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Episode 4: Bringing Care to the Communities We Serve

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Episode 4: Bringing Care to the Communities We Serve

Feb 06, 2024
Marcene Littledike and her Huntsman at Home™ team bring high-level care to patients’ doorsteps. She and her team know “a liter of fluid is a lifeline.”


Heather Simonsen, MA
Public Affairs Senior Manager
Huntsman Cancer Institute


Marcene Littledike
Nurse manager of Huntsman at Home™ at Huntsman Cancer Institute

Welcome and Introductions (00:51)

Heather Simonsen: Hello, and welcome to Cancer-Free Frontier, where we ask the question, how can we deliver a cancer-free frontier? I'm your host, Heather Simonson. So glad you’re with us.

Today on the podcast, we're talking about an innovative new way to bring cancer care to the communities we serve. It's called Huntsman at Home™. It's a unique hospital at home for cancer care service, and it brings the high standard and excellence of care you get at Huntsman Cancer Institute to patients in their homes. The service allows patients to leave the hospital sooner or avoid going in at all in some cases, which is critical in rural and frontier counties. Especially where traveling those long distances really can be so difficult. We are so excited to have Marcene Littledike, nurse manager at Huntsman Cancer Institute, with us today. Welcome, Marcene.

Marcene Littledike: Thank you for having me.

A glimpse into home health and hospice sparks a career of navigating the complexities of cancer care (01:50)

Heather Simonsen: How did you become interested in helping cancer patients?

Marcene Littledike: You think all of us have a story of impact of family or friends that have been involved with the cancer challenges, but I think having the opportunity to work in the home health and hospice arena really opened my heart to these challenges. How in the world do we make things simpler? Because they're so complex. When you have a cancer diagnosis, you have a minimum of about five specialists that are working with you. And there's just so many questions at each time. What is the best treatment? What is involved with how things happen? And the communication piece between all of those people makes the difference in the care of people. And I think that is what I've been so intrigued with. How do we make this as simple as possible?

Heather Simonsen: Well, and you mentioned that you've worked in ERs, and you've been a nurse a long time, right? For 45 years. And you've seen what happens in ERs and how difficult it is. And I would imagine cancer, it can be just as intense as the ER, but in some ways more complex with the ongoing care and coordinating all of that. Would you agree?

Marcene Littledike: Absolutely, And I think when a cancer patient goes into the ER, even our university ER, it is so hard to track everything. Everybody's nervous about making the wrong decisions. Can we give them this medication because they've had this kind of chemotherapy or this kind of treatment? And we find that they get stuck in that ER longer than they should. If we can take care of some of those things at home, it makes such a difference for somebody who is weak, who is nauseated, who's having all of these problems having to stay in an ER to get help five hours, six hours. That's really difficult.

Heather Simonsen: Well, and I think, you know, that hope piece is so important, right? And to be able to have a program and somebody who's on your side throughout that cancer journey, I would imagine would be so important.

The importance of having a team when you start treatment (04:05)

Marcene Littledike: I think it's so important that they have their team. And it really is a team. Oncologists are phenomenal, of course, but they can't stay on top of everything. And what we see in the home, and the assessments that we do in the home are so much different than having them in clinic, or having them in the ER, because we get the whole picture. Socially, economics has a lot to do with their hope. Problems with depression have a lot to do with their hope. When is it time to start my treatment? Where do we go? Can I have hope beyond treatment? What is my end plan? What is my end goal? And this in the midst of a home setting? So much different. It supports these people in a very different way.

Heather Simonsen: I’m sure. And can you tell us a little bit about how it works?

Marcene Littledike: You bet. This definitely is a unique program that was started in 2018 by two amazing people, that really had a vision for what hospital at home type care, under the home health arena, might look like. And be able to start something that really made an impact. Karen Titchener had done such programs in England, and Australia, and New Zealand, and across the board, and really brought a vision. Understandably, the United States is very difficult and challenging with things. With all of our health care costs, with all of the things that are involved. And so, again, it started as a demonstration. What can we do in the United States, with the umbrella of the Huntsman Cancer Institute, to ease the challenges of cancer?

Heather Simonsen: And as you mentioned, you know, working with your insurance company, let's be frank, it is difficult. Even in the best circumstances can be. It's wonderful to have that service, but I would imagine with an ongoing diagnosis and a disease, it does get complex. And to have somebody come into your home, and to help you through that, and to really make it as good as it can be, the treatment experience. To really bring, you know, what Huntsman Cancer Institute is, but into the comfort of people's homes. I mean, one of the things I love about working for Huntsman Cancer Institute is just everybody is involved in the mission, you know? From the person sweeping the floor to the person preparing the meals in The Point, or for patients in their rooms, to the CEO. We're all in the fight against cancer. And how cool that you can bring it, you know, to people's homes.

Marcene Littledike: Well and to the level of what our nurse practitioners bring to this. So, you were asking a little bit about the organization. And we do have nurse practitioners that are overseeing these cases, and we're working in coordination with oncologists, but they can make on-the-spot decisions to help with treatment issues, side effects that are coming from their chemotherapy, and that is huge. So it's not just home health, it is beyond that. It is a treatment program at home with our nurse practitioners overseeing, and our partners are in a home health arena, community nursing services stands right by our side. They bring what they bring in home health, and they work directly for us. They are trained by our nurse practitioners to a higher level of assessment, and more information about oncology itself, so that their skills, again, are brought to the highest levels and coordinated with our nurse practitioner team.

Heather Simonsen: I love what you said about, you know, the highest level. And that includes the science, the cutting-edge science, the very best treatments that medical science can provide. And I think that's what really sets it apart. Would you agree?

Marcene Littledike: Absolutely, absolutely.

A special interest in the rural areas we serve (08:27)

Heather Simonsen: And this is a test program along with, you know, and I didn't really understand this before I worked at Huntsman Cancer Institute, but that is where the best medicine is, in clinical trials and programs that are being tested, because it's the most innovative. It's on the forefront, it's the best you can get. So, what are you hoping in this test process to learn, to gain, to achieve?

Marcene Littledike: So I want to back up just a little bit. So again, in 2018, is when this organization started. And we had three years in that demonstration project for the Salt Lake. We are now part of what we identify almost as a clinic-based organization that can go in and make an impact on these people. Now, we also are blessed because the rural issue has just started about two and a half years ago, and that is in a demonstration project. How challenging for these people in our Moab and Price areas? If you're in Moab and you have to come up to the Huntsman, you're talking about a five-hour drive. What we have been able to say is how can we impact? What do we need to do? What needs to happen in those rural areas? There are over 250 people in those areas that have their hands with Huntsman. That's tremendous. They want the best care possible. They love the Huntsman innovation and the things that are happening at Huntsman that will impact their cancer. But how do we get them there? How do we get the service? What do we do? And that's what we're doing in that. Just as we started out in Salt Lake, we found things that are working, and going and moving forward. What do we do in the rural areas?

Restoring control over cancer (10:21)

Heather Simonsen: You mentioned like Moab, I mean, say you're living there, and you get that devastating diagnosis of cancer. And then your life changes, it impacts your family, your professional life. Everything, right? And so how does, you know, taking advantage of services like this, where much of the care can be done at home and you're not having to leave your home in Moab, how does that impact patient outcomes?

Marcene Littledike: Well, I think that impact is phenomenal. And especially our rural community is very independent. I come from a rural area and live in one right now, and you really see that there is the challenge of, “I want to be able to do this myself,” “I want to be able to add to what's around me even in my diagnosis,” and this gives opportunities. Especially in the rural, we have the opportunity to be able to help with some transportation. Angel Flight has been phenomenal with our team to bring those that are really challenged, they fly them up to a clinic. Then our nurse practitioners and our home care team can be in the home and coordinate with the oncology teams. And right there you've got your oncologists, you've got our practitioner, you've got the home care. And you may not have to come up to the hospital, we may be able to do it with a local clinic, we may be able to assist with the local hospitals. But you're not sitting in the ER, it's a guided plan. And you have a little bit of control. Because I think especially in the rural community with five hours away, or three hours away, you feel like you lose control.

The special touch of receiving care at home (12:17)

Heather Simonsen: For sure. And I'm also certain that's already an overwhelming feeling of losing control. But to be able to drive your cancer care and do it in that independent way that that you want to, I would imagine is really amazing. And it kind of reminds me of the old-fashioned house calls that doctors used to make. Would you agree that it's similar, and yet, even better, in many ways?

Marcene Littledike: Oh, I think it really gives that feel. Our nurse practitioners identify all the time how they love this. They love the impact, they love the fact that they can really make a difference for these people. And, boy, it's taken the old house calls to a whole new level! Of course, we can do the X-ray EKGs, remote monitoring, a lot of things, lab values, make sure that we have all of those things in place. Then we add the backing of the Huntsman, that gives our people so much education and understanding, and “you've had this chemotherapy, this is what we would expect, this is how we're going to be able to help you.”

Heather Simonsen: And it's not just end-of-life care, we're talking you’re in the fight, you've got a very good chance at recovery, which so many cancers now there is, you know, a 90% chance of a cure. Talk to us a little bit about that.

Marcene Littledike: Absolutely, and I think it's really important to know that this is not an end of life care we do and continue on. But our focus is the medical complexity of these cases, of these people, of these challenges, and to be able to impact them quickly. So as challenging as the chemotherapy is, being able to have hydration at home, that a lot of times is not covered by their insurance pieces, we can make sure the supplies are there, we can make sure our nursing team is there. And a liter of fluid is a lifeline, is a lifeline. So, we look for these medically complex cases that our clinic, our oncology clinics are going, “we just don't know how to move through this”. We hope to help solve some of those problems with our ability logistically, professionally, and our big hearts.

Heather Simonsen: Well, the big heart piece is so apparent. As we know, nurses are the the unsung heroes of the medical world. Even more so this in these cases, I would imagine they get very attached to patients and they become your friends.

Marcene Littledike: Absolutely.

The hurdles yet to be conquered (15:08)

Heather Simonsen: So wonderful to hear about this, and tell us a little bit about the challenges? I mean, I know that it's not all roses, it's tough work.

Marcene Littledike: Well, I think we have to think of the format that we're in when it comes to reimbursements. You wish that didn't ever have to be, but the reimbursement issues are a challenge across the board. So, the initiation, again, in 18 of this is, how can we impact this financially? How can we make it sustainable? How can we drive this forward in a way that we can really show the compassionate, understanding, professional care that needs to happen in these homes? So again, for three years, it was under that project, and now we are on our own. And the challenges, we hope, are being able to show what the worth is. For instance, being able to get people out of the hospital two or three days earlier, to be able to flip those beds. Those are the logistical things that are important. Of course, patients are the most important too. But we know that when they get home, their support system, their feel, everything else is so much better. And if they can control their environment with the assistance of what we do, how in the world can we, as the United States of America, not pay attention? To have those things covered in a way that it can remain sustainable?

Heather Simonsen: At home, I feel like, is where the healing really begins. Right?

Marcene Littledike: Absolutely, absolutely.

Heather Simonsen: So part of this test portion will be showing the impact on patient care, so that more of these services can be covered.

Marcene Littledike: Absolutely, and Dr. Mooney, Kathy Mooney, who again was one of the organizers of this in the beginning, has been able to do so many research projects involved with it, and she has presented all over the world. And the impact that it's made, especially right now she's focusing on the rural area, but it is life-changing to literally see what her team is accomplishing, proving the wonderful impact and outcomes of what we do with Huntsman at Home™.

Finding joy through hope (17:47)

Heather Simonsen: And I think that's got to be the joy of this as well. Can you tell us a little bit more about the joy of this program?

Marcene Littledike: People. People, that's the joy. I had the opportunity five years ago to join the Huntsman team, and I chose to do it because there is a feel when you walk in those doors. There is a feel when there is a Huntsman patient, even in Moab. You can tell that it is something amazing and powerful. And I believe we're leading and guiding in places that will eventually make what you talked about cancer, cancer-free. Those kinds of things, with the simplicity of the tasks that we're doing, I think it's imperative for our future. So, the joy comes when we can take a young mom with breast cancer, and see her through to a cure. See those challenges with her family, help coordinate those pieces with the oncology, and everything else. Every cancer diagnosis has hope. What that looks like is unique to the patients, unique to the people that we serve. So being able to put it all together in that feel of home and family, that's the joy. We take care of our acute patients, we take care of our palliative, which palliative is a big umbrella, and then we walk through the hospice experience in our Salt Lake area. Our role is just a little bit different with the hospice piece, but it's so important for people to have that continuity of care.

Heather Simonsen: And you mentioned picturing the young mom, and to be able to get that care that she needs to fight her cancer and then go see her kids in their bedrooms, or they come to her and cook dinner together, and that joy. To me that adds to the hope.

Marcene Littledike: Oh, absolutely. There's hope in end of life, there's hope in every step. And our nurse practitioners have such an ability, not only the skills, but the psychological edges to be able to help them find that hope through those discussions.

What’s next (20:26)

Heather Simonsen: Yeah. And, what’s next for the program?

Marcene Littledike: We are excited to see where the rural program goes. Does that impact services in those rural areas? Can we get across the board more reimbursement to keep this sustainable, to be able to show across the board that this is worth whatever has to be put into it to give people that hope and that care? So, for right now, this year for the Salt Lake area, we service everything from Layton south and go into all of Salt Lake County. And then we have our Tooele area too, and then we have the rural. We may just focus right there for a while now, refining our processes. Refining, and not so much in our physical, but the logistical pieces that happen when you're doing a home health project or a home care project. We refine our protocols all the time, our coordination of care with our partners and community nursing services every month. I feel like we improve those things. We have a couple of things that we want to continue to improve, and then we'll see if this expands further.

Achieving a cancer-free frontier through a different kind of hope (21:54)

Heather Simonsen: By expanding to the area we serve, right? So, the surrounding states where there is so much need. Marcene, my final question to you is a question we ask all our guests. What does delivering a cancer-free frontier mean to you?

Marcene Littledike: A different kind of hope for everyone. Can we imagine that? All cancers? I don't know if they can completely be eradicated from the get-go, but the treatment possibilities are up to 90 95% on each and every diagnosis. That to me, is a frontier. It takes innovation. It takes understanding. It takes everything that Huntsman organization has, that I think is possible. And there's a lot of prevention things, and we're getting better at that, but the numbers of cancer patients that we're seeing increase exponentially, maybe because we're more aware, and we're getting in and finding those diagnoses. I think probably a lot of people had cancer and had no idea. What a powerful thing to have a cancer diagnosis that has an outcome that you want, and I think we're getting closer all the time.

Heather Simonsen: That’s powerful. Thank you so much, Marcene, and thank you for being with us today. It was such a joy having you here.

Marcene Littledike: Thank you so much for inviting me.

Thank you (23:38)

Heather Simonsen: We extend our sincere gratitude to Marcene Littledike for telling us about this unique service, Huntsmen at Home™. And it's really changing cancer care by bringing science, the innovation, the compassion, into patients' homes. To our dedicated listeners, we appreciate your support. For additional resources, be sure to check out our show notes. And if you want to stay connected with us and be the first to know about our upcoming episodes, don't forget to hit that subscribe button on your favorite podcast platform. And we would be so very grateful if you could take a moment and leave us a rating or review. Your feedback is so important and meaningful. And please tell your friends and family about our podcast and share it on social media. We're always eager to hear from you. Whether you have questions, comments, suggestions for future topics, or a personal story you'd like to share, please visit our website, I'm your host and executive producer of Cancer-Free Frontier, Heather Simonson. Avery Schrader is our producer, with help from Carly Lehauli and Jill Woods. Thanks to the Communications and Public Affairs team at Huntsman Cancer Institute, we truly couldn't do this show without you. Also, a special thanks to The Pod Mill and Mix It Six Studios for their help with this episode.