Fully integrated multi-disciplinary care in head and neck cancer: The Henry Ford Health System model.

Background/Purpose: The Multidisciplinary Head and Neck Cancer (HNC) Division is part of the Henry Ford Cancer Institute (HFCI). The Multidisciplinary HNC offers fully embedded and dedicated supportive oncology services, including speech-language pathologists (SLP), registered dietitians (RD), nurse navigators, advanced practice providers, social workers, and a health psychologist/psycho-oncologist (PSO). As a part of their HNC care, a large majority of patients attend a pre-treatment clinic (SLP, RD, PSO) within the medical clinic with the purpose of education, evaluation, and interdisciplinary care prior to initiating treatment. Specifically, the PSO evaluates for psychosocial functioning and support, substance use, treatment understanding, and cognitive impairment while providing education and aiding in setting expectations and needs for treatment. Additionally, this pre-treatment team attends Tumor Board, meets regularly with patients across the survivorship spectrum, provides inpatient consultation, and functions within the oncology team to support optimal communication, patient care, and outcomes. Methods: Data between August 2015 through July 2018 were extracted from the EMR (Epic) based on billed CPT code and provider. Results: From August 2015 to August 2018, HFCI saw 1100 unique patients with HNC, with a total of 879 pre-treatment evaluations by the Psycho-oncologist. PSO services include both inpatient and outpatient. A majority of pre-treatment evaluations were done outpatient (93%). Follow up by PSO were less frequent, 31% of overall services. Conclusions and Implications: Embedded supportive oncology services, including early assessment by POS, can be provided within a Multidisciplinary HNC Division. This allows for early identification of psychosocial, substance use, and cognitive issues that may interfere in cancer treatment. Additionally, standardized meeting with PSO, in the same location as the medical team, as part of normal treatment work up, may decrease the stigma associated with mental health intervention and increases opportunity to identify issues, as research has found medical providers have low sensitivity/specificity when identifying the psychosocial issues that disrupt treatment