn, do any of you have anything that you'd like to add to the topic of shared decision making?

 

MZ: Sure. I think shared decision making is a huge part of therapy and rehab because we set goals with patients and so all of my treatment is really dictated by what the patient wants to be able to do or maintain doing. I think sometimes it's hard in the beginning, especially when someone's first diagnosed or starting treatment and you really don't feel good, or on the flip side you feel kind of like yourself and things aren't so bad to recognize that things will unfortunately change and it's really important to stay as active as possible during treatment. And sometimes it's really hard to look at someone who's not feeling well and say, well we need to exercise and so how do we meet in the middle and find a way to keep moving without making someone feel worse than they do at present. And we write goals in all of our evaluations and those are ever changing goals and evolving goals. So each time we see someone we might be making updates or you know, someone has a change in their performance status or things like that and we adapt to that and keep things, keep things moving so that way we can hopefully help someone maintain as much independence as possible. And I think for so many of our patients, that's what's important is to feel as much like yourself and maintain as much independence as possible. And so how can we meet in the middle to do that?

 

- Yeah, great. I love that. Thank you. Okay, Callee or Dawn? No, no, no pressure. If you want we can move on to the next question, which is a very good one. Callee, you unmuted, you want to join?

 

CB: I was just going to add, you know, I think it's important when I think about like making treatment decisions and when we proceed on with some sort of plan of care in terms of chemotherapy, there's always the step in the process of consenting the patient and I, when it comes to shared decision making, we do our best to provide the patients with as much information as we can give them in terms of what this will look like, how it might make them feel, and just kind of empowering the patient to feel like they can raise concerns of things that are really important to them, don't seem to jive well with the treatment plan that's being laid out for them. You know, that's the reason for that consent process and just being willing to speak up. I know some team members might be more approachable than others, but just, and I'm sure all everyone here has gotten patients telling them about things that you were able to raise to the team. So I think just letting patients know that please speak up during that consent process and don't feel like we're kind of putting this decision onto you and we always want to know, and make sure that you're agreeing to that, as well. And that we have given you enough information to make that decision.

 

- I love that. Thank you so much. Okay. I have a great question and this actually, this is a question that came up recently in a conversation I had with a patient last week. So the scenario is a patient who is, you know, has received treatment and is in remission but is at high risk given her genetic markers and is confident with her current clinician or oncologist at her local hospital, but is considering getting a second opinion but doesn't want to hurt the clinician's feelings and feels a little uncertain about whether it would be okay to get a second opinion. So Dr. Christopher, do you mind if I ask you to weigh in on that one first and then we can, if anybody else has any thoughts, you can flag me down and tack onto that?

 

- Yeah, sure. That's a good question. Look, these are important issues, why wouldn't you get a second? You get, if you want to get a swimming pool, you get a couple bids, right? We ask for second opinions in our daily life all the time for different, for things that are far less important than our health. So I've been on both sides of the second opinion thing, sometimes patients ask me, you know, how about if I get a second opinion? I say, absolutely. Go get a second opinion. It's a little complicated in the leukemia world though, because in St. Louis there's really one other, only one other place that sees leukemia patients and they don't see the volume that we do. But I've had patients go to other places, MD Anderson for example, to get second opinions and I've gotten second opinions from other places as well. So absolutely there's no, no doctor's going to get their feelings hurt by you going to get a second opinion. And if they do, that's their problem. I mean that's, you know, we're all grownups, so I would hope that patient doesn't feel that way or that their doctor reassures them that it's a perfectly good thing to do.

 

- Great, thank you. Anybody as a logistical matter, Dawn, I think you, you mentioned that you sometimes work with folks that are coming from out of town. Can you talk a little bit about that logistically and if they're coming for treatment or if they're just coming for a second opinion, do second opinions always happen in person? Does it sometimes happen virtually?

 

- So no second opinion, any opinion that we give the patient has to come in person so that we can do the appropriate diagnostic testing and the physical assessment. So it's, and it happens frequently and like Dr. Christopher said, it's very rare that you come across somebody who says their doctor has a problem with them getting a second opinion. And so part of, our intake nurse navigators are the ones who initiate or they initiate the process of assisting the patient with the logistics involved in coming across or coming from out of town for a second opinion. They'll help them with information and provide resources or for transportation, lodging, travel, parking, things of that nature. And so it's something that's frequently done. And I think that, you know, as a patient, a second opinion is absolutely necessary in this case, just as Dr. Christopher said that, you know, this is, these are important life decisions you're making and treatment decisions. And being that we're a research institute, you know, we have a lot of treatments that are available at our institution that are not available outside. So it gives the patient a broader selection of choices, which leads to their shared decision making opportunities and allows them to have the best outcome possible.

 

- Okay. Any other thoughts on the topic of second opinion?

 

EH: No, I would, I would concur with everything that's been said. I would offer that there's a certain kind of person who's going to feel guilty no matter how much you reassure them. And that's a very common thing. And I think it just comes right on back to the relationship, the trust that's established, you know, and certainly there's a low threshold for social work being involved if there's financial hardship, but it is something that people have to take on. And I'm also mindful of, you know, there's a finite amount of energy that people have to, you know, to go across the country at a time when they're feeling so poorly. But I try to also stress that, you know, that these oncologists in many cases, they know each other, they work together, they're, you know, comparing areas of research and so forth. So, but no, I think just to really underscore that, that is completely acceptable and reasonable to request.

 

- Thank you. Okay. So I would like to talk a little bit about how there's, from time to time there's overlap in questions that come from patients. For example, say we have a patient who's taking we, well, we received a question that was on a specific medication and the question focused on dietary restrictions while taking that medication and the medication is Venclexta. And the question was, are there dietary restrictions, food supplements or herbs? Who do we ask? And so the question is, is that just the pharmacist who we would ask those questions? Does the dietician get involved? How does that work? And so let's go to Callee first and then we'll talk to Lori.

 

CB: Yeah, I would say that these questions come up a lot, especially with Venetoclax or Venclexta, at our practice we have the nurse that kind of serves as the point person. So these questions would typically come through to them first and then they would decide who was the best person or most appropriate person to answer that question. So this would commonly come to the pharmacist in-basket where we would do a review if they had a specific question or we're just generally asking about a specific dietary restriction. Specifically grapefruit and grapefruit juice are common dietary things that can interact with medications. But aside from that, there aren't too many limitations when it comes to dietary restrictions with medications. So we could provide that information back to the patient in terms of avoiding grapefruit, grapefruit juice, also star fruit is kind of within that same category. That's how we would manage that.

 

- And, and so would the, does the question always come to you or do you sometimes meet with the dietician or do you sometimes meet directly with the patient and the question comes up and then they say, well, what should I eat then? Then you provide the referral to the dietician? All of the above?

 

CB: Yeah, all of the above. I would say normally. So aside from the specific grapefruit juice and starfruit, there really aren't too many dietary restrictions or things that patient, a whole group that patients should avoid or eat when it comes to their medications and interactions with their medications. So if patients were looking for more detailed information, that would certainly be my cue to let the team know that the patient would probably benefit from a dietician meeting with them to discuss those things further. So I'd be curious kind of what Lori's thoughts were.

 

LB: Yeah, we actually operate very much the same way. So it's depends on the nurse actually. They may handle the question themselves or they may ask the, where I am, the pharmacist meets with the patient at the first treatment, at the first visit and may check in by phone. So unless it's included in the initial teaching, which that typically happens when someone starts a new drug or treatment. That happens from the collaborative nurse who is kind of like the right hand man and woman to the oncologist. So that's where a lot of the initial upfront teaching would be. So dietary restrictions, like the one we're talking about would be an example. Sometimes that doesn't happen or as we're aware, a lot of our patients only retain like a third of what they're hearing. So we often find, I would say where I am, we're very redundant with our information. I am more patient facing where I am. So the pharmacists, the team where I am is really, they're kind of behind the scenes but always, you know, working with the team. So I often just get asked more questions because I'm much more patient-facing and I have a lot of patients who will ask me, what can I eat? What can I not eat? They may not even be aware of any sort of drug interactions. So that gives me the opportunity. However, anytime I'm doing an assessment and meeting with a patient, that is part of the assessment is I'm looking for any drug interactions. And I also ask about dietary supplements because they also can work very similarly to interact with treatment just like grapefruit juice might. And another part of what I love about where I am is, as part of the team we can offer the explanation of the why. So some of our patients want to know why. And so the pharmacist, no one can explain that better than the pharmacist. So I think that that just enhances the care that we give and again, sort of translates into more trust, I think, with our patient population.

 

- Great, thank you. Any other things to add on the topic of drug interactions with food or, or more generally, do you, do any of the panelists find that sometimes a patient or a caregiver might go to one of your colleagues when in fact you could have helped them? Like maybe Morgan, I don't know if you ever find that, you know, you're available to a patient that has a specific issue, but then you find out that one of your colleagues is trying to help them with it and you say, well, hey, how about referring them to me and I can work with them to help them? Any times where something like that might occur?

 

- I actually have good, I feel like if you're in a system that has strong interdisciplinary care, I don't run into that so much. The providers are really good about referring and if patients, for example, send a MyChart message or something like that to a provider that they know is for me to answer, they just forward it along to me and then I can reach out to the patient, which is really nice. So yeah, it's not something I actually run into, which is nice.

 

- Wonderful. That's the way we like it. Right? Okay. All right. Here's a question. Sometimes patients ask, how do I know, and this is in the outpatient setting, how do I know if I need to message my provider or if I should call my provider or if I should run directly to the ER and "do not pass go." So how do they, what's the guideline for who to contact and when? I don't know who, Dawn, should we start with you or is Dr. Christopher the better person to start with?

 

DU: I can let him, I think he's motioning for me to answer that. Okay. Yeah, so that's, you know, part of the teaching that we do at those designated time points and, and it's a lot of reinforcement reminding them that, hey, if you develop a fever, you need to go right away to our acute cancer care center to be evaluated. But if you've got a question about one of your symptoms and you need another medication or you need a refill, then we educate them to send a message through MyChart because that's the fastest way for the team to be able to coordinate and get everything done and let you know that it's been accomplished. But we always offer the opportunity for, or the option for them to call if they choose to call too. So it's an ongoing process of educating and reinforcing the patients on who to call for what reasons. And you know, it's very important that you reinforce it because it can change over time, but education and reinforcement's the most important thing.

 

- Great. Anybody have anything to add or, well, actually on the pharmacist or on the pharmacy side, maybe you could answer that question? So maybe it's, maybe it's someone who just can't, maybe they're outpatient setting, they need to get a refill in their medication, their pharmacy, where they normally get that refill, can't get it, then what do they do?

 

CB: Yeah, I would say in those situations it's probably best to call if it's within normal business hours or try to call the next day as opposed to sending in a message. Just because I think we'll tell patients with our portal specifically that if you need a response within like two business days to go ahead and call. I think that would be something that we would probably rather you call and make sure we're addressing it and that we're aware of it and the right people are involved to get those issues sorted out probably within the next business day to make sure there's no gaps in care and the medication that the patient needs.

 

- And in your case, they would call a nurse navigator or some point person on the team, not necessarily try and get the clinician or the pharmacist on the phone.

 

CB: Yeah, they would start with, that's just kind of how we tend to operate with Vanderbilt being the nurse triaging things typically. So that would be where they would call here.

 

- Okay, great. Okay. We've had one person, one person who is the care provider to their husband - her husband has been in remission for a while. He is still receiving treatment and has extreme lower extremity weakness and difficulty walking. Is there anything that she can do? So again, this is a patient in an outpatient setting. They're coming, they are receiving physical therapy twice a week, but it's not helping. So I don't know. Morgan you want to tackle that one? Any thoughts on other possible remedies or things to ask for?

 

MZ: Yes, and I saw in the question it was worded that therapy is coming twice a week, I believe. So it sounds like it's more of a home health type of approach. And I really, really strongly discourage home health therapy for my patients if they are able to come to outpatient appointments as much as possible because if you're not seeing an improvement in home health, it's likely because it's not a difficult enough challenge for that patient. The role of home health therapy is really important in making sure that patients are safe within their homes, helping to work within the confines of the home if someone's unable to get out. But for patients who are somewhat ambulatory or mostly ambulatory and coming to outpatient appointments for the correct intensity of treatment, I'd really, really encourage outpatient therapy. And if coming to outpatient therapy frequently is a lot of work, you know, a lot of times what I do with my patients because I understand appointment burden and appointment burnout, you know, we'll do once a week or once every other week and have a very strong home exercise program and I'll involve the caregivers or family members in terms of, you know, here's how you can guard the patient during this exercise or you can support them or hold their hands or hold their arm here and there. And I really try to strongly encourage patients to do exercises throughout the day in different positions. So I'll have an exercise program for laying in bed, sitting on the couch, sitting at your kitchen table, standing up at your kitchen counter just to kind of incorporate it throughout the day. And so the other thing is if say you are going to an outpatient therapist and you feel like results aren't coming along as much as you'd like, you can always ask for another therapist. It's always good. Similarly with medical opinions, it's always good to get a second opinion for PT. You know, we all have different viewpoints and different ways of treating and so sometimes maybe it just takes a different approach. And so similarly to, you know, asking for a second opinion medically, it's not going to hurt anyone's feelings. It can be really helpful to you as a patient or to the caregiver to make sure that you're getting the care that you need that's personalized to you. But biggest thing is I would really, really encourage outpatient therapy as much as possible if you're able to get up and out of the home.

 

- Great. Thank you. I love those points. That's really helpful.

 

MC: And I'm going to jump in just to say first of all that I, what Morgan says is great and, and we always try to, if they at all can get to outpatient physical therapy, that's better than, than home health physical therapy. Because just getting there is therapeutic, you know? Right. You're exercising, getting in and out of your car and you feel more normal. The other thing I would say though is that, it sounds like this patient is either having a clinical decline or maybe not? It's a little hard to know from not having the specifics, but I would definitely reach out to the care team and let them know about this because it could be as simple as deconditioning, which is what we've been talking about in physical therapy and time will get better, but you want to make sure there's not something else going on.

 

- Good. Yep. Okay. Thank you. Okay. And then we also received some questions from the parents of adolescent or actually a young adult patient who, so their daughter is 31 years old and they were asking how do they know what her limitations should be? What are some things that may be restrictions for her? They mentioned things like, you know, going to a spa for example, or other concerns about things that she should or should not do. So Dawn, I think you, you said you might be able to respond to those questions.

 

DU: Yeah, so encouraging the patient and the caregivers to have that discussion with the medical team is very important. And because we want to reinforce making sure that they're not going to do anything that's going to put them at a higher risk for infection. Because if she's an acute leukemia patient, her white blood cell count may be low, her platelet count may be low. So anything that's going to put them at risk for injury to the skin or anything that could cause bleeding or bruising are things that you're going to want to educate the patient about to make sure that they know this information, why it's important so that they can make the best decision about what activities to participate in and what should be avoided. So it's real important that they know that, but you also want to encourage that they be able to participate in activities and do things to help them live a good quality of life. So it's always important to consider that and, but main thing is to let them know to be careful about avoiding infection and any injury that could lead to excessive bleeding.

 

- Wonderful, thank you. So we're close to wrapping up here. We've got about 10 minutes left and I want to give each person just a minute or so just to share any closing thoughts if you have any. But in the meantime, before I do that, I have a question that was submitted by a patient that I actually know well, and I think he asked this question specifically because he himself benefited immensely from a kind of a specific type of therapy that he received while he was in his stem cell transplant, post-SCT recovery. And so his question was what are some inpatient modalities that folks may benefit from during their sometimes lengthy treatments? And he mentioned as suggestions, art therapy, music therapy, et cetera. And he actually was one of the individuals who benefited greatly from music therapy. There was an individual who came to the hospital, or actually it may have even been in his home, I'm not sure, or virtual while he was recovering and he learned to play the dulcimer. So I'm going to put that out there. It's a little bit of a high bar, but does anybody at your hospital have anything to share that might be a little bit more unique that folks can benefit from? Someone did mention pet therapy. I love that. Dawn, you want to start since you're on my screen right away.

 

DU: Okay. So we do offer all of those things on inpatient and curiously enough we also offer some things outpatient, not only for the patients but also for the caregivers. We found that we have a designated area for art therapy where they can go and do, you know, anything from arts and crafts to coloring, drawing, painting, they'll have different things available like little classes or presentations going on. And they also offer some things to the staff to help with stress management and relaxation. So there's a lot of things that are available both inpatient and outpatient like that, that are offered for everybody.

 

EH: We've got a wonderful music therapy team that frequents throughout our inpatient service and it's a near and dear to my heart, but it's really a wonderful offering in that it does not put any pressure on people to be musical or to want to learn an instrument. It can just, you know, be used as an opportunity to speak to their lifelong relationship with music. Whether it's creating a playlist together, talking about musical memories, remembering a concert, listening to music. But we've, you know, we've had professional musicians come through who don't even want to talk to the music therapist, just want to secure a nice instrument that they can make use of while they're there. But it's a real, a really a wide-open playing field. We've had art therapists in the past we're currently between, which is something that we're working on, but still something where we've got access to materials as we need it. Unfortunately on the inpatient service, pet therapy is simply not an option from an infectious risk. Which is sad because animals are so incredibly therapeutic, we find, but that's not something that we can offer. Massage, reiki, therapeutic touch are things that we bring to the bedside on a real regular basis too.

 

- Wonderful. Anybody else? Okay. Alright, well this has been fantastic. I just want to say I'm very excited to be processing the video from this and putting together the transcript and sharing out all of the various things that you all have shared in this program tonight. So thank you all so much for the not insignificant time commitment that you made to this and I hope you all thought it was helpful to just hear the perspectives of folks from other organizations. And I'm just going to invite you if you want to share a few minutes or just a minute or two - closing thoughts, if you have any. And then we'll wrap things up. Eric, you're still on my screen. You want to start?

 

EH: Certainly hey Lindsey, thank you again for including me in this, this is really a privilege and having been with this patient group for as many years as I have, it's just so rich, it's so rewarding. You know, we're a large hospital and we're, you know, we're doing more transplants and more cellular therapies all the time. But one thing that I think really bolsters the sense of team connectedness is the fact that we feel like we're a small practice. I mean, when people come into our program and all of you who have worked with this population will know what I mean unfortunately, you are likely to have a very long-term relationship with your program. Throughout the joys, throughout the bumps, throughout all points on the journey. And we get to know and we get very attached to the folks that we get to see. I have to remind myself that when a patient comes back in, even though it's really nice for me to see them because I haven't in three years, it's not a moment that they're especially happy to be back on my floor. But we find that the reconnection with the familiar faces and the relationships that were built years ago can be a strong asset in the healing process. So thank you.

 

- Great. Thank you. Lori,

 

LB: I have to make sure I'm unmuted. Thank you. It's such a pleasure to be invited and to learn from one another on the panel because I'm so passionate about oncology and nutrition. It's all I'll ever do. It's all I've ever done. It's going to sound like a bit of a plug for Cancer Wellness Center. I think a lot of individuals that I meet, they so appreciate being able to work with people who just kind of get it, as they put it, right? So they, I think if anyone is watching the recording, if you're curious to learn more, a lot of the services here are virtual. So if you're looking for a support group or just to meet your peers, other people who have been through in your shoes, you know, there's such a wealth of services that they offer here. My understanding is we serve 43 states across the country, it's all free. So even if you're just curious, I think there's a YouTube channel so you can see some of the programs there. I'm really proud to be a member of the team here, even though it's not very clinical. I think, ever since I've been in practice, I see an interest in and a growth in this area for these kind of complimentary services, you know, since we're talking about music therapy but also nutrition, you know, and I think that we recognize the value of exploring some of these other modalities to enhance, you know, the clinical expertise of where the patients are receiving treatment.

 

- Wonderful. Thank you. Callee?

 

CB: Yeah, thanks so much Lindsey for inviting me to be a part of this. I feel like I learned a lot too this evening kind of hearing everyone talk. And I think just, biggest takeaway is, you know, making sure patients feel comfortable speaking up and letting us know what's important to them and if they're having issues, as a pharmacist, we work very closely with the team and have a lot of tools in our belt to help with the supportive care aspect of things. You don't have to be having nausea when you're getting chemotherapy. And so that's just an example of ways that we can be really helpful. There's lots of things we can do to help the patient. So just feeling empowered to speak up and let us know what you're dealing with so that we can help you kind of have the best quality of life as you navigate your care.

 

- Wonderful. Thank you. Morgan?

 

MZ: Yes, I think as everybody else has echoed, we all really love our jobs and we're really passionate about this. So I always tell patients similar to what Callee just said, you don't have to live with certain symptoms. And so if you're really fatigued, if you have really bad neuropathy, if you feel like you can't get out of bed in the morning, you feel weak, you can't get in and out of the car, the stairs, you have brain fog, all these things- ask for physical or occupational therapy referral. And we are more than happy to see you through your journey and help you maintain as much independence and keep feeling as much like yourself as you can.

 

- Great, thank you. Dawn?

 

DU: Yes. Thank you very much Lindsey for this opportunity to participate in this. And I've learned so much from everybody else who's been on the panel and especially interested in learning more about the Cancer Wellness Center. And I'm writing down Lori's name as a possible resource to refer our patients to. But I want to echo also what Callee said, the empowering of the patients to speak up and engage in their care so that they can have all the information they need to make the best decision possible for their outcome is always the main important thing. And, I would encourage patients to always speak up and ask questions because you won't know until you ask and it's always important. And being involved with oncology for the past 18 years, I agree it is a passion. It is something that we are passionate about and we are here to help. And so it's important that patients know that and take advantage of it.

 

- Wonderful. Thank you. And Dr. Christopher.

 

MC: Well, I mean what to say? Everything that you guys have. Thank you Lindsey, for, for organizing this. It's wonderful meeting all of you. It's always wonderful meeting kindred spirits. You know, not everybody in medicine likes to take care of people with cancer, but I find that the people who do, for the people who do, it's a real calling. And for the patients who are going through this, who are listening to this, just to echo what everyone is saying, you're not alone. Not only do you have physical therapists and doctors and nurses and pharmacists and all of the ancillary professionals, but you've got, sometimes I think there's no one who understands it like someone else who's going through it. And so the patient support groups that you know now are so much easier to have access to because you can talk to people over zoom, you know, you can go to these things virtually. I think a lot of patients do benefit from that. So please reach out if you need anything at all. You've got healthcare providers who would do anything for you. So don't be shy!

 

- Wonderful. Yeah. Thank you. I totally agree. I should acknowledge the supporters of the program one more time. Thank you to Autolus, Johnson & Johnson, Cycle Pharma and Novartis for their support of this program. And thank you to our speakers. Again, I wholeheartedly agree with what everyone else has said that this was a unique opportunity to hear from people from very different places and different perspectives talking about how patients and caregivers can be supported. And it's so important and I'm so glad that we were able to do this. I do apologize for the technical issues, but I'm looking forward to working through the recording and sharing it out. And I'm sure that we will get a lot of very positive reports back from people. And so thank you all so much for your time and attention and hope to see you soon in one form or another. Thank you everyone.

 

EH: Thank you again.