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§ Dana-Farber was founded by Sidney Farber, MD, in 1947, and is committed to providing adult and pediatric cancer patients with the best treatment available today, while developing tomorrow’s cures through innovative research and clinical trials

§ Dana-Farber is a teaching affiliate of nearby Harvard Medical School

§ Dana-Farber’s signature “Total Patient Care” model serves the emotional, psychosocial, and spiritual needs of our patients and their families during and after their treatment at Dana-Farber

DFCI Overview

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DFCI's singular mission is to conquer cancer

Providing expert, compassionate care

Understanding cancer

Training the next generation of leaders

Promote prevention & early detection in the communities we serve

Disseminating innovative therapies

Ultimate goal iseradication of:

• Cancer, AIDS, and related diseases

• The fear engendered by such disease

Vision Mission

DFCI 2014 Strategic Plan

§ Lead the world in breakthrough discoveries, accelerating scientific discoveries to significantly improve high quality survival and care of patients

§ Reduce the burden of care globally, applying and disseminating our research in cancer prevention, screening, and advocacy

§ Be the role model for providing expert care and an ideal patient experience that is accessible, compassionate and cost effective for a diverse population of patients

§ Learn from every patient’s cancer experience, biology and outcome to continually improve all that we do scientifically, clinically, and operationally

§ Ensure the financial strength that will support our aggressive agenda

Delivering on the Promise of Cancer Science

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Statistics§ 383,599 Adult and pediatric outpatient

clinic visits and infusions§ 761 Clinical trials § 545 NIH-sponsored research grants§ $1 billion in operating budget and

expenses

Employees§ 4,274 Total Employees§ 467 Faculty (MDs, PhDs, MD/PhDs)§ 553 Total Registered Nurses § 219 Principal Investigators

Trainees§ 72 Clinical Fellows § 511 Research Fellows

DFCI Facts and Figures - 2014

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Dana-Farber/Harvard Cancer Center

§ Dana-Farber is a founding member of the Dana-Farber/Harvard Cancer Center — designated by the National Cancer Institute as one of 41 comprehensive cancer centers nationwide

§ In 2014, Dana-Farber/Harvard Cancer Center (DF/HCC) was the top recipient of National Cancer Institute (NCI) Grants with 449 awards — more than twice the amount received by other cancer centers

§ Within DF/HCC in 2014, Dana-Farber was the top recipient of NCI funding, both in terms of total dollars awarded and number of grants received

§ DF/HCC has 6 Specialized Programs of Research Excellence (SPORE) grants — The SPORE is the most prestigious grant awarded by the National Institute of Health

§ Approximately 7% of all NCI grant dollars reside in DF/HCC

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Dana-Farber Partners and AffiliatesDana-Farber/Brigham and Women’s Cancer Center§ Dana-Farber provides outpatient services for adults, while inpatient care is provided by Brigham and

Women’s Hospital§ Thirteen specialized centers make it possible for patients to receive expert evaluation and care from

multiple specialists during one visitDana-Farber/Boston Children’s Cancer and Blood Disorders Center§ Pediatric outpatients are seen at Dana-Farber’s Jimmy Fund Clinic, while patients requiring

hospitalization are treated at Boston Children’s Hospital§ There are eight treatment programs available for pediatric cancer patients

Dana-Farber/Partners Cancer Care§ Dana-Farber Cancer Institute and the founding members of Partners Healthcare System (Brigham

and Women’s Hospital and Massachusetts General Hospital) consolidated their adult oncology programs and clinical research under Dana-Farber/Partners Cancer Care

§ Today, the three Dana-Farber/Partners Cancer Care hospitals serve more than 12,000 new cancer patients annually and comprise the largest cancer-care system in the United States

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ClinicalGrowth:SatellitesandDFCCC

Londonderry

DFCCC- WeymouthLongwood

St.Elizabeth’sMC

SouthShoreHospitalMilford

DFCCC- MethuenDFCCC- Lawrence

LMA/Satellite

DFCCC

Collaborative

InDiscussion

KEY

1) Sources:ClinStats(GE/IDX,EpicData),DFCCCdatafromPulsesystem

FY06-16

Patie

ntsF

irstS

een

-

5,000

10,000

15,000

20,000

25,000

FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16

DFCCCSt.Elizabeth'sSouthShoreLondonderryMilfordLMA/Faulkner

ClinicalGrowth:10-YearNewPatientVolumeGrowthAcrossInstitute

NewPatients,AllDFCISites,FY06-16

ExceptforabriefslowdownpriortotheopeningoftheYawkeybuilding,DFCIhasseencontinuednewpatientgrowthatLongwoodthroughoutthepasttenyears

NetworkVolumeasProportionoftheEnterprise

1) Sources:SatelliteandLMAdatafromClinStats(GE/IDX,EpicData);DFCCCOperatingDatafromPulsesystem;ExcludesRadOnc exams2) “NewSatellites”includepotentialFoxboro,Brocktonlocations;“DFCCCConversions”includeLawrence,Methuen,andWeymouth;“CurrentSatellites”includesMilford,

SouthShore,Londonderry,andWeymouth3) Assumesnewsatellitesfullyramped-upbyFY194) Assumes2%annualgrowthfromFY16forLongwood,Londonderry,Milford,andSEMC5) SouthShoreandDFCCCprojectionsbasedon2%annualgrowthfromFY17annualizedvolume

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FY13Longwood/Faulkner14,965(84%)

Network2,851(16%)

Satellites2,851(16%)

Longwood17,437(69%)

Network8,009(31%)

Satellites4,058(16%)

DFCCCPractices3,951(16%)

Longwood17,784(61%)

Network11,347(38%)

CurrentSatellites4,581(16%)

NewSatellites3,221(11%)

DFCCCConversions

3,545(12%)

AdultNewPatients(MedicalOncologyOnly)

FY16

Fully-RampedFutureState

Morecomplexcare

PatientBaseofCommonCancers

EvolvingTreatments,SpecializedCare,ClinicalTrialsPotentiallythroughashared

caremodel

Acomprehensiveapproachtogrowthinlightofthecurrenthealthcarelandscape

Super-SpecializedCancerCare

Fewercases

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Today

DFCICommonCancers:

Longwoodandsatellites

CommonCancerstreatedbyour

Membersandotheraffiliates

Largernumberofcases

Lesscomplexcare

DFCIgrowthAffiliategrowth

PatientBaseofCommonCancers

EvolvingTreatments,SpecializedCare,ClinicalTrialsPotentiallythroughashared

caremodel

Acomprehensiveapproachtogrowthinlightofthecurrenthealthcarelandscape

Super-SpecializedCancerCare

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Future

DFCICommonCancers:

Longwoodandsatellites

CommonCancerstreatedbyour

Membersandotheraffiliates

How should we care for this growing population?

• Coordination of care, with patients and between providers to ensure that individual patients’ health needs are met and resources are used appropriately

• Surveillance, screening and prevention of recurrence and new cancers, including fostering adherence to clinical guidelines and risk-reducing treatments

• Identification and management of late and long-term effects, including medical and psychosocial, including before and during therapy (e.g., onco-fertility, cardio-oncology)

• Counseling & assistance with health behavior modification

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Coordination of Care Between Primary Care, Oncology, and Other Providers

Non-Cancer Related Medical Care

• Health promotion/disease prevention• Chronic care (e.g. diabetes)• Unrelated cancer screening

Cancer Related Medical Care• Surveillance/prevention of recurrence or

new primary breast cancer• Screening and treatment of

complications of treatment• Related cancer screening• Counseling/support re: cancer related

lifestyle recommendations and cancer-related health decisions

Psychosocial Care• Attention to quality of life, fear of

recurrence, depression, anxiety • Financial burden• Family/genetic counseling

(Nekhlyudov and Partridge, 2013)

Components of Care for an Individual with Cancer

Integrative Therapy and Survivorship Issues Span the

Cancer Journey

(Adapted from NCI, 2005)

Pre-Diagnosis

Diagnosis &

Treatment

Palliative Care; End of

Life

Adult Survivorship Program and

The Leonard P Zakim Center for Integrative Therapies

Jennifer Ligibel, MD, Ann Partridge, MD, MPH &Shoshana Rosenberg, ScD

2016

Goals at DFCI• Align survivorship with goals and strengths

of institute

– Outstanding, comprehensive, high quality clinical care

– Research

– Education, both patient and provider

4MajorAreasofFocusinCancerSurvivorship

Recurrence and new cancers

Long-termandlateeffects

Modifiablehealthbehaviors

Coordinationofcare

provider-provider

patient-provider

Adult Survivorship at DFCI

RisksandComplicationsManagement(Specialists)

PsychosocialIssues/

HealthBehaviorModification

PediatricSurvivorshipProgram

ExternalPartnersNCI/NCCSASCO

LIVESTRONGKomen

MovemberACS

PrimaryCare

DiseasePrograms

Survivorship

ISSUE Standard of Practice / Recommendation

Visit Frequency Whom to see and when History, exam +/- lab with ? Screening &Imaging

Routine lab workScreening for RecurrenceBone density

Site Specific Screening EchocardiogramMammogramBreast MRIScreening Colonoscopy

General Counseling GeneticsFertility and contraceptionPsychosocialHealth behaviorsSexual functioning Adherence with followup/ongoing Tx

Disease & site specific counselingFollow-up Primary Care

Vaccine scheduleGYN follow up

Created DFCI Follow-Up Care Standards: What?

Type of Cancer

Treatment Summary & Care Plan

Shared Oncology Care (MD & NP, PA

visits)

Disease Center Survivorship Visits NP/PA

only

Discharge to PCP or

Survivorship **

BOCER - 1st or 2nd visit

after completing active treatment

every 3-6 months for 5 years*

2- 5 years at 5 years

ER + 1st or 2nd visit after completing active treatment

every 6-12 months while on hormone*

yearly forever N/A

ProstateLow Risk 1st F/U post

completion of XRT/Surg

1st year 4 years At year 5

High Risk 1st F/U post completion of XRT/Surg

1-2 years 8-9 years At year 10

GIColorectal 1st F/U post

completion of treatment

2 years 3 years At year 5

** Except NP Only yearly if patient desires.

Follow-Up Care Standards: When and with whom?

Models of Care: Survivorship Program Care Options at DFCI

• Consultative model in Survivorship– one time, encouraged within 6-12 months after completion of

early active therapy

• Longitudinal model– transfer of care for longer-term survivors– intermittent follow-up for specific issues (shared)

• Disease-center based – Breast, lymphoma, GI

• Intervention specific– Specialized BMT follow-up care clinic

MainCampusSubspecialtyCare• Cardio-Oncology:A.NohriaandJ.Groarke

• Onco-Nephrology:A.LamandS.Motwani

• Onco-Endocrinology:Ole-Petter“OP”Hamnvik

• Onco-Fertility:E,Ginsberg,S.Serouji,– Onco-FertilityWorkingGroupwithChildren’s,BWH,DFCIwithrecentlyhirednurse

educator/navigator• Exercisecounseling,HealthyLivingAfterCancer(withZakim):N.Campbell

• SexualHealthProgram:S.Bober,S.Falk,E.Zhou

• SleepCounseling/Therapy:E.Zhou

• TobaccoCessationProgram:K.Pimentel,pilotandR01incollaborationwithPI,E.Park/MGH

Leonard P Zakim Center for Integrative Therapies

• Founded in 2000 to “build a bridge” between traditional and complimentary medicine

• Mission: integrating the practice of complementary therapies into traditional cancer treatment

– Provides integrative therapies and education

– Advances knowledge of the effectiveness and outcomes of integrative therapies through research

What is Integrative Medicine?• The Academic Consortium for Integrative Medicine and

Health defines Integrative Medicine as medicine “focused on the whole person, informed by evidence, and making use of all appropriate therapeutic and lifestyle approaches, healthcare and disciplines to achieve optimal health and healing.”

• Integrative medicine draws on both conventional and complementary and alternative medicine (CAM) approaches

• Coordination of care

• Surveillance, screening and prevention of recurrence and new cancer

• Identification and management of long-term, late effects

• Counseling and assistance with health behavior modification (e.g., exercise, weight loss, smoking cessation)

• Integrative medicine

•Nutrition

•Music and art therapy

Integrative Therapy and Survivorship Care

Adult Survivorship Zakim Center

Integrative therapy in oncology• Studies suggest that 65-90%

of cancer patients use some form of integrative therapy as part of their treatment

• A study of 232 patients living with advanced breast cancer found that*:

– 78% used at least one form of integrative therapy

– 43% used 2 or more types– 23% used 3 of more types

Visits to Alternative Health Providers

* Excludes exercise and prayer

Grosse et al. J Oncol Pract 2007

Research shows integrative therapies have health benefits in cancer patients

Zakim Center Clinical Program

• The Zakim Center seeks to provide Integrative Medicine and Healthy Living programs for Dana-Farber patients:

• Integrated with medical, surgical, and radiation oncology treatments

• Symptom-directed

• Zakim Center Services• Individual services • Group programs

– Movement– Creative Arts– Meditation/Mindfulness

Goals of these two unique and related programs at DFCI

• Align integrative medicine and survivorship with goals and strengths of institute

– Outstanding, comprehensive, high quality clinical care

– Research

– Education, both patient and provider

Thank you for your attention

Special thanks to Ann, Jennifer, Shoshanna, Elizabeth Liebow and

their colleagues for slides and assistance in preparing this

presentation