Promoting Excellence : Urban Research Cancer Center

Supportive Care Program
Pain and Palliative Care Service
Memorial Sloan-Kettering Cancer Center
New York, New York

Nessa Coyle, RN, MS, NP, FAAN

Nessa Coyle The Supportive Care Program at Memorial Sloan-Kettering Cancer Center (MSKCC) bridges the gap between hospital and community care. It provides continuity of intensive palliative care for cancer patients and their families who are being followed by the hospital’s Pain and Palliative Care Service and who are returning home. The program extends the team concept by bringing the expertise of a comprehensive cancer center, including a commitment to palliative care, into the community. There is no charge to patients or their families for this service.

Most patients with progressive, debilitating cancer have palliative care needs. Some are at high risk for poorly controlled pain and other uncomfortable symptoms. Some also suffer heightened psychological distress when they are discharged back into the community. These patients and their families are referred to the Supportive Care Program for intensive follow-up. Patients with advanced disease may fit the hospice admission criteria. Those who do not, however, may benefit from a parallel system of care that focuses on life-prolonging therapy as well as aggressive palliative care. Both types of patients and their families are followed in the MSKCC Supportive Care Program.

Caring for Patients at Home
The purpose of the program is to provide expert palliative care to patients at home. Many program patients, though not all, live within the five boroughs of New York. Because most of the team’s work is done via telephone, however, location is not an issue. The APN is available via telephone 24 hours a day.

The program provides a link between MSKCC and community health practitioners working with program patients. The program APN, with support from the MSKCC Pain and Palliative Care Service interdisciplinary team, facilitates continuity of care and, as requested, offers symptom control expertise to community clinicians.

The program also acts as an expert resource for patients, families and health professionals throughout the country who care for cancer patients with pain and other symptoms. In addition, it offers education and support for nurses and physicians who are increasingly faced with the care of chronically ill and dying cancer patients who have complex symptoms and family members who are exhausted and grieving.

A Collaborative Effort
The MSKCC Supportive Care Program is a collaborative effort among APNs, physicians and social workers. Consulting team members come from psychiatry, rehabilitation, nutrition services and chaplaincy. Other MSKCC resources are also available to the program’s APN coordinator and through her or him to the patient, family and community team.

APNs Nessa Coyle and Mary Laymen-Goldstein work with a caseload of 12 to 15 patients each. Their salaries are paid through the Department of Neurology and are considered part of MSKCC’s clinical overhead. Each year, they make or receive approximately 3,200 telephone calls, 40 home visits, 200 outpatient clinic visits and 600 hospital visits. The small number of annual home visits is testimony to the fact that the Supportive Care Program works with the community home care team and is not intended to replace local clinical teams and practitioners.

The length of time that patients and families are followed varies from weeks to years. Intensity of involvement also varies, depending on need, from multiple telephone contacts in a day to weekly contact or even less. Although patients may be in a hospice program, they often require an ongoing relationship with the Supportive Care Program if their symptoms are particularly complex. Some patients may not meet hospice admission criteria but have palliative care needs, nonetheless. Others may decline to join a hospice program.

Personal Reflection
“This is a wonderful and personally enriching area to work in,” Coyle says. “I am constantly learning from patients and their families. To work in this field, you need to have a good grounding in symptom management and the domains of suffering. You also need the ability to listen. Patients and their families are our constant teachers,” Coyle continues. “Listen and you will learn what they need. They will also teach you about living and dying.”

Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying persons and their families. Visit for more resources.

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