October 2017 Edition Vol.11, Issue 10

How Providers and Bio-Pharma Manufacturers Can Partner to Improve Outcomes and Lower Costs

By Gena Cook, CEO, Navigating Cancer

As the pressures on cancer care stakeholders converge, it’s time to identify ways providers and the bio-pharmaceutical industry can work together to deliver better care at a lower cost. Providers are increasingly moving towards implementing value-based models, such as the Oncology Care Model (OCM), and are facing increasing pressure to deliver quality care and outcomes while reducing costs. Industry wants to ensure treatment regimens are being followed to ensure the best possible patient outcomes and treatment value; and patients are becoming more active in treatment decisions and expect care transparency.

One of the most effective strategies to meet stakeholder expectations is improving medication adherence. This is an area where bio-pharmaceutical manufacturers can be an important partner with providers, achieving important gains for patients, providers, and industry alike.

When patients don’t take their medications — in the right dose, at the right time — there are many negative impacts. Patients get sicker, require more physician visits and hospital stays, and face higher mortality rates.1

Despite these high stakes, medication adherence in the United States is poor.2 The good news: even modest improvements in medication adherence among patients with cancer can have dramatic benefits, such as improving tumor-response and survival rates, lowering recurrence rates, and reducing costs. Thanks to advances in technology, improving medication adherence has several new untapped solutions.

Medication Adherence Among Cancer Patients is Surprisingly Low

Adherence to long-term oral medication regimens — not just for cancer but for a wide range of diseases — averages around 50%.3 Despite the life-and-death nature of cancer treatment, medication adherence among cancer patients is not much better than this average.

A recent medication adherence analysis for oral breast cancer and chronic myeloid leukemia (CML) therapies looked at 48 studies published from 1990 to 2015. With adherence rates ranging from 14% to 100%, the authors concluded that adherence to oral cancer therapies is a major issue.4

It’s not just oral treatment regimens that are concerning; adherence to IV treatment is also less than optimal. For example, a recent study of commercially insured patients with metastatic colon cancer found that 25% of patients had an IV chemotherapy adherence rate of less than 80%.5

The impact on outcomes and costs associated with cancer treatment non-adherence is significant. In one study of privately insured patients with CML, utilization costs — including hospitalizations and outpatient costs — were 283% higher for patients with adherence rates of less than 85% compared with CML patients with higher adherence (>85%).6

A separate study looked at outcomes and found that no CML patient with less than a 90% adherence rate experienced a complete molecular response (CMR) rate compared with a 43.8% CMR rate for those patients with CML whose adherence rates were greater than 90%.7

 

Why Real-World Medication Adherence is So Poor 

To boost adherence, it’s important to understand why patients skip their medication or treatment appointments. Research points to a wide range of reasons. Some patients simply forget or intentionally skip doses due to side effects. Some experience depression or lose motivation after years of treatment. Others cut back to save money.8

Making matters worse, physicians don’t always discuss the importance of adherence with patients. In an eye-opening study that included 14 oncologists and videotaped interviews with 28 patients,9 the doctors, as a whole, did not talk to patients about how adherence could impact survival, or what to do if they missed a dose.

 

Improve Medication Adherence Through Strong Provider-Patient Relationships

Each cancer patient faces different barriers to adherence and, for any given patient, these barriers may change over time. Strong communication between the patient and their care team has been shown to be an important driver in supporting medication adherence.10

This underscores the importance of continually engaging with the patient within their care model. Newly published research has shown that cancer treatment adherence — even IV treatment adherence — can be improved through approaches that support the patient-care team relationship. Two digital direct-to-patient approaches that improve care are 1) digital reminders and monitoring of patient reported outcomes, and 2) digital delivery of personalized education and self-care instructions.

 

Digital Monitoring of Patient Reported Outcomes

Traditionally, medication reminder services have been external to the patient’s care team, minimizing the team’s ability to stay on top of adherence problems or investigate what may be causing them. By contrast, software that allows for efficient remote monitoring by the care team enables providers to track adherence and watch for emerging symptom-management issues.

A recent Memorial Sloan Kettering Cancer Center study demonstrated the positive impact of integrating real time patient monitoring into care delivery.11  In this study, solid tumor patients undergoing outpatient chemotherapy treatment regularly self-reported symptoms using tablet devices. Staff pro-actively responded to emerging issues by reaching out to patients, resulting in patients staying on chemotherapy longer. The impact on patient outcomes was real as patients were more likely to stay out of the ER, and on average lived 5 months longer.

By capturing patient status on a regular basis, pro-actively responding to patient needs, supporting them through symptom management, and giving them important information, cancer care teams create a transparent environment where patients are empowered, and feel better supported. Patients are confident in their treatment plan and stick with it.

 

Digital Delivery of Personalized Patient Education and Self-Care Instructions

It is sobering to consider that fewer than 50% of patients leave their provider’s office understanding what was just said.12  Patients need access to relevant and credible information to equip them to stick with their regimen. Yet, busy staff can’t be there 24/7 to consistently provide the right information, and in this digital age seeking credible information online can be an overwhelming challenge.

By shifting to a digital platform, busy providers can address challenges related to patient education. Tailored, automated, electronic delivery of patient education has been shown to improve adherence for better survival. A retrospective, multi-center analysis looked at 944 patients with advanced lung cancer on IV treatment who received treatment specific education in a series of electronic communications. The 441 patients (47%) who accessed the education stayed on their IV treatment 50 days longer (21%), for a 13% increased survival rate at one year.13

With patient relationship management software, providers can automatically deliver tailored educational information and self-care instructions to patients so that patients can access and refer back to information from any device, at any time. Electronic information can also be shared with loved ones: another way to help patients with adherence.14

 

What Role Does Pharma Play in Improving Medication Adherence?

For nearly a decade, I have seen partnerships between the bio-pharma industry and providers successfully improve patient care. When they leverage patient relationship management technology, bio-pharmaceutical expertise can be integrated directly into the provider’s care delivery process. Staff workload is decreased, symptoms are managed via patient reported outcomes, and patients are given a direct connection to medication adherence education and self-care instruction. The result? Medication adherence rates go up and costs go down.

As the costs associated with cancer care come under greater scrutiny, new technology innovations such as patient relationship management software provides the bio-pharmaceutical industry the opportunity to support providers in the care model while achieving the mutual goals of improved patient outcomes and lower costs.

 

About the Contributor

Gena Cook is Co-Founder and CEO of Navigating Cancer.  Navigating Cancer was founded in 2008 as the result of two healthcare and technology veterans coming together to fill a critical gap in oncology care: a better patient experience. Driven by a shared passion to leverage technology in the healthcare space, the co-founders set out to create the first patient-centered platform for oncology. Today, our Navigating Cancer platform supports over one million patients and thousands of cancer care providers nationwide to lower costs, improve patient satisfaction and drive better outcomes.
For more information: visit http://www.navigatingcancer.com

 

References:

  1. DiMatteo MR, Giordani PJ, Lepper HS, et al. Patient adherence and medical treatment outcomes: a meta-analysis. Med Care. 2002;40:794-811.
  2. Brown M, Bussell J Medication Adherence: WHO Cares?,Mayo Clin Proc. 2011 Apr; 86(4): 304–31.
  3. Brown M, Bussell J Medication Adherence: WHO Cares?,Mayo Clin Proc. 2011 Apr; 86(4): 304–31.
  4. Marillet M et al, Oral antineoplastic agents: how do we care about adherence? Br J Clin Pharmacol. 2015 Dec; 80(6): 1289–1302.
  5. Seal BS, Anderson S, Shermock KM, Factors Associated with Adherence Rates for Oral and Intravenous Anticancer Therapy in Commercially Insured Patients with Metastatic Colon Cancer, J Manag Care Spec Pharm. 2016 Mar;22(3):227-35.
  6. Wu EQ, et al. Healthcare resource utilization and costs associated with non-adherence to imatinib treatment in chronic myeloid leukemia patients.Curr Med Res Opin. 2010 Jan;26(1):61-9.
  7. Marin D et al, Adherence is the critical factor for achieving molecular responses in patients with chronic myeloid leukemia who achieve complete cytogenetic responses on imatinib, J Clin Oncol. 2010 May 10;28(14):2381-8.
  8. Hansen L. “Impact of Nonadherence to Cancer Therapy” The Oncology Pharmacist-Online First. May 21, 2015. http://www.theoncologypharmacist.com/ton-online-first/3639-ton-3639.
  9. Davidson B, Vogel V, Wickerham L. Oncologist-patient discussion of adjuvant hormonal therapy in breast cancer. Results of a linguistic study focusing on adherence and persistence to therapy. J Support Oncol. 2007 Mar;5(3):139-43.
  10. Stewart M et al Evidence on Patient-Doctor Communication, Cancer Prevention & Control 1999; 3(1):25-30.
  11. Basch E, et al Symptom Monitoring with Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial J Clin Onc 34, no. 6 (February 2016) 557-565.
  12. Atreja A, Bellam N, Levy SR. Strategies to Enhance Patient Adherence: Making it Simple. Medscape General Medicine. 2005;7(1):4.
  13. Howard SC et al Increasing the durations and efficacy of intravenous chemotherapy using a patient-centered digital education program: Navigating Cancer’s program for patients receiving pemetrexed for lung cancer, J Clin Oncol 35, 2017 (suppl; abstr e18025).
  14. Atreja A, Bellam N, Levy SR. Strategies to Enhance Patient Adherence: Making it Simple. Medscape General Medicine. 2005;7(1):4.

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