Cleveland Clinic Starts Shared Medical Appointments for Early Stage Melanoma Patients

In August, Cleveland Clinic Cancer Center launched a new initiative for early stage melanoma patients – shared medical appointments (SMAs). “Early stage melanoma is highly treatable, and we can prevent recurrence,” says Jung Song, CNS, RN. The SMAs will help achieve those goals. Song leads the appointments along with Carolyn Stanek, RN, a melanoma care coordinator, and Joel Marcus, PsyD, an oncology psychologist.

Statistics support Song’s assertion: According to the American Joint Commission on Cancer Melanoma Staging Database, the five-year survival rate for Stage 1A melanoma is 97 percent, compared to 62 percent for regional stage melanomas (lymph nodes) and 18 percent for distant stage melanomas (other organs). By holding shared medical appointments, the melanoma care team hopes to address common questions, encourage patients to take preventive measures against future melanomas and provide a setting where survivors can share experiences.

SMAs offer exams, plus education

Approximately 200 patients were diagnosed with early stage melanomas – localized tumors that hadn’t spread to the lymph nodes or other sites – at Cleveland Clinic’s main campus last year, according to Song. While they were treated at the healthcare system’s top-rated Melanoma Program, not all of them required appointments with a medical oncologist or other specialists on the multidisciplinary team. By implementing shared medical appointments, Song and her peers are able to devote more time to early stage melanoma patients.

The SMAs, which are held once a month for 90 minutes, are designed for four to six post-melanoma extraction patients. The appointments begin with a one-on-one physical exam in a private room. Song assesses the patient’s heart and lung functions, examines the surgical site and checks lymph nodes for local metastasis. Afterward, the patients gather for a group session that covers the stages of melanoma, identification of problem moles, the relevance of personal and family history, the importance of preventive measures, such as sunscreen, and more. “Patients leave the SMA with a lot more information than the traditional one-on-one appointment,” says Song.

In addition, Dr. Marcus assesses each patient’s emotional state. Some patients may feel anxious or depressed soon after diagnosis. During the group session, patients also share stories and ask questions. At the end of the SMA, each patient receives an individual plan of care depending on their diagnosis, risk factors, and personal and family history.

If patients have a family history, they can be added to the Melanoma Program’s new study on identifying familial melanomas, which is being led by Principal Investigator Pauline Funchain, MD. The study includes genetic testing and counseling, as well as a melanoma registry. Ultimately, results of the study could lead to more specialized patient care.

Nurses in ideal position to lead SMAs

The care team currently offers the SMAs to patients within its group, but plans to expand and promote the appointments to Cleveland Clinic’s Dermatology and Cosmetic & Plastic Surgery Departments, too. The team hopes that shared medical appointments will help prevent recurrence. “We believe that SMAs may encourage patients to adopt better self-care behaviors,” says Song. “Hopefully, they will understand more about melanomas and commit to preventive measures, such as using sunscreen, wearing protective clothing in the sun and making regular visits to dermatologists.”

Song is excited to lead the new SMAs, the first of their kind in the Cleveland Clinic Cancer Center. “As a clinical nurse specialist, I’m in a position to provide quality care,” she says. “I can use a combination of nursing skills and relationship-building skills to connect with patients as people, not just treat the disease.”