Cancer treatment can be so focused on overcoming the disease that other aspects of a patient’s health receive insufficient attention. The Duke Cancer Institute’s Center for Onco-Primary Care is designed around the philosophy that a cancer diagnosis and treatment affect every aspect of a patient’s life—so their care should address all those concerns on a comprehensive basis.
“When people are in cancer treatment, they tend to not see their primary care providers, so comorbidities often go unmanaged,” says Kevin C. Oeffinger, MD, director of the Center for Onco-Primary Care. A relatively new field, the idea of onco-primary care grew out of this realization.
In addition to onco-primary care, Duke also provides cancer support services through the Duke Supportive Care and Survivorship Center. “We are committed to providing care for the whole person, their family, and loved ones,” says Cheyenne Corbett, PhD, co-director of the Duke Supportive Care and Survivorship Center.
Services entail addressing the many psychological impacts of a frightening diagnosis, such as coaching a patient about how to talk to children or grandchildren about their situation or connecting patients with therapists who recognize that cancer affects a couple and their relationship or a patient’s relationships with family members.
Or it can involve pain treatment through behavioral interventions. “We offer options like yoga, mindfulness classes, tai chi, and sound healing,” says Corbett. “Our patient navigators help people through their cancer experience, empower them to participate in their care, and address barriers, whether it is health literacy or practical barriers like affording transportation to get here.” Prosthetics and orthotics services are also available.
“From diagnosis to treatment, recovery and survivorship, as well as end of life, we offer services for every step throughout the cancer experience,” Corbett says.
“We are trying to improve collaboration between primary care providers and oncology providers across the full spectrum of cancer care, including cancer screening, referral of patients with new cancers, managing non-cancer health problems like high blood pressure and diabetes, and providing survivorship or end-of-life care,” Oeffinger says. “Our goal is to work hand-in-hand with our oncology providers, not just when patients are on active cancer therapy, but throughout their care—before, during, and after treatment.”
For example, many patients diagnosed with stage 1 to 3 cancer have a higher likelihood of dying from a heart attack or stroke than they do from cancer, so one major goal is to reduce cardiovascular risk factors by ensuring blood pressure, cholesterol, and diabetes are adequately managed, Oeffinger says.
Sometimes primary care providers are unsure of how aggressively they should treat the other conditions of patients undergoing cancer therapy. The center is conducting a multi-million-dollar study funded by the National Cancer Institute to test techniques that improve primary care and oncologist collaboration in patients with cardiovascular risk factors.
“The onco-primary care center does a lot of research to see how we can improve communication and collaboration throughout our health care system,” Oeffinger says.