Susan Mingesz, MS, LCSW Linda Glaudell, MSW, LCSW, OSW-C Molly Megan, MHS, PT Stacey Dickert, MA

1. Hospital & Community Organization Partnerships Susan Mingesz, MS, LCSW Linda Glaudell, MSW, LCSW, OSW-C Molly Megan, MHS, PT Stacey Dickert, MA

2. Hospital & Community Organization Partnerships Scope Problem: Finishing cancer treatment is a transitional time for survivors and many feel it is difficult to navigate the change from active treatment into survivorship. Solution: A collaboration between Columbia St. Mary’s and Gilda’s Club Southeastern Wisconsin to provide the Cancer Transitions: Moving Beyond Treatment™ to cancer survivors in our community.

3. Hospital & Community Organization Partnerships So that no one faces cancer alone.®

4. Hospital & Community Organization Partnerships • Gilda’s Club Southeastern Wisconsin, an affiliate of the Cancer Support Community, offers a professionally led, community based program that includes: • Support and Networking Groups • Healthy Lifestyle Activities • Educational Workshops • Social Connections • Resources and Referral

5. Hospital & Community Organization Partnerships

6. Hospital & Community Organization Partnerships

7. Hospital & Community Organization Partnerships About Columbia St. Mary’s • Two Hospitals • Columbia St. Mary’s Hospital Milwaukee • Columbia St. Mary’s Hospital Ozaukee • Sacred Heart Rehabilitation Institute • 65 Community Physician Clinics • Columbia College of Nursing • Seven Community Benefit Clinics

8. Hospital & Community Organization Partnerships Columbia St. Mary's exists to make a positive difference in the health status and lives of individuals and our community, with special concern for those who are vulnerable. At Columbia St. Mary's we are committed to providing high quality, accessible, values-driven programs and services with equal attention to the physical, spiritual, and emotional dimensions of health.

9. Hospital & Community Organization Partnerships The CSM Oncology Program provides: • A comprehensive, innovative and multi-disciplinary approach to care • Access to clinical trials • Community cancer screenings and education • Awide range of support services • Quality Cancer Care in state-of-the-art facilities

10. Hospital & Community Organization Partnerships

12. From Cancer Patient to Cancer Survivor: Lost in Transition • The 2006 Institute of Medicine report concluded that in many cases, cancer survivors have specific needs that arenot being met. • Of the 12 million cancer survivors in the U.S., about 62% are expected to live at least five years after diagnosis. • Many may face a heavy physical and psychological burden as they transition from cancer patient to survivor. • Cancer is increasingly being viewed for many as a chronic illness.

13. Cancer Transitions: Moving Beyond Treatment™ • The Cancer Support Community and LIVESTRONG developed program in 2006. • Based on CSC survivorship program, Return to Wellness, for breast cancer survivors, an evidence-based national program. • This evidence-based program was built upon the Patient Active Concept: • “Patients who participate in their fight for recovery along with their healthcare team, will improve the quality oftheir lives and may enhance the possibility of recovery.”

14. Interactive Program • Cancer Transitions participants learn the benefits of exercise, nutrition, emotional support and medical management -- core issues for cancer survivors. • The six-week program is designed to help redefine how we live our lives from this point forward. • Research shows that both men and women who participate can experience: • Less worry about the negative impacts of cancer • Better physical and social functioning • More commitment to physical activity • Improvements in fat related dietary habits

15. Transitioning from Patient to Survivor • Learnthe common feelings that cancer survivors experience after treatment • Recognizewhen you need support with emotional issues • Knowwhere to get support for you and your loved ones to move forward

16. Program Components • Professionally led customized exercise each session • Expert lectures: time for Questions/Answers • Group discussion • Tracking personal progress

17. Program Materials • Cancer Transitions™ workbook • Weekly Wellness Assignments • Facing Forward: Life After Cancer Treatment booklet • Action Plan tools: • Action plan log • Exercise log • Pedometers • Food diary • Summary • Program Evaluation Survey

18. Participant Eligibility • Adult survivors, 21 years of age and older, of any cancer diagnosis • Completed active anti-cancer treatment within the past 0-18 months • May be receiving hormonal or other similar agents (e.g. tamoxifen)

19. Exercise for Wellness Research conducted on the positive and consistent effects of physical activity on: • Vigor and vitality • Cardio-Exercise for Wellness • Respiratory fitness • Quality of life • Depression, anxiety • Fatigue/tiredness ( Holtzmanet al., 2004) • Cancer Transitions • Customized Exercise Plan to address

20. Nutrition Beyond Cancer Research Cancer survivors should follow dietary guidelines established for primary prevention of cancer as well as other diseases. (Doyle et al., 2006; Brown et al., 2003; AICR, 2004) Cancer Transitions • Focus on plant-based foods • Inclusion of whole grains, • Reduce fat especially saturated fat • Limit alcohol

21. Emotional Health & Well-being • Research • Distress is the most common, yet under-reported, side effect of cancer and can strain a person’s coping style. • - (Jacobsen et al., 2005) Cancer Transitions Teaches how to productively express negative emotions, reduce stress, increase positive emotions and enhance QOL through different techniques.

22. Medical Management Research After treatment, cancer survivors: • have different health risks than before • may have a hard time communicating with healthcare team • Cancer Transitions Teaches how to: • work most effectively with the participant’s healthcare team • discuss ways to manage physical changes

23. Study Findings and Summary • Participants experienced positive changes in health-related quality of life and lifestyle change following the intervention and at 3- and 6-month follow-up • Increase in HRQOL around physical, mental and social functioning • Decrease in negative IOC, particularly health-related worry • Increase in physical activity • Improvement in fat- and fiber-related dietary habits

24. Hospital & Community Organization Partnerships • Cancer Transitions™ helps meet the needs of the medical community and of the growing cancer survivor population by bridging the important gap between cancer treatment and life after cancer.   • The initial offering of the Cancer Transitions™ program was funded by Columbia St. Mary’s Hospital/Columbia St. Mary’s Foundation.

25. Hospital & Community Organization Partnerships • Community Need • More than 12 million cancer survivors are living in the US today. • The number of cancer cases will increase dramatically for two key reasons: • Cancer is increasingly viewed as a chronic illness • 77 million baby-boomers maturing to age when cancer becomes more likely. • In the Milwaukee area, there are approximately 23,100 people diagnosed with cancer annually.

26. Hospital & Community Organization Partnerships Structure of Activities Gilda’s Club • Program content & management • Educational toolkit • Program facilitation: • Licensed Clinical Social Worker trained in Cancer Transition™ model • Site management • Participant interface • Marketing Columbia St. Mary’s • Funding • Content Experts: • Oncology Nurse Specialist • Physical Therapist • Dietitian • Marketing

27. Hospital & Community Organization Partnerships General Program Challenges • Unknown program to Columbia St. Mary’s • Trademarks limit ability to view content in entirety prior to purchasing license • Multiple internal meetings to come to agreement on program delivery • Medical model vs. Social Model • HIPPA and referrals

28. Hospital & Community Organization Partnerships Challenges from a hospital perspective • Determining best credentialed staff to lead each of the sessions • Managing the time approvals for staff • Working with Trademarked materials • How to tailor and update information within the TM • Addition of materials that were not part of purchased programs • Facilities • Culture of organization hosting workshops • Space allocation for the class • Audiovisual • Equipment needs for exercise portion

29. Hospital & Community Organization Partnerships Benefits to Columbia St. Mary’s Internal Benefits • Helped us meet the needs of some of our patients who needed help transitioning between end of treatment and follow-up care • Connected our referred patients to a community model • Assisted CSM in meeting our organizational goals of increasing services for survivors post treatment (per the Commission on Cancer and the National Cancer Institute Community Cancer Centers Program goals) • Allowed CSM providers to seeing another side of survivorship – one outside of the hospital setting – and interact with patients away from our everyday roles • Increased visibility for our program, the NCCCP and the work we are doing in the survivorship arena

30. Hospital & Community Organization Partnerships Benefits continued… External Benefits • Brought more options for follow up and filled a gap for survivors in our community • Caused CSM to think beyond the hospital walls to meet our goals and look at partnering with community organizations to meet shared goals and fill non-medical patient needs. • More to come?  We expect to see more long term benefits to the Cancer Transitions program in both our patients and our community

31. Hospital & Community Organization Partnerships Participant Benefits • Bridge from hospital to community • Introduced community based resources • Recognized when support is needed and understood where to get help • Created a sense of community with other survivors • Shared experience

32. Hospital & Community Organization Partnerships Participant Evaluation Program Content Post program, participants completed a 15 question evaluation to provide insight for future programs. This covered the following areas: • Emotional • Educational • Physical

33. Hospital & Community Organization Partnerships As a result of this program, I feel I have more control over…

34. Hospital & Community Organization Partnerships As result of this program, I am more hopeful about my future…

35. Hospital & Community Organization Partnerships As a result of this program, I have a better understanding of…

36. Hospital & Community Organization Partnerships As a result of this program, I am more positive about meeting the challenges of my cancer experience

37. Hospital & Community Organization Partnerships Future of Cancer Transitions Program • Gilda’s Club Southeastern Wisconsin is committed to the advancements that are becoming the standard in complete cancer care. • We are committed to delivering four Cancer Transitions ™ annually open to all cancer survivors. • Our vision is to create a partnership that would include all Milwaukee area health systems. • Our goal is for each health system to sponsor sessions to sustain this vital program.

38. Hospital & Community Organization Partnerships What Participants Say • I’ve noticed I’ve moved forward in my wellness…I’m very excited!!! • I’m ready to exercise and move!!! • I have gotten a lot out of each session & hate to see it end. • This program was very helpful to me at this stage of the recuperation. I’m not sure I could have done it in the beginning. Very valuable information. Thanks for everything! • It felt homey, warm and comfortable. The people seemed genuine, empathetic and caring. More importantly...THEY GET IT. • Thanks for letting me be a part of this program! I loved it!