IMPACT OF YOUR GIVING
in support of The Adolescent & Young Adult Survivorship Clinic
a partnership with Levine Children’s & Levine Cancer Institute presented with gratitude to The Leon Levine Foundation
The Adolescent & Young Adult Survivorship Clinic
Atrium Health’s Commitment to Cancer Survivorship Services
Cancer and its treatments have lifelong effects, even after you or your child is in remission. The survivorship experts at Atrium Health Levine Children’s Hospital and Levine Cancer Institute have spent years helping children, adolescents, and young adults navigate these long-term issues. We’re one of the few survivorship programs in the greater Charlotte area working to identify health risks from childhood cancer and taking steps toward management and prevention.
The Adult Survivors of Childhood Cancer Clinic (ASCC) promotes successful transition from pediatric to adult survivorship care and facilitates adherence to follow-up, per the Children’s Oncology Group’s Long-Term Follow-Up Guidelines. Our Survivorship Oncology Clinic works collaboratively with a pediatric oncologist and nurse practitioner from Levine Children’s Hospital.
Transitioning from pediatric to adult care can be challenging, especially after adult survivors of childhood cancer have experienced long-term relationships with care providers. The ASCC clinic provides support in transitioning to adult survivorship care, in collaboration and partnership with the pediatric provider, adult survivorship team, patient, and care partners.
A Commitment To Cancer Patients Well Beyond Treatment
Winning a battle with cancer takes a group effort. For young patients who have experienced cancer and are now facing life with new hope, learning to move forward after recovery is also a group effort.
A Commitment To Survivorship Education
The survivorship team is multidisciplinary – consisting of a doctor, nurse practitioner, psychologist, dietician, social worker, and child life specialists. Under the leadership of Jennifer Pope, MD, the team educates cancer survivors about their past medical history while guiding them to live their best lives.
Program Leadership
Jennifer Pope, MD
Pediatric Hematology-Oncology
Levine Children’s
Kathy Martin, NP
Pediatric Hematology-Oncology
Levine Children’s
Mike Kendall, MD Supportive Oncology
Levine Cancer Institute
Dori Beeler, PhD
Supportive Oncology
Levine Cancer Institute
Ana Chavez
Pediatric Hematology-Oncology
Levine Children’s
Supportive Oncology
Levine Cancer Institute
Team Expansion
In June 2024, Emma Dixon joined the Adult Survivors of Childhood Cancer team as an Exercise Specialist. Emma earned a Master of Science degree in Kinesiology with a concentration in Clinical Exercise Physiology from the University of North Carolina at Charlotte. She works with young adult survivors to understand the importance of physical activity in maintaining their health and well-being in addition to creating an individualized exercise plan for them.
Denise Reynolds RDN CSO LDN CHWC has over 25 years of experience as a registered dietitian, the last 10 years at Atrium and LCI. She obtained her BS in Human Nutrition at Winthrop University and completed the Board Certification Exam for Specialist in Oncology Nutrition. She has also completed training as a Certified Health and Wellness Coach through Wellcoaches. Denise is currently the survivorship dietitian with Pediatric, Adolescent, and Adult patients.
Optimizing Transitions to Adult Care for Adolescent & Young Adult Cancer Survivors
Dr. Pope, Kathy Martin, and Ana Chavez from the pediatric team are working with Dr. Mike Kendall, Jacqueline Edwards, and Susan Yaguda from the adult survivorship team. Together, with quality improvement coaches and data analysts, the group is working to improve the transition of young adult survivors from the pediatric team to the adult team utilizing the Six Core Elements of Health Care Transition.
1 2 3 4 5 6
POLICY & GUIDE
TRACKING & MONITORING
Develop, discuss, and share transition and care policy/guide
Age 12-14
Track progress using a flow sheet registry
READINESS
PLANNING
TRANSFER OF CARE
Age 14-18
Assess self-care skills and offer education on identified needs Age 14-18
To date, the team has accomplished the following:
Develop HCT plan with medical summary
Transfer to adultcentered care and to an adult practice
Confirm transfer completion and elicit consumer feedback
• Developed a written transition policy that is distributed to all pediatric cancer survivors in survivorship clinic
• Created and implemented a readiness assessment tool for teens and young adults to identify gaps in knowledge about their medical care/history and healthcare utilization
• Standardized tracking of young adult patients visits to ensure successful transition to the adult team
Commitment To Multidisciplinary Program Development for Survivorship
The survivorship team is multidisciplinary – consisting of a doctor, nurse practitioner, psychologist, dietician, social worker, and child life specialists. Under the leadership of Jennifer Pope, MD, the team educates cancer survivors about their past medical history while guiding them to live their best lives.
Interdisciplinary Team Meetings
On the first Wednesday of the month, all patients scheduled for their transition visit the upcoming month are presented at an Interdisciplinary Team (IDT) meeting for in-depth discussion.
A total of 12 IDT meetings in 2024 provided a formal platform for case discussion, though the Levine Children’s Hospital and Levine Cancer Institute providers openly communicate as questions arise regarding a patient. The Interdisciplinary Team meetings, virtual or in person, occur prior to each patient’s transition appointment. Both the Levine Children’s Hospital and Levine Cancer Institute teams attend, including the pediatric oncologists, pediatric cardio-oncologists, survivorship providers, oncology nurse practitioners, pediatric oncology social worker, pediatric oncology nurse, survivorship nurse manager and survivorship program coordinator.
In Kind Donations
Dr. Dori Beeler provided close to 2 hours a week of research support, through 2023. Her time was devoted to data collection and analysis of the Adult Survivors of Childhood Cancer needs assessment provided to patients during their visits to clinic. In early 2024, Dr. Beeler presented her work at the Society for Integrative Oncology and her poster received 3rd place out of nearly 100 post submissions.
The survivorship project manager and nurse manager provided about 2 hours a week for programmatic support and development. The RN Program coordinator contributes an average of 4 hours per week on ASCC and an additional 4 hours per week on Wake Forest Baptist Health Adolescent & Young Adult Programs.
Background and Process
• Started in September 2019, this clinic is a partnership between Atrium Health’s Levine Children’s Hospital & Levine Cancer Institute.
• Adult survivors of childhood cancers are scheduled for a transition visit with Dr. Pope/Kathy Martin, NP in the Department of Supportive Oncology at Levine Cancer Institute.
• Patients receive a comprehensive survivorship care plan, per the Children’s Oncology Group’s long-term follow-up guidelines.
• Monthly interdisciplinary team discussions are used to facilitate transition to Dr. Kendall and discuss complex needs.
• Patients have access to adult services, groups, and classes offered by the Department of Supportive Oncology.
• Subsequent visits are scheduled with Dr. Kendall at the same location.
• Transition support services include opportunities for therapeutic writing, art, and music therapy – all which serve as tools for processing this change and for survivors to share their stories in meaningful ways.
• The adult survivors celebrate this transition by adding a ribbon to the adult survivorship wreathe displayed in the Department of Supportive Oncology. They can choose a ribbon indicating their cancer type, childhood cancer, or the survivor ribbon.
Total Visits
Total survivorship visits declined in 2023 because cardio-oncology is now offered through Sanger Heart & Vascular Institute; however, the number of Adult Survivors of Childhood Cancer visits to survivorship increased. In quarter 3 of 2023, the sexual health clinic opened to its second pilot group. With the expansion of sexual health and the Adolescent & Young Adult clinic pilot opening second quarter of 2024, we anticipate seeing some gradual growth through the survivorship service line.
Looking Forward: Growth for The Adult Survivors of Childhood Cancer Clinic
• Commemorating transitions
o Transformation rituals
o Legacy work
o Art, music, writing compilations
• Completing study
• Adding exercise physiology
• Adding mental health support
• Levine Children’s and Levine Cancer young adult synergies
Integration With Wake Forest Baptist Health Adolescent & Young Adult Programs
The integration with Wake Forest Baptist Comprehensive Cancer Center and Brenner’s Children Hospital continues to offer a comprehensive Adolescent & Young Adult (AYA) program across the combined area.
The AYA Program is supported and guided by the invested physicians and researchers on the AYA Steering Committee and patients in the AYA Advisory Group. It is anchored by the Department of Supportive Oncology at Atrium Health Levine Cancer and the Oncology Service Line at Atrium Health Wake Forest Baptist Comprehensive Cancer Center.
Financially supported by various sources – such as The Leon Levine Foundation – AYA collaborates with the Wake Forest University School of Medicine and partners with various disease-specific young adult programs, such as EMPOWER, YALL, and the Sandra Levine Young Women’s Breast Program.
Integration With Wake Forest Baptist Health Adolescent & Young Adult Programs
• In early 2024, Dr. Erin Trovillion and Dr. Anne Wofford were appointed as Co-Medical Directors for AYA care.
• AYA Program Manager position for the Greater Charlotte Market was approved and filled.
• Programmatic integration is under way, with an emphasis on 3 foundational pillars: Advocacy and Education, Clinical Care, and Research.
• Marketing is engaged to provide a strategy for promoting AH AYA programs across the Southeast Region.
• In November, Winston-Salem hosted an AYA Workshop for both markets to align goals for AYA programing, set priorities for AYA care, and work on future projects.
Medical Directors
Program Managers
Integration With Wake Forest Baptist Health Adolescent & Young Adult Programs
Advocacy and Education
• A patient and family AYA Advisory Group has been assembled.
o This group meets bi-monthly to help review and prioritize program initiatives, with the goal of providing feedback and direction to improve patient experience and outcomes.
o They completed patient “roadmaps” outlining their healthcare journeys, facilitating better navigation of services and resources. Quotes from these roadmaps have been used to develop training materials for healthcare professionals and guide discussions around program goals.
• Two support groups focusing on AYA-specific needs were created.
o Connecting Young Adults with Cancer: virtual peer meetup offered monthly in the evenings and led by Abbie Mauney, AYA survivor
o Young Adults with Cancer Luncheon: virtual and in-person support group with complimentary lunch held every other month and led by clinical social workers, Maya and Isabella.
• Two AYA Program Managers attended CancerCon Live 2024, a conference presented by Stupid Cancer for AYA patients, survivors, caregivers and healthcare professionals. This event was a fantastic opportunity to strengthen knowledge and skills around the unique needs of AYAs and network with other AYA Programs across the country.
Presentations
Dr. Erin Trovillion and Whitney Mitchelides presented at DSO Grand Rounds
Whitney Mitchelides presented at the 2024 Navigator Academy
Presentations
Dr. Erin Trovillion and Dr. Tara Streich-Tilles from Duke Cancer Institute presented on oncofertility at the NC AYA Symposium
Clinical Care
Initiated New Clinics
• AYA Clinic
Supportive care clinic in the DSO at LCI-Morehead for patients 18-39 years old to address needs identified by the NCCN Guidelines for AYAs
Provider: Dr. Scott Gremillion
• Oncofertility Clinic
Virtual clinic at LCH providing dedicated support and resources for patients seeking fertility options during and post-treatment
Provider: Dr. Erin Trovillion
Identified Clinical Projects
• Menstrual
Suppression
Collaborative effort with pharmacists to standardize utilization of Lupron for menstrual suppression across institutions and educate providers on its use
• Bone Health
Multi-disciplinary effort to educate providers and standardize guidelines for vitamin D screening and repletion in patients with increased risk across institutions
