Gabby Cinnamon (Host): Welcome back to Conversations on Cancer, brought to you by the Riverside Cancer Institute. I'm your host, Gabby Cinnamon, and today I am so excited to be joined by Kirstin Carson, Riverside's Director of Oncology and Infusion Services. In today's episode, Kirstin is going to share some facts about the Riverside Cancer Institute that might surprise you.

Intro: Welcome to Conversations on Cancer, brought to you by the Riverside Cancer Institute. Providing answers, debunking myths, and sharing patient stories.

Host: Thank you so much for coming on the podcast today, Kirstin.

Kristen Carson: Thank you for having me.

Host: So since you are a first time guest on the show, can you just tell us a little bit about yourself and your background?

Kristen Carson: Sure. So, I am the Director of Oncology and Infusion Services. I've been at Riverside since 2005. So, I had a lot of longevity there. I did start as a nurse in the operating room and then went to the infusion center and worked my way to manager there, director there. And then in about three years ago, I took over the cancer center as the director there as well.

Host: Awesome. A fun fact about Kirstin is that when I had my tonsils and adenoids removed in the fifth grade, Kirstin was my nurse, so a fun connection from a long time ago. But today's topic, like we talked about, is some facts about the cancer institute that might surprise you. I think we talk about this a lot, but people don't realize how much care they can get close to home and what the Cancer Institute has to offer. So in today's episode, we hope to share more about that and highlight all the amazing things that the Riverside Cancer Institute has to offer. So, the first thing that I kind of want you to talk about is that we have the latest in radiation therapy technology. Can you share more about that?

Kristen Carson: Sure. So in July of 2023, we went live with our new TrueBeam linear accelerator. This is an awesome piece of equipment that is the latest and greatest in the world of radiation oncology. With this technology, we are able to treat tumors with pinpoint accuracy, sparing healthy tissues and organs from receiving radiation dosing. And for those of you that don't know, radiation can often kill those tissues, so we want to spare as much good healthy tissue as we can.

On this machine, we can treat a larger field for our patients. So by doing this, we are able to treat multiple tumor sites, say, within the abdomen. We can treat all of those sites at one time. This allows for the patient's treatment to be cut down tremendously in a time factor. Where as before, we would have had to treat them in two separate treatments on a day. We also have new technologies within this where if a patient moves, the beam will turn off until we reposition the patient. This helps to, again, spare that tissue and those other organs that don't need to be treated by radiation. And for breast cancer patients or chest wall patients, we also have a new technology that's called DIBH, or Deep Inspiration Breath Hold. This allows for the beam of the radiation to only treat when the patients are holding their breath. By doing this, we can avoid that heart muscle and treat just what we need to treat on the tumor site.

Having this new machine as what we call our workhorse, where we perform a majority of our treatments, allows us to use our second machine to focus on special procedures, such as stereotactic surgeries of the brain and lung. Many facilities don't even have this capability, especially here in this community. We're very lucky to have it and do these non-invasive surgeries in collaboration with our neurosurgeons and that team. And we can spare the areas of the brain from being damaged by radiation. In the past, we've had to do whole brain radiation, which then would impact the entire brain. You can imagine the side effects of this from memory loss, from function loss. And now, we can just pinpoint treat those brain tumors without having to surgically intervene. You can imagine how great this is for our community. And we're extremely lucky to have these technologies. They are truly state-of-the-art.

Host: Yeah. I think sometimes I forget too that radiation, while it's meant to help and treat the cancer, but also the damage that it can cause, so the preciseness when I'm hearing you guys talk about this is something that never would have even crossed my mind with the breath holds and then how trying not to damage the tissue around it because we only want to treat the area that's impacted, not the healthy stuff.

Kristen Carson: Right. And so, it's very awesome that we have this in our community and can really treat patients and only their tumors.

Host: Yeah, that's amazing. So, the next thing I want you to talk about is the multi-skilled team that you guys have at the Cancer institute.

Kristen Carson: So, we're super lucky to have such a diverse team to assist our patients. I don't think that people in the community even realize the huge group of people that we have treating our patients. And if they're being referred to an academic center or specialty, they're getting that same treatment. We may have to refer out for stem cell transplants or bone marrow transplants, but we don't have to for many of our cancers, and we have a huge team to help with that. We have social workers right on site, which is amazing. We don't have to refer on those from the hospital.

When a patient's receiving treatment for cancer, we need to ensure that they have the resources they need at home for their treatment, such as home nursing care, oxygen, assistive devices, help with transportation to their appointments. Our social workers meet with all of these patients and help coordinate that care, ensuring there are minimal gaps in their needs. They also assist patients in assistance programs available for drug companies, enrolling them in Medicare and Medicaid, applying for financial assistance through Riverside to really help our patients.

We also have an on site dietician. When patients are going through cancer treatments, there are so many side effects. Some patients lose their ability to swallow and have to have a G-tube placed. Some lose their appetite for food, because it doesn't taste good or they're suffering from side effects such as nausea and vomiting. Our dietician meets with these patients to assist in the training for G-tube feedings, ensuring that they're getting enough calories and protein to heal and to supplement them or to work with small meal ideas just so that they can get the proper nutrients.

We also have pastoral care on site with patients. This is new for 2024, and we're very excited to have it. We've had a great response from our patients on the pastoral care and the support that they get from our pastor for mental health as well as spiritual health while navigating their journey.

We have a lab and pharmacy services on site, and what does this mean? It means that we can get same day results for labs, which indicate if the patients can or cannot receive their chemotherapy or immunotherapy on that day. And with pharmacy on site, we can mix medications right there. This allows for the patients to receive those treatments the same day and in a quick fashion where we don't have to wait for them to be transported from the main hospital. We also have a specialty pharmacist on site who helps with the authorization processes and the financial processes for all oral chemotherapy drugs and educates the patients on how they should be taken, when they should be taken, and the side effects that might come from those.

And another area of expertise that we have on site is an authorization team. Many, many times, we find ourselves fighting a battle with insurance companies for the treatments or testing that our patients need. Having a team of people to do this specifically for cancer care allows for our patients not to have to fight this fight. We fight it for them. This team knows the information to provide to the insurance companies and ensures that the services are received and covered properly for their payers.

Host: So, part of that multi-skilled team that you just talked about is that we have three oncologists, one radiation-oncologist, and three oncology nurse practitioners. Can you talk a little bit about that and how they work together to coordinate care?

Kristen Carson: Sure. So, we are really lucky to have all of them. We have three medical oncologists, a radiation-oncologist, two medical oncology nurse practitioners, and we have another one starting hopefully around May, and we have one more radiation nurse practitioner. This team provides the best care that they can, working together to ensure that they're all on the same page for those patients and giving high quality care the whole time.

Host: Awesome. It's truly a great group of people, getting to work and talk with all of them. So, another thing is that, there are actually three treatment locations throughout the community. Can you talk about those and why that's important?

Kristen Carson: Sure. So, we currently have oncology services available in Bourbonnais, Frankfort, and Watseka. This geographic span allows us to treat patients closer to the home and collaborate the patient's primary care providers and ancillary services to make them available close to their home. We're planning to expand our service line also to Cole City towards the end of this year and really help those patients in that community as well.

Host: That's very exciting. so kind of switching gears a little bit, you know, when someone is diagnosed with cancer, I think sometimes people don't realize, the financial impact, that that can have. And you guys have financial counselors that work with patients and their family members. Can you talk a little bit about this and how they support those patients?

Kristen Carson: Yeah. Financial toxicity is a huge concern when patients are receiving cancer care. The therapies are so, so expensive. And we really do our best to help the patients in this field and give them one less burden on this journey. We work with the patients to find drug assistance programs, enroll them in benefits that they may be eligible for that they weren't enrolled in already. We screen them for financial assistance programs to help decrease the financial toxicity. The patients and their families should not have to worry about how they're going to pay for these treatments. And we do our best to find all the assistance that we can. Cancer is a devastating diagnosis, and we want to do our best to make the journey as easy as possible.

Host: For sure. Before we get into the next thing that might surprise you about the Riverside Cancer Institute, I want to take a quick break to talk about primary care at Riverside.

Riverside knows that health is your greatest asset and staying up-to-date on routine screenings helps you be the healthiest version of yourself. Talk with your primary care provider about which preventative screenings you should be getting. If you do not have a primary care provider, good news, Riverside can help. Find a primary care provider that fits your needs at riversidehealthcare.org/primarycare. A cancer screening could save your life.

Now, back to this episode with Kirstin. So, another thing that you guys like to emphasize is that you follow all cancer treatment guidelines and protocols the same as people would get at a larger academic institution. Can you talk about those protocols and kind of what goes into that?

Kristen Carson: I think there's a huge misconception that you can receive better treatments if you go to an academic center in Chicago. And yes, at times, there's treatments we can't provide within our community, but there are specialty treatments that take different teams of people, and we do refer out for those if needed. But we follow the NCCN guidelines for cancer care. What does this mean? It means we are following the national protocols for treatment of cancer, that you get the same medication and protocols no matter if you're with us or at an academic center. We'll often have patients seek second opinions for their treatments in the Chicagoland area, and they are told that they would be getting the exact same treatment that Riverside is prescribing.

Our doctors are there to work in agreement with any other teams and make sure that we're giving the highest standards of care for their diagnosis. You don't have to travel far from home to receive the best cancer care. And in many cases, we're all using the same treatment guidelines and protocols to treat the cancer the best.

Host: Yeah. I think sometimes people don't think about the drive. And if you've just had treatment and you're maybe not feeling great, the difference of being in your car for an hour and a half trying to get to the city versus being able to get treated closer to home, that makes such a huge difference.

Kristen Carson: Absolutely. I would personally want to be 10 minutes away or 20 minutes away compared to driving in Chicago traffic or wherever it may be to get the same care.

Host: Yeah, exactly. One group I certainly do not want to leave out is the nurses that work at the cancer institute. So, you guys have oncology-certified nurses. Can you talk about why that's important?

Kristen Carson: Part of our requirements for our nursing staff is that they become certified oncology nurses. This ensures that our nurses are certified in the area of treatment and stay up to date on protocols, medications, side effects, and proper treatment of patients with cancer and/or hematologic disease. We want our team to be at the highest level of knowledge to best treat our patients, and they always have to renew this certification as well. So, they're staying up-to-date on the practices and the ever changing field. This helps to ensure that our providers and nurses are all giving the highest level of care and getting the right information to provide that.

Host: Yeah, that's very important and something that people definitely might not think about. So, another group of wonderful people I always admire how they have the radiation therapy hallway decorated and just how much fun they are is the radiation therapy team. You guys have an awesome group of therapists. Can you talk about that?

Kristen Carson: Yeah. We do have a really awesome team of radiation therapists. They're consistently growing in their knowledge of radiation therapy. And with the new TrueBeam and all of the modalities that it provides, we've had a lot of change and a lot of learning through all of this. They're an awesomely fun team, as you said, and they work really well with our medical oncology nurses.

We are celebrating all the milestones of victories with our patients on their journey. They really try to make the experience enjoyable and work with the patients to ensure they can stay compliant with treatment and be comfortable while doing so. Our therapists really focus on team standards and ensure all players are on the same page. With patient's treatment plan and that the patient is on board with that as well. We work really hard with a group of physicists, with dosimetrists, with our providers to ensure that we're getting the plans right and only treating what the patients need to have. It's a really awesome team.

Host: Yes, yes, it is. It is truly. So unfortunately, cancer is more common in our community than I think people realize. Can you talk about how many patients you guys treat per year on average?

Kristen Carson: Yeah. So in 2023, we delivered over 3,800 radiation treatments and over 8,000 chemo or immunotherapy doses and had almost 14,000 office visits. We saw over a thousand new patients in 2023 for oncology and hematology.

Host: That's amazing. You guys are treating a lot of people.

Kristen Carson: We really are. And it's sad, but we do our best to make it the best we can.

Host: Yeah, for sure. So the last thing, in case you've lost count as you're listening as I almost have, number 10 is that you guys treat patients like they're your own family. Can you talk about your team's philosophy of care?

Kristen Carson: Absolutely. I'm so, so proud of our team. We truly take on our patients as family members. We celebrate victories with our patients, we mourn setbacks or losses with patients, and we fight every step of the way to ensure the patients are receiving the best care. We put our heart and soul into every patient, every single day.

It's truly a difficult field of care from both the physical and psychological perspective. The mental and emotional drain I see sometimes on our team is real. And when a patient is not winning their battle with cancer, our employees take on that burden with them. Sometimes we just have to ensure that the patients understand what their journey is and what that outcome is going to be and ensure that they're comfortable and that their family members are comfortable with all of this. Our employees take this on daily and truly do their very best to help the patients and their families. And we really, really celebrate when a patient completes their journeys.

My office is right down the hallway from the bell that is rung at the end of every treatment. And I promise you every single time that bell is rung, I'm in tears. And yes, I'm a marshmallow, but I love the fact that we are celebrating someone's victory.

Host: Yeah. That's something that I wish that everyone could just get to hear, because it is amazing. The other day, we had a meeting and I was sitting and just waiting, finishing up some work, and there was a bell ringer at the end of the day. And I think that might've been one of first ones that I've heard in person. We share a lot of these stories on the Riverside Cancer Institute Facebook page. But just getting to hear that in person, I feel like you could be having a not so great day and just getting to hear that is amazing.

Kristen Carson: Absolutely. I mean, cancer is no joke and our team truly gives everything they can to ensure that the patients are cared for holistically. And they continually go above and beyond to make sure our patients feel that care, know that care, and are getting the best care possible. They really truly treat with love and you can see it every single day.

Host: That is a great way to end off this episode. Thank you so much, Kirstin, for coming on the Conversations on Cancer podcast today.

Kristen Carson: Absolutely. Thank you for having me.

Host: And thank you listeners for tuning in to Conversations on Cancer, brought to you by the Riverside Cancer Institute. For more information about the Riverside Cancer Institute, visit riversidehealthcare.org/cancer. Also, make sure to leave a review for our show on Apple, Spotify, or wherever you listen to podcasts.