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UVA Nurses Offer Post Cancer Video Care

RadioIQ

Treatment for cancer can be tough, and even after a doctor says the disease is in remission, patients can be depressed, worried and confused. 

They may live far from their health care team, but the University of Virginia is testing a way to provide reassurance and care.

When Pam DeGuzman came to the University of Virginia to practice nursing, she was surprised by the lack of resources in many rural areas.

“I had a patient from Madison County.  This woman came in and had a broken hip," she recalls.  "We had to get her a bedside commode for her house, because the only place she had to go was a bucket.”

And she learned that patients with head and neck cancers face an even greater challenge.

“Think about Roger Ebert.  That’s an image that comes to mind for a lot of people.  It was obvious he had some facial disfigurement, and that’s somewhat common, but then add on that you might have speech problems.  You might have swallowing problems.  These are all part of the way you interact with the world,” DeGuzman explains.

So it’s no wonder people recovering from head and neck cancer are far more likely to commit suicide than most other cancer patients. DeGuzman and her team at UVA’s School of Nursing think they can help and have launched a study that involves regular video chats using cell phones, tablets, laptop or desk top computers.  Nurse Allen Cupp is one of those who checks surgical incisions and asks patients to rate their distress on a scale of one to ten around a series of possible problems.

“Loss of interest in usual activities?"
 he asks patient Don Surrena.

That would be a three," Surrena replies.

"Okay," says Cupp.  "What about breathing?" 

" Maybe a two," Surrena says.

"Eating?" 

" Back when we first talked it was probably a nine," Surrena says. "Today it’s a zero.  No problem.” 

"Alright!"  Cupp cheers.

He also offers to connect patients with mental health professionals in their communities, but the stigma surrounding psychologists and psychiatrists is still a barrier.

“Patients usually say, ‘I’m okay.  I don’t need that,” he explains.

So Cupp will assess the patient’s overall condition. He probes gently and offers suggestions.

“It looks like the highest score that you have is a five in dealing with your partner," he tells Surrena.              "What’s going on with that?"

"It is very difficult for her to see me as always a strong individual, now becoming frailer and more fragile,” Surrrena explains.

He is a retired builder who underwent a series of treatments for squamous cell cancer that began in his throat.  He was referred to a surgeon at UVA.

“He removed 56 lymph nodes and my right tonsil," Surrena recalls. " He said, ‘You should be good, but I still recommend having chemo and radiation.’”

Through it all, nurse Cupp was available to answer questions and provide support.  Surrena and his wife were grateful.

“He helped me by reassuring me that some of the solutions that I’d come up with – I was on the right track: things to do to make my throat not as sore, things that would help me swallow. It helped her also to understand what would be coming up for me and what I was going through.”

Credit RadioIQ
The post cancer video team at UVA -- nurse Allen Cupp, data coordinator Ivy Hinton, lead researcher Pamela DeGuzman and PhD candidate Veronica Bernacchi, a nurse who helps recruit patients for the study.

Surrena lives in Fredericksburg and is comfortable with technology.  For patients who reside in more rural places, the university may lend a cellular-enabled tablet, and DeGuzman thinks someday local libraries could play an important role in post-cancer treatment.

“Every public library has fixed broadband," she says. "Every public library has at least one librarian. These days, their main job is to help people with technology, and a lot of them have a private space where you could do this, and every single county in Virginia has a public library.”

Ivy Hinton, who has family in rural communities, thinks that’s a great idea, but as a breast cancer survivor, she also sees the value in serving city people with post cancer care.

“My home is right next to the hospital, but there were times when it felt like it may as well be 100 miles away. Being able to turn on my computer, my cell phone, my iPad and being able to talk to the nurse, so that the nurse could see me.  I could see the nurse.  That’s just a feeling you can’t get on the telephone,” Hinton says.

Today, she works at the nursing school and is delighted to be helping Pam DeGuzman with her study.  

***Editor's Note: The University of Virginia is a financial supporter of Radio IQ.

Sandy Hausman is Radio IQ's Charlottesville Bureau Chief