November 2014 Edition Vol.11, Issue 11

Experts Tackle Gaps in Cancer Care and Best Use of Interventions

Experts Tackle Gaps in Cancer Care and Best Use of Interventions

By Alice Goodman

Attendees at the 2014 ASCO Quality Care Symposium heard the latest research and thinking about how to improve cancer care by providing appropriate care with “value” and weeding out unnecessary and costly interventions. Two areas that got a good deal of attention were unmet needs in quality care and inappropriate use of health care interventions. On the positive side, the Radiation Oncology-Incident Learning System (RO-ILS) initiative holds great promise to limit radiation errors.

UNMET NEEDS

Financial Toxicity

Financial toxicity should be assessed as one of the potential side effects of cancer treatment, according to Yousuf Zafar, MD, Duke University Medical Center. Many oncologists do not ask about insurance coverage and whether patients can afford to pay for cancer care.

“Financial toxicity is the elephant in the room. You can ask your patients one simple question about whether their cancer care is covered by a drug plan to get the conversation started,” said Yousuf Zafar, MD, Duke University, Durham, NC.

Several studies show that financial stresses are harmful to patients, he continued. “There is mounting evidence that increasing out-of-pocket costs impact patient well being,” Dr. Zafar said.

A study conducted by Dr. Zafar et al. gives some idea of the financial burdens of 254 insured cancer patients treated at an academic medical center.  Seventy-five percent applied for drug co-payment assistance; 42% found their cancer treatment a significant or catastrophic burden; 46% stinted on food and clothing to pay for their medications; 46% used their savings to pay for care, and adherence was compromised in 63% of patients (24% avoided taking the drugs altogether).

“Financial toxicity has an impact on quality care. There is a growing list of financial adverse events as a result of the care we are providing. These include delaying care, non-adherence, missed appointments, and taking fewer medications,” he continued.

There is little agreement among quality care experts as to which healthcare professional should initiate discussions about finances with patients and when these conversations should take place.

Care for Vulnerable Populations

New reimbursement models are needed for treating elderly patients and patients with multiple comorbidities to enable delivery of patient-centered coordinated care to these populations, experts agreed.

“The silver oncologic tsunami is coming. Cancer is a disease associated with aging, and meeting the challenges of elderly patients with cancer is a challenge that will only grow in importance over the next few decades,” stated Andrew E. Chapman, DO, FACP, of the Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA.

Dr. Chapman presented an urgent “to do” list to meet this challenge: 1) empower the health care workforce to improve health care delivery in the geriatric setting; 2) develop health care delivery models focused on the elderly; 3) develop oncology-based relevant data sets; and 4) establish new standards of care to be able to implement the data and modeling in clinical practice.

He emphasized the appropriateness of palliative care at the end of life rather than intensive interventions.

“The need for palliative care should be discussed with cancer patients and their families as early as possible. Payers need to create a model for reimbursement of these discussions, which can reduce costs associated with inappropriate interventions,” he stated.

“Problems related to communication and transitions of patients from in to outpatient care are amplified in individuals with cancer and other chronic conditions,” stated Neeraj K. Arora, PhD, National Cancer Institute, Bethesda, MD.

“One in 3 individuals enrolled in Medicare have 5 or more other chronic conditions. These people see between 5-16 different physicians per year in 3-9 different practices,” he stated.  “I am a 20-year cancer survivor and I find it challenging to coordinate my own follow-up care. I can only imagine what it is like to walk in the shoes of an elderly patient with 5 or more comorbidities,” he told listeners.

Dr. Arora listed the following actionable goals for the cancer care team:

  • Foster healing relationships
  • Enable patient self-management
  • Manage uncertainty
  • Respond to emotions
  • Exchange information
  • Making decisions

Other important factors to address are:

  • Planning and counseling before therapy
  • Use of palliative care/hospice services
  • Interdisciplinary coordinated care
  • Comprehensive symptom assessment and treatment
  • Patient experiences of care

“Now we need a model of how to pay for patient-centered care,” Dr. Arora stated.

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