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A Model for Embedding Primary Care in Oncology— [PODCAST] EP 89

August 9, 2022

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For cancer programs and practices, silos between specialties make it challenging to address the comorbidities (e.g., hypertension, diabetes, and heart disease) many patients with cancer experience. In the same healthcare system, a patient’s primary care provider (PCP) may not know what their cancer care team knows and vice versa. Hear how an embedded PCP at ChristianaCare's Helen F. Graham Cancer Center & Research Institute—a 2022 ACCC Innovator Award winner—allows a patient’s oncology care team and PCP to be informed and collaborate on treatment plans when necessary.


Debra DelaneyDebra Delaney MSN, FNP-BC
Primary Care Nurse Practitioner
ChristianaCare Health System, Helen F. Graham Cancer Center & Research Institute

“I always enjoyed primary care…. It adds an extra layer for support for my oncology patients because they know that they can reach out to me with any question that they may have, and I get great satisfaction from caring for them.”



This podcast is part of a special series on the 2022 ACCC Innovator Award winners. For a deeper dive into this content, visit ACCC’s Innovator Award website.


CANCER BUZZ: Welcome back to CANCER BUZZ. The podcast of the Association of Community Cancer Centers (ACCC). I'm your host Summer Johnson. On today's mini episode, a model for embedding primary care providers into the cancer service line. Since 2011, the Annual ACCC Innovator Awards have recognized many creative and cost-effective solutions from ACCC member programs and practices. Delivering high quality patient centered care in communities across the country.

This episode is part of a CANCER BUZZ series highlighting one of the 2022 winners, ChristianaCare’s Helen F. Graham Cancer Center & Research Institute in Newark, Delaware. Now employs a primary care provider or PCP to address comorbidities in patients who are inactive anti-cancer treatment. Debra Delaney MSN, FNP-BC, is the primary care nurse practitioner who leads this new PCP program.

Debra Delaney MSN, FNP-BC: There's many reasons why patients do not always have an established relationship with a primary care. One is they feel well and they don't see a reason to go. Another reason is transportation sometimes cost sometimes their primary care retires, and they need to find a new one and it gets pushed to the bottom of the list. And sometimes there's a fear that they don't really want to know.

They may feel or realize there's an issue, but they just kind of push it off, thinking it may go away.

CANCER BUZZ: Debra, what inspired you to develop this model of incorporating primary care into the cancer program?

Debra Delaney MSN, FNP-BC: The idea for embedding a primary care practice within a cancer center came from an informal survey that was completed in gynecological Oncology practice. And it was found that 15% of their patients did not have a primary care provider. So the idea was formed and by Embedding a primary care practice within the cancer center, this allows the specialties for Oncology, hematological, and surgical Oncology to focus on their program and allow the primary care to address those needs.

CANCER BUZZ: What does that relationship between your program and the cancer team look like

Debra Delaney MSN, FNP-BC: At this time, I'm the only primary care provider. Hopefully as the program grows, we can add on more staff, but all of the other disciplines have been very open to me and reach out to me if they have any concerns about a patient or if there is an issue that comes up during their treatment, they can contact me and I can get the patient in and treat the issue at hand.

CANCER BUZZ: How does that interaction work? Are they screening patients and then referring to you?

Debra Delaney MSN, FNP-BC: So it's a little bit of everything. The front desk does do a Screening, asking if the patients have a primary care provider. And then when the physician, the oncologist or hematologist, the specialist talks to the patient, if there is an issue noting, increased blood sugars or high blood pressures or some other issue that they feel is more primary care related, they may ask the patient, do you have a primary care to follow up with if there's not one listed or if there was one listed, sometimes it's been a while since they've seen that doctor, if they don't have an established relationship with a primary care provider, then the oncologist sends down a referral to me.

Additionally, I attend multi-discipline conference. And when the patients come through to determine a cancer treatment plan for them at that time there's nurse navigators and they will ask the patient as well. If they have a primary care provider, the nurse navigators will reach out to me the care management team as well can also reach out to me.

CANCER BUZZ: Talk to your colleagues about the big picture, why should primary care and cancer teams work together?

Debra Delaney MSN, FNP-BC: So I have a patient currently who is referred for surgery for a cancer. And during her initial lab work, her blood sugar was noted to be extremely elevated to the point where they can't do surgery, it's considered a high risk. So she was referred to me and I have started to bring down her blood sugars to prepare her for surgery. She had not seen a primary care and I believe 40 years

CANCER BUZZ: Debra, how did this process impact your own job satisfaction and engagement?

Debra Delaney MSN, FNP-BC: So I always enjoyed, and by being there for the patients, I can help them navigate through this process in Oncology as well. We have a lot of support for our patients, with the nurse navigators, with social work and the oncologist. And then with primary care, it's an extra layer of support when patients call me up and say, they have a question about which testing they need next or where they should go for imaging or any kind of question at all.

It, you know, it makes me happy that I can provide this care for them. I get my satisfaction from helping them. So being there for my patients, it adds an extra layer of support for my Oncology patients, because they know that they can reach out to me with any question that they may have. And I satisfaction from caring for them.

CANCER BUZZ: You can learn more about the model discussed today at the upcoming annual ACCC 39th National Oncology Conference. That's October 12th through the 14th in West Palm Beach, Florida. There's more information and a link to register in the show notes. Until next time before the CANCER BUZZ team, This is summer Johnson.

CANCER BUZZ is a resource of the Association of Community Cancer Centers (ACCC).

The views and opinions expressed herein are those of the author(s)/faculty member(s) and do not reflect the official policy or position of their employer(s) or the Association of Community Cancer Centers.