The first palliative medicine program in the US was established in 1987 at the Cleveland Clinic. A broader concept of Supportive Oncology based on the Cleveland experience is in development at the Levine Cancer Institute in Charlotte, North Carolina.

The Institute is a clinical-academic hybrid with a multi-location structure and approximately 16,000 new cancer cases/year. The Department of Supportive Oncology (DSO) consists of nine Sections (8 clinical and one research). A section of Education is planned. The clinical Sections are: 1. Cancer rehabilitation 2. Integrative oncology 3. Navigation 4. Oncology nutrition 5. Palliative medicine 6. Psycho oncology 7. Senior Oncology 8. Survivorship. Clinical services are provided at 6 locations regionally with a dedicated 25K square foot DSO floor in the main Cancer Institute. DSO now has approximately 200 employees. Clinical services are provided both face to face and virtually and include traditional patient-physician encounters as well as a full spectrum of other professional services such as psychotherapy, acupuncture and physical therapy. All services are fully integrated into the wider Cancer Institute structure including education of medical oncology fellows. New training fellowships have been established in cancer rehabilitation, palliative medicine and psycho-oncology. Niche clinical programs have been developed including lymphedema, sexual health and cardio oncology. There are now in excess of 150,000 DSO clinical encounters of all types annually. The research Section is separate from the cancer clinical trials structure because of the differences in philosophy and study conduct. Research focus is on malnutrition, fatigue and symptom assessment by a variety of investigative approaches. An endowed Chair in Supportive Oncology has been created. Key concepts in DSO development have been a formal business planning process, weekly interdisciplinary administrative, project management, clinical and research meetings. Lessons learned include the importance of DSO marketing, efficient services to support the medical oncologists and rapid access to clinical services. Based on our experience to date we believe every major cancer center in the US will establish similar departments in the next decade.