A Collaborative Primary and Cancer Care Model

This blog post is the second of a five-part series highlighting the achievements of the 2022 ACCC Innovator Award winners before their in-depth presentations at the ACCC 39th National Oncology Conference. You can learn more about the innovations being recognized this year and the people who pioneered them by joining ACCC in West Palm Beach, Fla., on October 12-14, 2022.

Technology, science, and medicine continue to evolve at a rapid pace. Despite these advances and a strong focus on optimizing care delivery and improving care coordination, silos between specialties persist.

For cancer programs and practices, these silos make it challenging to address the comorbidities many patients with cancer experience, such as hypertension, diabetes, and heart disease. In the same healthcare system, a patient’s primary care provider (PCP) may not know what the patient’s cancer care team knows and vice versa. The solution: building a bridge between patients, their cancer care teams, and their PCP—a passion of Debra Delaney, MSN, FNP-BC, a primary care nurse practitioner at ChristianaCare's Helen F. Graham Cancer Center & Research Institute in Newark, Del.

Primary Care in Oncology

In January 2021, Delaney accepted a position with the Graham Cancer Center, effectively embedding primary care services within the oncology service line. This role was the brainchild of Nicholas Petrelli, MD, FACS, the cancer center’s medical director, and Cydney Teal, MD, service line leader, Primary Care Community Medicine and chair, Department of Family and Community Medicine at ChristianaCare. “I think primary care in oncology has been a long-standing issue, and all I ever wanted to do was take care of patients,” explained Delaney. "This is where I get my satisfaction.”

The team’s goal is to help oncology patients manage their comorbidities to maximize their anti-cancer treatment. At the program’s conception, only patients with a cancer diagnosis were given access to Delaney’s services. Her role has since expanded to include all patients who are referred to the cancer center, regardless of a malignancy. “We opened the program up, which has been wonderful because it's a whole new avenue for patients,” said Delaney. “I can get patients connected to primary care even if they don't have a cancer diagnosis.”

Because it is difficult to get oncology patients who are having primary care issues an appointment with a new PCP—a process that can take months—Delaney is uniquely suited to streamline that process. In describing her role in oncology as a bridge, Delaney goes the distance to match patients with a local PCP to continue their care after treatment. She also keeps detailed patient records for when the new PCP takes over the patient’s care.

Delaney works out of the oncology express unit, a department dedicated to giving patients intravenous fluids and blood transfusions, within the cancer center. If patients have acute care needs like rashes or urinary tract infections, they can be treated in the express unit rather than the more costly emergency room setting.

Program Successes

A multidisciplinary approach has facilitated the success of this program. When patients arrive at the cancer center, front office staff now ask them about their primary care needs. “Patients may be under the impression that their oncologist can manage all of their healthcare needs,” said Delaney. “But having a primary care practitioner to help coordinate medical care allows the oncologist to further focus on patients’ cancer treatment.”

While embedding a PCP in a cancer program is not commonplace, the Graham Cancer Center has experienced many benefits. The cancer center sees more than 70 percent of all the patients in Delaware. These patients now have one place they can go to for their oncology and related primary care needs—a convenience factor many appreciate. Further, Delaney’s integration in the cancer center allows the oncology care team and primary care provider to be informed and collaborate on treatment plans when necessary.

Delaney’s patient-centered ethos is one the reasons she is excited to attend the ACCC 39th National Oncology Conference. “We need people to attend this meeting and hear what else is out there in our world,” she said. “This may be what I am doing, but what is everybody else doing? Together, we can combine our knowledge and help the patient population.” To learn more about embedding primary care in your cancer program or practice, including challenges Delaney and the team had to overcome, register and attend the National Oncology Conference.