On this episode, Dr. Francis, the mastermind behind the UPMC Hillman Cancer Center Wellness and Integrative Oncology Program in Pittsburgh, PA shared the how her personal belief system and the loss of her mother to cancer inspired to her to create the program. She talked about the different services that are provided, the intake process, how cancer patients/survivors come into the program, as well as cost and insurance coverage. Dr. Francis also shared her vision for the future of holistic programs.
Dr. Francis is a board certified hematology, oncology, and internal medicine physician. She currently works in oncology at the Hillman Cancer Center. In 2016, Dr. Francis created the Wellness and Integrative Oncology Program.
Dr. Francis always believed in the importance of lifestyle for general health and happiness. When she finished her oncology training, it always seems it should be common place or common sense to ask patients about lifestyle, breathing exercises, recovery after surgery, and their support system. In her early practice, she provided her patients with a lot of different resources on a more holistic approach to their treatment. She realized that it was almost not fair to ask these questions as patients were looking for direction from their oncology team. Many patients are not only overwhelmed but also scared to do anything outside of what was recommended by their doctors. Through asking these questions, she realized that something was missing- holistic care. Doctors have become more accepting of the need for holistic treatment and are sending patients to the program.
While she always had this belief system of the importance of lifestyle for general health and happiness, her mother also served as inspiration for the development of the program. In the 4th grade of practicing, Dr. Francis’ mother, who had a longstanding history of lymphoma, was being treated at the Hillman Cancer Center. Her cancer become more aggressive and she passed away. Dr. Francis was able to see firsthand at the front line, how many hours of the day people are struggling on their own and without resources. She feels that the doctoring that happened maybe on half an hour every three weeks was only the tip of the iceberg for cancer patients. She realized that build any sustainable way to manage the implications of this disease, it had to be brought in more systematically and more deliberately. It was as if she had this crazy battery pack of intensity and emotional around this goal as her mom was going through her treatments. Dr. Francis thought about how much more understanding her family could have had if her mom had more awareness and holistic guidance during her treatment.
The wellness suite is located on the 3rd floor of the Hillman Center but there is a major expansion currently in process. The current space has a welcoming, non-medical room for patients to have a consultation with Dr. Francis to talk about cancer, diagnosis, treatment, and goals with a more holistic approach. Within the suite, there are also two treatment rooms for acupuncture, massage, one-on-one yoga, meditation, or exercise and resistance training. There is also an open are with educational resources on topic such as how to talk to kids about cancer, incorporating yoga into a home practice, smoking cessation, and medical marijuana. There is a juice bar and an aromatherapy corner. There are also resources and essential oils for children. The suite has become kind of like a club house for those things that are missing in supportive care.
Individual plans are created by Dr. Francis based on symptoms and goals. Patients may be newly diagnosed, survivors, or have stage IV disease. Services are provided across the spectrum for all patients with cancer. When a patient is referred to the program, an intake coordinator reaches out to explain the program. A nurse then reaches out to see what the patient can be doing in the here and now and provides information about a meditation app or refers the patient out to a dietician if appropriate. Dr. Francis blocks off an hour for each consultation. Following the first visit, consultation, and development of an individualized plan, everyone is offered 3 free sessions. Sometimes, 3 sessions is all that someone may need. After the 3 sessions, a nurse meets with the patient again to go over how everything went and to develop a long term plan.
Patients are being referred to the program by their oncologists and PCPs but many patients are referred through the Nurse Ambassador program. This program provides training to oncology nurses on symptom management at the bedside or chair side through aromatherapy, hand/foot massage, guided meditation, or seated yoga. They are provided with the correct information about the program and bring in the right patients to be seen by Dr. Frances. There are currently 80 nurse ambassadors throughout UPMC. Nurses continue to receive training on topics such as hospitality, how to be patient-centered, how to deal with difficulty, and how to deal with self-care. The Nurse Ambassador program will be expanding outside of the UPMC network through a training in February 2020. Dr. Francis wants to help other medical institutions implement this model.
Dr. Francis has recognized that the after-care for survivors has not been there. While organizations and institutions have tried many ways to work on the aftercare for survivors, in her opinion, those efforts have not really stuck. However, Dr. Francis feels that an integrative approach is the answer. Those who are 5-10 years out from their diagnosis and/or treatment still have access to the program. Sometimes they are referred from there PCP because of symptoms experienced. While these individuals are farther out from their treatments, they still receive the same experience as someone actively in treatment.
The consultation appointment is covered by insurance like a medical oncology visit. Fundraising is done to allow everyone to try the programs at no cost. Patients then decide where they want to invest their money to support their health. The cost of the services and programs are kept as the lowest possible price with the best integrative care. While there has been some progress in coverage for acupuncture regionally, it is still hit or miss. Dr. Francis would love to see an insurance company that believes in integrative care and would provide $1000 in the year to be spent on integrative care for someone newly diagnosed and $500 for every survivor. She would like to see a model that is more outcome based, responsive, and truly holistic. She is trying to build this case for this by documenting what the program is doing, the outcomes, and the numbers to later pitch it to an insurance company. There are extension packages that are offered to patients who may not have the means to pay for additional services beyond the 3 free sessions but are truly benefiting from those services. While she would love to do more than that, it becomes complicated legally with giving away free services. She is trying to think about other models to have things be less expensive and hopes that with the expansion of a larger space, it will allow for more community offerings.
Individuals can get involved and support the program by conducting their own fundraisers to support the Wellness Center. Individuals can reach out and receive a toolkit for third party fundraising. In addition, individuals can donate directly to UPMC Hillman Cancer Center with a note to direct it to Integrative Oncology. The money is used to provide free services. Each year, the center also has an event called Breathing Room that serves as their annual fundraiser.
Dr. Francis indicated that she believes that they process of creating the wellness center has provided the tools to bring this type of program into any institution or setting. She believes that they can really personalize integrative oncology into any center and hopes that with the current structure in place and with the support of the UPMC leaders, she can take it and help other places build an integrative oncology program.