Connie Fiebiger, RN, director of clinical programs, Virginia Piper Cancer Institute: The cancer care coordinator is a registered nurse who is experienced in cancer and understands the impact that that has on patients and their loved ones.

As you can imagine, a diagnosis of cancer is very overwhelming and anxiety provoking. And our health care system is very difficult to navigate at times. Cancer patients have a lot of questions that they are looking for answers to and just kind of wondering what do I do next. And so the cancer care coordinator can help them through that process.

Cancer care coordinators can assist the patient in making informed decisions about their treatment options.

The cancer care coordinator can help make connections to the different healthcare team members. So a patient may need to go to several different types of specialty physicians, it might be the medical oncologist, the surgeon, the radiation oncologist. And the care coordinator makes sure that the patient is getting to the right specialty physician in a timely manner.

Part of that process is to make sure that the patient is also getting tests and procedures done prior to those appointments so that they're not wasting the patient's time

The cancer care coordinator can help the patient get connected to cancer rehabilitation services through Sister Kenny Rehabilitation Institute, as well as more integrative therapies through the Penny George Institute for Health and Healing.

We know that survivorship begins at diagnosis and we want to make sure that the patient is accessing those types of services and programs in a timely manner.

When we're caring for a cancer patient, were really caring for the whole family. So we like to include the patients loved one to make sure that the loved one also understands what's going on and can help to support them so that they can support the patient.

The patient may be having concerns around their financial situation. They may have questions around their sexuality. They may be dealing with some concerns about their own mortality. They may be losing their hair and the impact that that has on their body imagine as well as self-esteem. So the cancer care coordinator can assist the patient in helping them to get connected to the right individuals or services, not only within Allina Health but also within the community.

Our goal is that every cancer patient will have access to a cancer care coordinator. We are looking at having that cancer patient get connected at diagnosis. The most benefit that the care coordinator can add to that relationship with the patient is at the very beginning.

Shari Baldinger, manager of genetic counseling services for Virginia Piper Cancer Institute: A genetic counselor is a special trained medical professional whose function, in the cancer realm, is to try to help individuals and families clarify what their risk for cancers are. In light of those risks, families partner with their physicians to try to get a plan in place, a management plan, that fits that individuals risks and if genetic testing is indicated to help in that regard to help them make an informed decision about genetic testing.

Those tests are complex. The results are sometimes difficult to understand, and we are specially trained to help both the physician and the patient understand the ramifications of the test result as well as the limits of the test and what it means for them and their families.

A man or woman who has been diagnosed with cancer, they sometimes will say, "Why do I need to see a person in genetics, I have cancer what difference does it make to me?" Or "I might not have kids."

If we can figure out the underlying reason for the cancer and if there's a reason to suspect it might have a genetic piece to it or an inherited piece to it, it may help their physicians to choose a better treatment. It also may give us guidance as to how to best screen them to perhaps prevent another cancer from occurring or diagnose it early.

For an individual who has a family history of breast cancer, they're often very concerned. What's the chance this is going to happen to me? Should I get a genetic test? Will that tell me? And the genetic counselor is in the perfect position to help assess the risk.

For some of our colon cancer patients, we need to start them at 20 instead of 50 and maybe do them every year instead of every 5 or 10 years. So we want to make sure that the right people are screened and that people who don't need to be don't have excessive screenings.

We haven't found all the genes that cause cancer. So genetic counseling does not always equal genetic testing. People can be high risk even if they've had a normal gene test. So genetic counseling's about clarifying risks and making informed choices.

Virginia Piper has really started the forefront of promoting genetics as a component of cancer services.

We try across the whole system of Virginia Piper Cancer Institute, to be sure that the physicians and the nurse coordinators and every cancer patient at Virginia Piper Cancer Institute should have a nurse coordinator help guide their care, is aware of the little ticklers of what is it about a patients personal diagnosis or family history says they may benefit from seeing a genetic counselor.

We've done a really good job at the Virginia Piper Cancer Institute of having genetics a part of all the tumor conferences and so when issues come up that we can remind the providers that this needs to be thought of. And so that the patient and their family is aware that this service is available.

We have genetic counselors at all of the major metro hospitals. We also have it at some regional hospitals.

Because access is so important and we want to be sure people do have access, we've begun a tele-health on genetic counseling to some of the out state regions so that people can stay in their own communities and get this service. It's about screening, prevention. That would be great to put oncologists out of business.

Nancy Hutchison, MD, medical director for cancer rehabilitation, Virginia Piper Cancer Institute: Sister Kenny Rehabilitation Institute is a comprehensive rehabilitation facility that includes two in-patient rehabilitation units for people recovering from major comprehensive severe disabling illness. We have a unique partnership between Sister Kenny Rehabilitation Institute and Virginia Piper Cancer Institute.

Now that people have so many good results from their cancer treatment in terms of these treatments being effective for the cancer itself, some of the treatments do have side effects that are associated with function. So the major areas that seem to be problems for some cancer survivors are areas like fatigue, weakness, neuropathy, balance problems, sometimes thinking and memory problems, speech or swallow problems, swelling; and all these areas can be addressed through cancer rehabilitation. It's important that patients who have been treated for cancer though are treated by specialty therapists and specialty physiatrists in cancer rehabilitation because cancer rehabilitation is designed to address the specific areas of function that are affected by cancer treatment.

We have seen excellent results from this program, mainly in the area of getting people in earlier so that we can get involved in treating them earlier before they have a lot of decline. And that's very key in cancer rehabilitation. For example a person might be referred into my clinic whose had chemotherapy and might have a balance problem because they've had a specific chemotherapy that effects their nerves, but they're also very weak and they haven't been able to be active for a while and I'm able to prescribe for them a special program of therapists who can address these specific needs. But not only that, we're able to hand them off to a wellness system if you will where they can continue their own recovery on their own. And that's really important with cancer rehabilitation.

The way that patients access cancer rehabilitation through our program is actually through a central scheduling area that has been created collaboratively with Virginia Piper and Sister Kenny. That STAR scheduling, it stands for Survivorship, Training and Rehabilitation. It allows people access through one central location without having to know exactly what type of therapy to call or who to call.

We recognize that people are receiving their cancer treatment in their own locations and they consider that their oncology home. So our program specifically is designed to place specialty teams around the Allina system of care and our Sister Kenny facilities and all of our Allina Health hospitals and many of our Sister Kenny Sports and Physical Therapy Centers so that people have access to these services .

Courtney Jordan Baechler, MD, vice president, Penny George Institute for Health and Healing: The Penny George Institute for Health and Healing is the largest integrative medicine center in the country.

Integrative health to me is the best of both Eastern and Western medicine. I am a Western trained cardiologist and there's no place I'd rather be that the United States if I was having a heart attack. However both before and after acute illness we want to really bring the best of all of available therapies and for that, that's a lot of things that tend to be outside of the traditional Western practices of health care.

We really try to focus on the mind, body and spirit approach of health and we appreciate that our mind is as tied to our physical health as our spirit and try to bring that all together into one product that is the best type of health care for the individual.

We have a variety of integrative therapies for our Virginia Piper Cancer Institute patients. When we have cancer patients in the in-patient setting, we have things like medical massage, acupuncture, aroma therapy and stress based therapies to help in the acute setting. That helps people with pain and nausea. In the outpatient setting we have a variety of things to help peoples body be in the strongest capacity to have their mind, body and spirit aligned. Those things include bio-feedback, reflexology, medical message, guided imagery, aromatherapy, acupuncture in that setting as well. These days we have almost a standing protocol for folks going through chemotherapy to have that tied with acupuncture because the results are so much better.

When people go through chemotherapy its really, it can be quite a physical process on their body, both before and during that process we want to make sure they're as strong as they can possibly be. Through elements like acupuncture and aroma therapy we can help decrease some of the nausea and pain that tends to go with both potentially the cancerous process alone as well as the chemotherapy. It allows people to be able to eat more and be nourished internally. We've seen through years now these services that folks who get acupuncture along with their chemo services, do much better long term.

We are in the process of increasing our coverage throughout Allina Health. Many of the nurses have been through the transformative nursing training program which is a training that we do through the Penny George Institute where the nurses are trained in aroma therapy, message, basic acupressure, things like that, at a variety of our Allina Health institutes.

Having seen many people both personally and professionally go through cancer treatments, I know that the best model that we can deliver is really a model that encompasses both integrative therapies and our traditional Western therapies, and that's really where we produce the best cures, we produce the best survivors and hopefully we prevent the most people from ever experiencing cancer in the first place.