Colleagues of Abramson Cancer Center oncology nurse navigator Margaret “Peg” Rummel MHA, RN, HONN-CG, nicknamed her “the Tooth Fairy.” That’s because she had collected so many resources to get head and neck cancer patients the dental care they needed before they would be cleared to start radiation.
She did everything she could to find dentists for them, but it wasn’t easy.
Now, thanks to a collaboration with fellow oncology nurse navigator Jen Jacobs, MPH, BSN, RN, and Penn’s School of Dental Medicine, what was once a single person's bespoke effort to help patients individually has grown into a seamless path for patients to get needed care.
Barriers to dental care
Oncology nurse navigators Margaret “Peg” Rummel, left, and Jen Jacobs
To be cleared for radiation therapy to the head and neck area, patients must first undergo a dental exam and take care of any cavities, extractions, root canals, or other needed dental work, because “you don't want to start radiation and then have to stop it for a dental issue, and delay care,” Rummel said.
Until recently, Rummel faced countless barriers finding dentists who could provide timely pre-treatment dental care for cancer patients. Many patients—especially those of low socioeconomic status—had gone without dental visits for years and now needed extensive dental work. They often were uninsured or under-insured and could neither afford to pay out-of-pocket expenses nor find a dentist who would work with them. Public dental clinics wouldn’t provide more than basic dental care; some community dentists weren’t comfortable caring for patients with complex medical issues; and the dentists willing to take the patients often had long wait times. Without timely care, patients risked delaying their cancer treatment. Meanwhile, Jacobs, who joined Penn Medicine in 2021, had worked with head and neck cancer patients at her previous organization, where she faced the same obstacles. When Jacobs arrived here, she was working on her capstone project for a master’s degree in public health, focusing on those dental care barriers—and small-scale interventions that could smooth the path to cancer care.
She and Rummel discussed the challenges, and the nurse navigators agreed a systemic approach was needed.
In guiding patients through different steps of care, the system’s cancer nurse navigators have a big-picture vantage point that uniquely positions them to tackle process improvements, as when they identified a gap in care for patients leaving the emergency department with a suspicion of cancer. Now, it was time to address the issue of patients' dental needs more systematically.
A collaboration is born
“The problem has always been that we didn't have anything specific for the oncology population,” Rummel said. “We really didn't have a venue for oncology patients to get expedited care so they could start their treatment.”
Jacobs remembers asking Rummel: “We have a dental school, right?”
Over several months, Jacobs and Rummel met with leaders from Penn Dental Medicine to create a system for cancer patients to receive expedited care by dental residents. Their dedicated efforts reflect Penn Medicine’s strategic emphasis on making care easy for patients and putting it within reach. At the same time, Jacobs and Rummel demonstrated an important value for Penn Medicine employees, who strive to be accountable to make sure they follow through to address patients’ needs and prevent harm.
Marc Henschel, DDS
Now, when a navigator calls Penn Dental Medicine on a patient’s behalf, “I guarantee that we can get that patient an appointment for an initial examination as quickly as possible,” said Marc Henschel, DDS, director of the Advanced Education General Dentistry program at Penn Dental Medicine, who oversees the residents.
Henschel and his colleagues inherently understood the need for expedited dental care for this demographic while also having the expertise and comfort with medically complex patients. It was the perfect partnership.
“This is a cohort of patients that really needs to have dentistry completed in a timely fashion prior to their oncology therapies,” said Henschel, who led a similar program at his previous institution. “We're willing to help where and when we can.”
The partnership has been in place since January 2024 and has made a huge difference for patients, Jacobs and Rummel said. Not only can patients get in quickly to take care of any necessary dental work before starting radiation, but the dental school will also see them for ongoing care, which is important because radiation to the mouth can cause dental complications. The dental residents also treat patients with other cancers—not just head and neck. If patients are uninsured or underinsured, the school will work with them to get their expenses covered.
From January to July 2024, the cancer center referred 160 patients to Penn Dental. In that time, nearly half were cleared to begin or continue cancer treatment, and the others were in the process of dental care prior to treatment, Herschel said.
“I’m so happy we were able to find an avenue in our Penn backyard for patients to get the care they need. It's so much easier to just streamline patients from their oncology team to the dental school, and if they need follow up care, they can just stay within the Penn network,” Jacobs said. “It's a much more collaborative, tight-knit system for our patients.”