DFCI Overview. Dana-Farber is a teaching affiliate of nearby Harvard Medical School

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2 DFCI Overview Dana-Farber was founded by Sidney Farber, MD, in 1947, and is committed to providing adult and pediatric cancer patients with the best treatment available today, while developing tomorrow s cures through innovative research and clinical trials Dana-Farber is a teaching affiliate of nearby Harvard Medical School Dana-Farber s signature Total Patient Care model serves the emotional, psychosocial, and spiritual needs of our patients and their families during and after their treatment at Dana-Farber 2

3 DFCI's singular mission is to conquer cancer Vision Mission Ultimate goal is eradication of: Cancer, AIDS, and related diseases The fear engendered by such disease Providing expert, compassionate care Understanding cancer Training the next generation of leaders Promote prevention & early detection in the communities we serve Disseminating innovative therapies

4 DFCI 2014 Strategic Plan Delivering on the Promise of Cancer Science Lead the world in breakthrough discoveries, accelerating scientific discoveries to significantly improve high quality survival and care of patients Reduce the burden of care globally, applying and disseminating our research in cancer prevention, screening, and advocacy Be the role model for providing expert care and an ideal patient experience that is accessible, compassionate and cost effective for a diverse population of patients Learn from every patient s cancer experience, biology and outcome to continually improve all that we do scientifically, clinically, and operationally Ensure the financial strength that will support our aggressive agenda 11

5 DFCI Facts and Figures Statistics 383,599 Adult and pediatric outpatient clinic visits and infusions 761 Clinical trials 545 NIH-sponsored research grants $1 billion in operating budget and expenses Employees 4,274 Total Employees 467 Faculty (MDs, PhDs, MD/PhDs) 553 Total Registered Nurses 219 Principal Investigators Trainees 72 Clinical Fellows 511 Research Fellows 3

6 Dana-Farber/Harvard Cancer Center Dana-Farber is a founding member of the Dana-Farber/Harvard Cancer Center designated by the National Cancer Institute as one of 41 comprehensive cancer centers nationwide In 2014, Dana-Farber/Harvard Cancer Center (DF/HCC) was the top recipient of National Cancer Institute (NCI) Grants with 449 awards more than twice the amount received by other cancer centers Within DF/HCC in 2014, Dana-Farber was the top recipient of NCI funding, both in terms of total dollars awarded and number of grants received DF/HCC has 6 Specialized Programs of Research Excellence (SPORE) grants The SPORE is the most prestigious grant awarded by the National Institute of Health Approximately 7% of all NCI grant dollars reside in DF/HCC 6

7 Dana-Farber Partners and Affiliates Dana-Farber/Brigham and Women s Cancer Center Dana-Farber provides outpatient services for adults, while inpatient care is provided by Brigham and Women s Hospital Thirteen specialized centers make it possible for patients to receive expert evaluation and care from multiple specialists during one visit Dana-Farber/Boston Children s Cancer and Blood Disorders Center Pediatric outpatients are seen at Dana-Farber s Jimmy Fund Clinic, while patients requiring hospitalization are treated at Boston Children s Hospital There are eight treatment programs available for pediatric cancer patients Dana-Farber/Partners Cancer Care Dana-Farber Cancer Institute and the founding members of Partners Healthcare System (Brigham and Women s Hospital and Massachusetts General Hospital) consolidated their adult oncology programs and clinical research under Dana-Farber/Partners Cancer Care Today, the three Dana-Farber/Partners Cancer Care hospitals serve more than 12,000 new cancer patients annually and comprise the largest cancer-care system in the United States 5

8 Clinical Growth: Satellites and DFCCC Londonderry St. Elizabeth s MC Milford DFCCC - Methuen DFCCC - Lawrence Longwood DFCCC - Weymouth South Shore Hospital KEY LMA / Satellite DFCCC Collaborative In Discussion 8

9 Clinical Growth: 10-Year New Patient Volume Growth Across Institute Except for a brief slowdown prior to the opening FY06-16 of the Yawkey building, DFCI has seen continued new patient growth at Longwood throughout the past ten years New Patients, All DFCI Sites, FY06-16 Patients First Seen 25,000 20,000 15,000 10,000 DFCCC St. Elizabeth's South Shore Londonderry Milford LMA/Faulkner 5,000 - FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 1) Sources: Clin Stats(GE/IDX, Epic Data), DFCCC data from Pulse system

10 Network Volume as Proportion of the Enterprise Adult New Patients (Medical Oncology Only) FY13 Longwood/ Faulkner 14,965 (84%) Network 2,851 (16%) Satellites 2,851 (16%) FY16 Longwood 17,437 (69%) Network 8,009 (31%) Satellites 4,058 (16%) DFCCC Practices 3,951 (16%) Fully-Ramped Future State Longwood 17,784 (61%) Network 11,347 (38%) DFCCC Conversions 3,545 (12%) Current Satellites 4,581 (16%) New Satellites 3,221 (11%) 1) Sources: Satellite and LMA data from Clin Stats(GE/IDX, Epic Data); DFCCC Operating Data from Pulse system; Excludes Rad Onc exams 2) New Satellites include potential Foxboro, Brockton locations; DFCCC Conversions include Lawrence, Methuen, and Weymouth; Current Satellites includes Milford, South Shore, Londonderry, and Weymouth 3) Assumes new satellites fully ramped-up by FY19 4) Assumes 2% annual growth from FY16 for Longwood, Londonderry, Milford, and SEMC 5) South Shore and DFCCC projections based on 2% annual growth from FY17 annualized volume 10

11 Today A comprehensive approach to growth in light of the current healthcare landscape More complex care Super- Specialized Cancer Care Fewer cases Evolving Treatments, Specialized Care, Clinical Trials Potentially through a shared care model Less complex care DFCI Common Cancers: Longwood and satellites Patient Base of Common Cancers Common Cancers treated by our Members and other affiliates Larger number of cases 11

12 Future A comprehensive approach to growth in light of the current healthcare landscape Super- Specialized Cancer Care DFCI growth Evolving Treatments, Specialized Care, Clinical Trials Potentially through a shared care model Affiliate growth Patient Base of Common Cancers DFCI Common Cancers: Longwood and satellites Common Cancers treated by our Members and other affiliates 12

13 How should we care for this growing population? Coordination of care, with patients and between providers to ensure that individual patients health needs are met and resources are used appropriately Surveillance, screening and prevention of recurrence and new cancers, including fostering adherence to clinical guidelines and risk-reducing treatments Identification and management of late and long-term effects, including medical and psychosocial, including before and during therapy (e.g., onco-fertility, cardio-oncology) Counseling & assistance with health behavior modification

14 Components of Care for an Individual with Cancer Non-Cancer Related Medical Care Health promotion/disease prevention Chronic care (e.g. diabetes) Unrelated cancer screening Cancer Related Medical Care Surveillance/prevention of recurrence or new primary breast cancer Screening and treatment of complications of treatment Related cancer screening Counseling/support re: cancer related lifestyle recommendations and cancerrelated health decisions Psychosocial Care Attention to quality of life, fear of recurrence, depression, anxiety Financial burden Family/genetic counseling Coordination of Care Between Primary Care, Oncology, and Other Providers 10 (Nekhlyudov and Partridge, 2013)

15 Integrative Therapy and Survivorship Issues Span the Cancer Journey Pre- Diagnosis Diagnosis & Treatment Palliative Care; End of Life (Adapted from NCI, 2005)

16 Adult Survivorship Program and The Leonard P Zakim Center for Integrative Therapies Jennifer Ligibel, MD, Ann Partridge, MD, MPH & Shoshana Rosenberg, ScD 2016

17 Goals at DFCI Align survivorship with goals and strengths of institute Outstanding, comprehensive, high quality clinical care Research Education, both patient and provider

18 4 Major Areas of Focus in Cancer Survivorship Recurrence and new cancers Long-term and late effects Modifiable health behaviors Coordination of care provider-provider patient-provider

19 Adult Survivorship at DFCI Primary Care Risks and Complications Management (Specialists) Disease Programs External Partners NCI/NCCS ASCO LIVESTRONG Komen Movember ACS Survivorship Psychosocial Issues/ Health Behavior Modification Pediatric Survivorship Program

20 Created DFCI Follow-Up Care Standards: What? ISSUE Standard of Practice / Recommendation Visit Frequency Whom to see and when History, exam +/- lab with? Screening & Imaging Site Specific Screening General Counseling Disease & site specific counseling Follow-up Routine lab work Screening for Recurrence Bone density Echocardiogram Mammogram Breast MRI Screening Colonoscopy Genetics Fertility and contraception Psychosocial Health behaviors Sexual functioning Adherence with followup/ongoing Tx Primary Care Vaccine schedule GYN follow up

21 Follow-Up Care Standards: When and with whom? Type of Cancer BOC ER - ER + Prostate Low Risk High Risk GI Colorectal Treatment Summary & Care Plan 1st or 2nd visit after completing active treatment 1st or 2nd visit after completing active treatment 1st F/U post completion of XRT/Surg 1st F/U post completion of XRT/Surg 1st F/U post completion of treatment Shared Oncology Care (MD & NP, PA visits) every 3-6 months for 5 years* every 6-12 months while on hormone* ** Except NP Only yearly if patient desires. Disease Center Survivorship Visits NP/PA only Discharge to PCP or Survivorship ** 2-5 years at 5 years yearly forever N/A 1st year 4 years At year years 8-9 years At year 10 2 years 3 years At year 5

22 Models of Care: Survivorship Program Care Options at DFCI Consultative model in Survivorship one time, encouraged within 6-12 months after completion of early active therapy Longitudinal model transfer of care for longer-term survivors intermittent follow-up for specific issues (shared) Disease-center based Breast, lymphoma, GI Intervention specific Specialized BMT follow-up care clinic

23 Main Campus Subspecialty Care Cardio-Oncology: A. Nohria and J. Groarke Onco-Nephrology: A. Lam and S. Motwani Onco-Endocrinology: Ole-Petter OP Hamnvik Onco-Fertility: E, Ginsberg, S. Serouji, Onco-Fertility Working Group with Children s, BWH, DFCI with recently hired nurse educator/navigator Exercise counseling, Healthy Living After Cancer (with Zakim): N. Campbell Sexual Health Program: S. Bober, S. Falk, E. Zhou Sleep Counseling/Therapy: E. Zhou Tobacco Cessation Program: K. Pimentel, pilot and R01 in collaboration with PI, E. Park/MGH

24 Leonard P Zakim Center for Integrative Therapies Founded in 2000 to build a bridge between traditional and complimentary medicine Mission: integrating the practice of complementary therapies into traditional cancer treatment Provides integrative therapies and education Advances knowledge of the effectiveness and outcomes of integrative therapies through research

25 What is Integrative Medicine? The Academic Consortium for Integrative Medicine and Health defines Integrative Medicine as medicine focused on the whole person, informed by evidence, and making use of all appropriate therapeutic and lifestyle approaches, healthcare and disciplines to achieve optimal health and healing. Integrative medicine draws on both conventional and complementary and alternative medicine (CAM) approaches

26 Integrative Therapy and Survivorship Care Adult Survivorship Zakim Center Coordination of care Surveillance, screening and prevention of recurrence and new cancer Integrative medicine Nutrition Music and art therapy Identification and management of long-term, late effects Counseling and assistance with health behavior modification (e.g., exercise, weight loss, smoking cessation)

27 Integrative therapy in oncology Studies suggest that 65-90% of cancer patients use some form of integrative therapy as part of their treatment Visits to Alternative Health Providers A study of 232 patients living with advanced breast cancer found that*: 78% used at least one form of integrative therapy 43% used 2 or more types 23% used 3 of more types * Excludes exercise and prayer Grosse et al. J Oncol Pract 2007

28 Research shows integrative therapies have health benefits in cancer patients

29 Zakim Center Clinical Program The Zakim Center seeks to provide Integrative Medicine and Healthy Living programs for Dana- Farber patients: Integrated with medical, surgical, and radiation oncology treatments Symptom-directed Zakim Center Services Individual services Group programs Movement Creative Arts Meditation/Mindfulness

30 Goals of these two unique and related programs at DFCI Align integrative medicine and survivorship with goals and strengths of institute Outstanding, comprehensive, high quality clinical care Research Education, both patient and provider

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32 Thank you for your attention Special thanks to Ann, Jennifer, Shoshanna, Elizabeth Liebow and their colleagues for slides and assistance in preparing this presentation