August 9, 2018

Radiation Oncology Survivorship Program adds telemedicine care

The Vanderbilt-Ingram Cancer Center Department of Radiation Oncology is offering survivorship care in Clarksville, Tennessee, via telemedicine to patients after they complete curative treatment.

Rachel Conklin, MMS, PA-C, leads Vanderbilt-Ingram Cancer Center’s Radiology Oncology Survivorship Program. (photo by Steve Green)

The Vanderbilt-Ingram Cancer Center Department of Radiation Oncology is offering survivorship care in Clarksville, Tennessee, via telemedicine to patients after they complete curative treatment.

About 30 patients from the Gateway-Vanderbilt Cancer Treatment Center in Clarksville have enrolled in the new telemedicine service, which could be a prototype for other radiation oncology survivorship programs.

The initiative has received a grant to support a research study around this program from the Radiation Oncology Institute, a nonprofit founded by the American Society for Radiation Oncology (ASTRO).

The planned study will evaluate feasibility of the program along with patient satisfaction with the telemedicine care model.

The team also intends to measure participant adherence to recommendations outlined in a survivorship care plan delivered as part of the visit, along with any change in health-related quality of life.

The satellite clinic in Clarksville is about 50 miles from Vanderbilt, but many of the people it serves live farther than that.

“We know that asking patients to come from their medical home for radiation treatments for survivorship care can be a barrier,” said Rachel Conklin, MMS, PA-C, who heads the Radiology Oncology Survivorship Program and is principal investigator of the study.

“Not only do they have the traffic and the parking to navigate through, but there is also the issue of going to a place where you actually haven’t been treated before and seeing someone new. They also don’t have to face other barriers of time and money spent getting to Nashville and possibly having to be away from work.”

Telemedicine technology allows Conklin, a physician assistant based at Vanderbilt, working with a nurse in Clarksville, to do a complete evaluation of a survivorship patient at the Gateway-Vanderbilt Cancer Treatment Center.

A specially designed stethoscope even allows her to hear the patient’s heart sounds and lung sounds, and a video-enabled dermatoscope enables her to closely examine any areas on the skin in the radiation treatment field or elsewhere.

“It’s a comprehensive visit,” Conklin said. “If any medication needs to be prescribed, we do that. If we need to order any diagnostic tests or imaging, we do that.”

A survivorship visit involves reviewing a personalized care plan based on the patient’s medical history.

It’s a roadmap that takes into account risks related to diagnosis and treatment and recommends prevention practices for avoiding chronic illnesses as well as screening schedules to detect cancer recurrence or development of other cancers.

VICC has offered survivorship care through the REACH for Survivorship Program for many years under the leadership of Debra Friedman, MD, the E. Bronson Ingram Professor of Pediatric Oncology and leader of the Cancer Control and Prevention Program.

The Radiation Oncology Survivorship Program, a partner program to REACH, is the newer of the two initiatives, having been established in 2017 as part of an effort to provide survivorship care to patients completing curative treatment in radiation oncology.

“Survivorship at Vanderbilt-Ingram Cancer Center is a top priority,” Conklin said. “We have an obligation to our patients to make sure we are offering this service to as many of our cancer patients as it is appropriate for and encouraging uptake. It’s ultimately the patient’s decision if they participate in that element of their care, but we believe it is beneficial.”

The standards of the Commission on Cancer require that 50 percent of patients who complete curative treatment receive a survivorship care plan.

Conklin previously worked as a clinical trails associate with REACH before pursuing graduate training and returning to Vanderbilt University Medical Center.

“Our program in Radiation Oncology is designed to deliver survivorship care unique to radiation patients, as many of our patients are not treated in medical oncology — but the mainstay of their treatment and their symptom burden may have been taken care of in Radiation Oncology,” Conklin said.

“Our cancer center has a large volume of survivors. In order to accommodate them, our program partners with the REACH clinic to meet this goal.”

Team members with Conklin and Friedman include other co-principal investigators, Eric Shinohara, MD, MSCI and Lisa Kachnic, MD, the Cornelius Vanderbilt Professor of Radiation Oncology and chair of the Department, in addition to Tatsuki Koyama, PhD, director of Biostatistics Programs in the Center for Quantitative Sciences. Based on the results of the study, the team may pursue larger trials involving multiple institutions.