a major source of resources is the community’s 30-bed hospital, Tahoe Forest Hospital. A relocated oncologist and Tahoe Forest Hospital created a solo physician ambulatory oncology practice that routinely incorporates attention to psychosocial health needs as part of oncology care. The solo oncologist uses hospital personnel to help address psychosocial needs of patients.

TFCC’s multidisciplinary staff of oncology nurses, social workers, physical therapists, and others are employees of the hospital (which also owns the free-standing ambulatory oncology office). Through these staff (who also work at the hospital), TFCC offers psychological services; social services; nutritional counseling; rehabilitation therapy; and support group meetings for cancer patients, family, and friends at the hospital’s local Center for Health and Sports Performance. TFCC also offers the Look Good … Feel Better Program® and provides or links to a variety of other patient supports and resources on its website (http://www.tahoecancercenter.com).

Patients with psychosocial needs are identified during office visits or weekly meetings of the entire team. (The center does not yet use a standard screening tool.) Physicians link patients to psychosocial services by checking off “psychosocial evaluation” on a disposition sheet after patient visits. The staff schedules an appointment with the social worker, who then provides the necessary linkages to the psychosocial team. Coordination of biomedical and psychosocial care takes place at weekly team meetings. Follow-up is performed at these meetings and in the interim by TFCC nurses. Patients are supported in managing their cancer and its treatment in several ways. Each patient receiving chemotherapy spends 1 hour with a TFCC nurse for education about chemotherapy. In addition, patients receive customized printouts from the American Society of Clinical Oncology’s (ASCO’s) People Living with Cancer that provide specific details regarding their disease and planned treatments. TFCC also solicits volunteers from the community to provide assistance and companionship to patients receiving chemotherapy and help with other patient needs. TFCC’s 250 patients are covered by a variety of insurers, including Medicare (18 percent), commercial insurance (61 percent), and Medicaid (19 percent); 2 percent pay out of pocket or are uninsured.10

Discussion

This approach is feasible for many oncology providers because of substantial growth in the number of providers of psychosocial health services

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10Personal communication. Laurence J. Heifetz, MD, Medical Director, Tahoe Forest Cancer Center, August 10, 13, and 28, 2007.



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