In February 2020, Michael Patalan-Thompson was diagnosed with colon cancer. As a busy father, he was helping his wife care for their 3 children – age 13, 11 and 8. Plus, he was working full time as a production specialist with NASCAR. At only 39 years old, Michael wondered how he would keep up with everything while having surgery and several rounds of chemo.
“Cancer doesn’t happen in a vacuum,” revealed Mohamed E. Salem, MD, clinical leader of Atrium Health Levine Cancer Institute’s EMPOWER program. Dr. Salem highlights the true impact of a cancer diagnosis – how it happens when everything else continues to go on in your life.
For patients under 50, cancer is especially disruptive. Unlike many retirees, young adults are usually busy pursuing a career, paying a mortgage, exploring new relationships and raising a family. “Life is already busy enough, then you add cancer to the mix,” explained Dr. Salem. “These patients can be easily overwhelmed by having to find the time, emotional strength and resources to deal with cancer and its required treatment while juggling everything else.”
Dr. Salem as well as many gastrointestinal oncologists have seen this situation affect many young adults who are battling colorectal cancer, an alarming phenomenon of the past 2 decades. “While the incidence and mortality of colorectal cancer in older patients is decreasing, these are both on the rise for patients age 50 and younger, especially in left-sided colon and rectal cancers,” Dr. Salem said.
By the year 2030, experts predict that CRC incidence rates will have increased by 90% for patients aged 20 to 34 years and 27.7% for patients aged 35 to 49 years. That means there will be a growing population of patients who need extra support to cope with the challenges of living with cancer, beyond just testing and treatment.
Increasing rates of early-onset CRC poses global health, economic and psychological challenges and a significant burden on patients and their families.
“As a doctor, we’re doing a great job taking care of cancer and finding effective treatments,” said Dr. Salem. “But as a community, we haven’t done enough to take care of the patient as a whole. Beyond treatment, we need to give them the tools to cope with the diagnosis that may seem to be overtaking their life.”
Essential areas of care
To help young adults cope with colorectal cancer, Levine Cancer Institute launched the EMPOWER program in fall 2020. This program is a collaboration between GI oncology team and Atrium Health Levine Cancer Institute’s Department of Supportive Oncology, Department for Genetics and the ReHope program with the Women’s Institute.
The EMPOWER program includes 4 areas of comprehensive care:
1. Multidisciplinary clinic:
The monthly Patient-Centered Multidisciplinary Clinic platform provides colorectal cancer patients (age 18-55) with multiple in-person entire needs and ancillary services in 1 appointment. “Providing services all at once means that patients don’t need to schedule multiple appointments for multiple services,” said Dr. Salem. “This helps us meet patients’ needs more conveniently and efficiently- it is one day, one place and one visit for everything”
The clinic provides the following services:
- Genetic counseling and testing
- Financial counseling/Patient Assistance Program
- Pelvic rehab assessment
- Nutrition services
- Colostomy care
- Integrative oncology
- Fertility counseling
- Psychotherapy
“This clinic is designed to allow patients to talk about all aspects of their cancer care – not just chemo or surgery,” said Dr. Salem. “The psychological support is especially important since it provides patients and their loved ones with the coping skills needed to move beyond the diagnosis and communicate with family and friends about their health and feelings.”
In conjunction with the monthly multidisciplinary clinic, Chasse Bailey-Dorton, MD, runs the Integrative Medicine Consult Clinic to provide holistic cancer care services that address the physical, emotional and spiritual needs of patients.
2. “Know your tumor indicatives” Tissue and tumor profiling:
Dr. Salem’s team studies the unique characteristics of colorectal tumors in order to determine the best course of treatment. Molecular profiling of cancer tumors can also be used to help identify treatment options and clinical trial for patients. In addition to profiling the cancer tumors, the team at LCI uses liquid biopsy technology to determine how the tumor changes over time and also to see if there are any remaining cancer cells in the blood following surgery.
3. “We all are in this together” Peer matching program:
The program helps colorectal cancer patients connect with other patients who share a similar cancer experience. “Giving patients opportunities to talk with peers and vent about challenges and coping strategies is very helpful,” said Dr. Salem. But more importantly to learn from each other who to best navigate this hard journey.
4. Outreach and screening initiative:
The team uses outreach and screening to help prevent colorectal cancer. “Prevention is much better than treatment,” explained Dr. Salem. “If we can detect it early with colonoscopy and sigmoidoscopy, we can treat it sooner and deliver a better outcome.”
According to Dr. Salem, it’s important to increase awareness about symptoms, especially in patients under age 45. “You know your body better than anyone else,” he explained. “So, if you feel like there’s something wrong, get yourself checked.” Ask yourself: Am I losing weight? Have I experienced changes in my bowel habits? Is there blood in my stool? “Unfortunately, there’s a lot of shame associated with the discussion of bathroom habits and rectal symptoms,” Dr. Salem said. “But feeling free to discuss these sensitive topics with your doctor could save your life.”
Program coordination
Within Levine Cancer Institute, the EMPOWER program’s nurse coordinator conducts assessments and helps arrange patient referrals to various specialists, including psychiatry, fertility, genetics and rehabilitation. The Tridiuum screening system, which is in place across Levine Cancer Institute, identifies and triggers referrals for nutrition, social work and chaplain support based on the software algorithms.
Positive experiences and outcomes
In Dr. Salem’s experience, cancer care tends to be more effective when it’s based on a group effort. “Providing a collaborative and comprehensive approach may improve patient experience and outcomes,” he said.
For example, Michael was one of the first patients to join the EMPOWER program. “For the past year, I’ve been fortunate to have physical and emotional support from my family,” revealed Michael. “Going into the program, I was looking for pragmatic results. From a nutritional standpoint, I wanted to learn how I could eat better. From a physical standpoint, I wanted to know what activities I could do safely. I really wanted to learn how to get better and stay better.”
As far as exercise, Michael has been taking it slow. “I’m outside for an hour playing catch with the kids, which helps fill my time,” he said. “My overall goal is to get in better shape than I was before my diagnosis, and I’m really motived to do so!”
According to Michael, the EMPOWER program provides invaluable information and access to a wide range of resources. “What I like most is that it’s not a one-size-fits-all program, and the physicians don’t pressure you to enroll,” he explained “They make sure you’re fully informed so you can take advantage of all the support resources Levine Cancer Institute has to offer.”
Future plans
In the future, Dr. Salem’s team plans to organize the following activities in support of the EMPOWER program:
- Support group: The support group will have a social worker or a representative from the Department of Supportive Oncology lead and moderate the discussions, listening for areas where patients need extra support.
- Ask-Your-Doctor sessions: During these question-and-answer sessions, patients will be able to ask surgeons and other doctors questions using a virtual platform. For example, questions may be related to causes of symptoms, side effects of treatment or nutrition.
- Research projects: Upcoming research opportunities may include studying the microbiome and how it affects colorectal cancer.
Learn more
To learn more about supportive oncology services at Atrium Health, visit the Department of Supportive Oncology page or email Ebony.Phillips@atriumhealth.org
