Challenges and Opportunities in Delivering High-Quality Cancer Care: A 2016 Update

Herein, both the rationale and scope of current initiatives aimed at improving the quality of cancer care delivery in the United States are described. First, we discuss a recent report from the Institute of Medicine that issued a strong call for both the development of quality measures in oncology and implementation of a learning health care system in which data and experience from clinical practice can inform continuous improvements in cancer care. Second, we review the multiple, diverse initiatives that are underway to identify, test, and validate quality measures for the entire spectrum of cancer care. Finally, we discuss regional quality improvement collaboratives as one successful approach to creating a cycle of quality measurement, identification of best practices, and implementation of changes in practice patterns that ultimately yield improved care and outcomes for patients with cancer.

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Evolving oncology provider perspectives on care delivery during the COVID-19 pandemic.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18609 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18609-e18609

Author(s):

Divya Ahuja Parikh ◽

Meera Vimala Ragavan ◽

Sandy Srinivas ◽

Sarah Garrigues ◽

Eben Lloyd Rosenthal ◽

...

Keyword(s):

Cancer Care ◽

Care Delivery ◽

The United States ◽

Advanced Practice ◽

Curative Surgery ◽

Time Points ◽

Patients With Cancer ◽

Provider Perspectives ◽

Significant Difference ◽

The Impact

e18609 Background: The COVID-19 pandemic prompted rapid changes in cancer care delivery. We sought to examine oncology provider perspectives on clinical decisions and care delivery during the pandemic and to compare provider views early versus late in the pandemic. Methods: We invited oncology providers, including attendings, trainees and advanced practice providers, to complete a cross-sectional online survey using a variety of outreach methods including social media (Twitter), email contacts, word of mouth and provider list-serves. We surveyed providers at two time points during the pandemic when the number of COVID-19 cases was rising in the United States, early (March 2020) and late (January 2021). The survey responses were analyzed using descriptive statistics and Chi-squared tests to evaluate differences in early versus late provider responses. Results: A total of 132 providers completed the survey and most were white (n = 73/132, 55%) and younger than 49 years (n = 88/132, 67%). Respondents were attendings in medical, surgical or radiation oncology (n = 61/132, 46%), advanced practice providers (n = 48/132, 36%) and oncology fellows (n = 16/132, 12%) who predominantly practiced in an academic medical center (n = 120/132, 91%). The majority of providers agreed patients with cancer are at higher risk than other patients to be affected by COVID-19 (n = 121/132, 92%). However, there was a significant difference in the proportion of early versus late providers who thought delays in cancer care were needed. Early in the pandemic, providers were more likely to recommend delays in curative surgery or radiation for early-stage cancer (p < 0.001), delays in adjuvant chemotherapy after curative surgery (p = 0.002), or delays in surveillance imaging for metastatic cancer (p < 0.001). The majority of providers early in the pandemic responded that “reducing risk of a complication from a COVID-19 infection to patients with cancer” was the primary reason for recommending delays in care (n = 52/76, 68%). Late in the pandemic, however, providers were more likely to agree that “any practice change would have a negative impact on patient outcomes” (p = 0.003). At both time points, the majority of providers agreed with the need for other care delivery changes, including screening patients for infectious symptoms (n = 128/132, 98%) and the use of telemedicine (n = 114/132, 86%) during the pandemic. Conclusions: We found significant differences in provider perspectives of delays in cancer care early versus late in the pandemic which reflects the swiftly evolving oncology practice during the COVID-19 pandemic. Future studies are needed to determine the impact of changes in treatment and care delivery on outcomes for patients with cancer.

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The State of Cancer Care in America: Impact of State Policy on Access to High-Quality Cancer Care

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2020.7541 ◽

2020 ◽

Vol 18 (4) ◽

pp. 400-404

Author(s):

Terrell Johnson ◽

Lindsey A.M. Bandini ◽

Kara Martin ◽

Lee Jones ◽

Jennifer Carlson ◽

...

Keyword(s):

Health Policy ◽

Cancer Care ◽

Policy Decision ◽

The State ◽

Washington Dc ◽

Patients With Cancer ◽

Quality Cancer Care ◽

Challenges And Opportunities ◽

Health Policy Decision ◽

Policy Decision Making

Health policy in America has shifted rapidly over the last decade, and states are increasingly exercising greater authority over health policy decision-making. This localization and regionalization of healthcare policy poses significant challenges for patients with cancer, providers, advocates, and policymakers. To identify the challenges and opportunities that lay ahead of stakeholders, NCCN hosted the 2019 Policy Summit: The State of Cancer Care in America on June 27, 2019, in Washington, DC. The summit featured multidisciplinary panel discussions to explore the implications for access to quality cancer care within a shifting health policy landscape from a patient, provider, and lawmaker perspective. This article encapsulates the discussion from this NCCN Policy Summit.

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Defining current gaps in quality measures for cancer immunotherapy: consensus report from the Society for Immunotherapy of Cancer (SITC) 2019 Quality Summit

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2019-000112 ◽

2020 ◽

Vol 8 (1) ◽

pp. e000112 ◽

Cited By ~ 1

Author(s):

Sara Pai ◽

David Blaisdell ◽

Rachel Brodie ◽

Robert Carlson ◽

Heidi Finnes ◽

...

Keyword(s):

Cancer Immunotherapy ◽

Cancer Care ◽

Expert Panel ◽

Care Delivery ◽

Quality Measures ◽

Quality Measure ◽

Long Term Outcome ◽

Quality Cancer Care ◽

National Quality ◽

Immunotherapy Of Cancer

BackgroundQuality measures are important because they can help improve and standardize the delivery of cancer care among healthcare providers and across tumor types. In an environment characterized by a rapidly shifting immunotherapeutic landscape and lack of associated long-term outcome data, defining quality measures for cancer immunotherapy is a high priority yet fraught with many challenges.MethodsThus, the Society for Immunotherapy of Cancer convened a multistakeholder expert panel to,first, identify the current gaps in measures of quality cancer care delivery as it relates to immunotherapy and to,second, advance priority concepts surrounding quality measures that could be developed and broadly adopted by the field.ResultsAfter reviewing the existing quality measure landscape employed for immunotherapeutic-based cancer care, the expert panel identified four relevant National Quality Strategy domains (patient safety, person and family-centered care, care coordination and communication, appropriate treatment selection) with significant gaps in immunotherapy-based quality cancer care delivery. Furthermore, these domains offer opportunities for the development of quality measures as they relate to cancer immunotherapy. These four quality measure concepts are presented in this consensus statement.ConclusionsThis work represents a first step toward defining and standardizing quality delivery of cancer immunotherapy in order to realize its optimal application and benefit for patients.

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Delivering High-Quality and Affordable Care Throughout the Cancer Care Continuum

Journal of Clinical Oncology ◽

10.1200/jco.2013.51.0651 ◽

2013 ◽

Vol 31 (32) ◽

pp. 4151-4157 ◽

Cited By ~ 49

Author(s):

Ya-Chen Tina Shih ◽

Patricia A. Ganz ◽

Denise Aberle ◽

Amy Abernethy ◽

Justin Bekelman ◽

...

Keyword(s):

Cancer Care ◽

Primary Care Physicians ◽

New Technologies ◽

Financial Burden ◽

The United States ◽

Institute Of Medicine ◽

High Quality ◽

Care Continuum ◽

Quality Cancer Care ◽

Cancer Care Continuum

The national cost of cancer care is projected to reach $173 billion by 2020, increasing from $125 billion in 2010. This steep upward cost trajectory has placed enormous an financial burden on patients, their families, and society as a whole and raised major concern about the ability of the health care system to provide and sustain high-quality cancer care. To better understand the cost drivers of cancer care and explore approaches that will mitigate the problem, the National Cancer Policy Forum of the Institute of Medicine held a workshop entitled “Delivering Affordable Cancer Care in the 21st Century” in October 2012. Workshop participants included bioethicists, health economists, primary care physicians, and medical, surgical, and radiation oncologists, from both academic and community settings. All speakers expressed a sense of urgency about the affordability of cancer care resulting from the future demographic trend as well as the high cost of emerging cancer therapies and rapid diffusion of new technologies in the absence to evidence indicating improved outcomes for patients. This article is our summary of presentations at the workshop that highlighted the overuse and underuse of screening, treatments, and technologies throughout the cancer care continuum in oncology practice in the United States.

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Successful Strategies to Address Disparities: Insurer and Employer Perspectives

American Society of Clinical Oncology Educational Book ◽

10.1200/edbk_279959 ◽

2020 ◽

pp. 292-300

Author(s):

Manali I. Patel ◽

Richard Snyder ◽

Otis Brawley

Keyword(s):

Health Care ◽

Health Care Providers ◽

Low Income ◽

Cancer Care ◽

Care Delivery ◽

The United States ◽

Cancer Disparities ◽

Care Providers ◽

High Quality ◽

Quality Cancer Care

Disparities in cancer have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Disparate cancer outcomes continue to affect many populations in the United States and globally, including racial and ethnic minorities, populations with low income and education, and residents of rural areas or low socioeconomic neighborhoods, among others. Addressing cancer disparities requires approaches that are multilevel. Addressing social determinants of health, such as removing obstacles to health (e.g., poverty, discrimination, access to housing and education, jobs with fair pay, and health care) can reduce cancer disparities. However, to achieve cancer health equity, multilevel approaches are required to ensure that access to high-quality cancer care and equitable receipt of evidence-based services can reduce cancer disparities. Policy, health system interventions, and innovative delivery and health care coverage approaches by private and public payers, employer-based payers, and labor union organizations can assist in ensuring access to and receipt of high-quality cancer care while addressing the high costs of care delivery. Partnerships among patients, caregivers, employers, health care providers, and health care payers can make impactful changes in the way in which cancer care is delivered and, in turn, can assist in reducing cancer disparities.

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Results of a multistate, multi-institution implementation of a multidisciplinary cancer conference quality measurement tool.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.212 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 212-212

Author(s):

Lijo Simpson ◽

Anju Mathew ◽

Robert Wojciechowski ◽

Irina Hill

Keyword(s):

Clinical Trials ◽

Cancer Care ◽

Quality Measurement ◽

The United States ◽

Quality Metrics ◽

Lower Percentage ◽

High Quality ◽

Quality Cancer Care ◽

Psychosocial Counselling ◽

Virtual Platform

212 Background: The 2006 ASCO and the ESMO consensus statement on quality cancer care defined the delivery of multimodality treatment by a multidisciplinary team of appropriately skilled health professionals as an essential component of quality cancer care. Furthermore, MDCs have demonstrated improved survival in breast, head and neck, ovarian and colorectal cancers. Despite these advantages, health care systems struggle to implement and sustain MDCs due to the heavy burden imposed by the required work processes. We report on the large-scale utilization of a propriety quality measurement platform OncoLens to run MDCs across the country. Methods: Technology quality metrics were collected from the ongoing daily usage of the platform including cancer characteristics, care team utilization metrics, average attendance, quality metrics collected for accreditation and clinical trials matching on the OncoLens platform. Results: The virtual platform was accessible to around 8000 providers across the United States. In 2020, 13771 cases were discussed. Attendance of the required specialties for high quality care of Medical Oncology, Radiation Oncology, Surgery, Pathology and Radiology was attained, with the average conference attendance being 14. Race/ethnicity data on the cases revealed White (9197, 67%), Black (1817,13%), Hispanic (363,3%) and Other (2356,17%). Optional quality metrics were collected during discussions for CoC, NAPBC and NAPRC accreditation. These included NCCN guidelines discussed, Staging discussed, clinical trials discussed, Genetics discussion, palliative care discussion, rehabilitation services, reproductive counselling discussed, psychosocial counselling discussed, nutritional counselling discussed, reconstructive surgery discussion, tobacco cessation discussion across General and Site-specific conferences. Most of the case presentations were prospective. This format does enable cancer programs to collect quality metrics around Cancer program accreditation by the American College of Surgeons. 66% of patients discussed potentially matched to clinical trials during the discussion. Conclusions: A technology platform can assist cancer programs to collect quality metrics around cancer care. This gives them the ability to run data driven quality programs targeting specific quality metrics. Hispanics have a lower percentage of cases presented at MDC compared to other race/ethnicities. It is possible to have high quality discussions and attain metrics for Commission on Cancer accreditation utilizing a virtual platform.

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Achieving a High-Quality Cancer Care Delivery System for Older Adults: Innovative Models of Care

Seminars in Oncology Nursing ◽

10.1016/j.soncn.2016.02.006 ◽

2016 ◽

Vol 32 (2) ◽

pp. 122-133 ◽

Cited By ~ 3

Author(s):

Janet H. Van Cleave ◽

Esther Smith-Howell ◽

Mary D. Naylor

Keyword(s):

Older Adults ◽

Delivery System ◽

Cancer Care ◽

Care Delivery ◽

Models Of Care ◽

High Quality ◽

Quality Cancer Care

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Pharmaceutical assistance foundations in the financing of cancer care.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.8 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 8-8

Author(s):

Aaron Philip Mitchell

Keyword(s):

North Carolina ◽

Cancer Care ◽

Kinase Inhibitors ◽

Care Delivery ◽

Private Insurance ◽

Standard Of Care ◽

Drug Manufacturer ◽

Cancer Drugs ◽

Assistance Programs ◽

Patients With Cancer

8 Background: The rising cost of cancer drugs may make treatment unaffordable for some patients. Patients often rely on drug manufacturer-administered Pharmaceutical Assistance Programs (PAPs) to obtain drugs at reduced or no cost. The overall impact of PAPs on cancer care delivery is unknown. Methods: We identified all patients obtaining cancer drugs across an academically affiliated, integrated health system in the state of North Carolina during 2014. The proportion of patients receiving PAP assistance, and the retail value of the assistance, were quantified for each oncology drug. Cancer drugs were analyzed with respect to route of administration. Results: 215 unique patients submitted a total of 478 successful PAP requests for cancer drugs. The majority of the retail value of drugs obtained was for oral cancer drugs, particularly targeted therapies including tyrosine kinase inhibitors. Among all cancer patients who received medical treatment, 5.5% required PAP assistance, whereas 10.6% receiving an oral agent required PAP assistance (Table). The proportion receiving PAP assistance varied substantially by drug, ranging from <1% of patients (e.g., carboplatin, methotrexate) to 50% of patients (e.g., ponatinib, temsirolimus). Patients obtained a total of $1,556,575 of imatinib and $1,449,633 of dasatinib, which were the two drugs with the highest aggregate retail value. 40% of PAP-utilizing patients were uninsured, 26% had Medicaid coverage, 20% had Medicare coverage, and 14% were commercially insured. Conclusions: A substantial proportion of patients with cancer receive private charitable assistance through PAPs in order to obtain standard-of-care treatments. In particular, a disproportionate share of patients treated with orally-available cancer drugs require PAP assistance. This includes patients with federal and private insurance, suggesting an inability of patients to meet cost-sharing requirements. [Table: see text]

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The HOLA COVID-19 study: Evaluating the impact of caring for patients with COVID-19 on cancer care delivery in Latin America.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.1537 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 1537-1537

Author(s):

Carolina Bernabe Ramirez ◽

Ana I. Velazquez Manana ◽

Coral Olazagasti ◽

Cristiane Decat Bergerot ◽

Enrique Soto Perez De Celis ◽

...

Keyword(s):

Latin America ◽

Latin American ◽

Cancer Care ◽

Online Survey ◽

Care Delivery ◽

Healthcare Delivery ◽

Significant Proportion ◽

Multiple Choice Questions ◽

Patients With Cancer ◽

The Impact

1537 Background: The severe acute respiratory syndrome 2 (SARS-cov-2) virus causing COVID-19 has brought great challenges to global health services affecting cancer care delivery, outcomes, and increasing the burden in oncology providers (OP). Our study aimed to describe the challenges that OP faced while delivering cancer care in Latin America. Methods: We conducted an international cross-sectional study using an anonymous online survey in Spanish, Portuguese, and English. The questionnaire included 43 multiple choice questions. The sample was stratified by OP who have treated patients with COVID-19 versus those who have not treated patients with COVID-19. Data was analyzed with descriptive statistics and Chi-square tests. Results: A total of 704 OP from 20 Latin American countries completed the survey (77% of 913 who started the survey). Oncologists represented 46% of respondents, followed by 25% surgical-oncologists. Of the respondents, 56% treated patients with COVID-19. A significant proportion of OP reported newly adopting telemedicine during COVID-19 (14% vs 72%, p=0.001). More than half (58%) of OP reported making changes to the treatments they offered to patients with cancer. As shown in the table, caring for patients with COVID-19 significantly influenced practice patterns of OP. Access to specialty services and procedures was significantly reduced: 40% noted significantly decreased or no access to imaging, 20% significantly decreased or no access to biopsies, 65% reported delays in surgical oncology referrals, and 49% in radiation oncology referrals. A vast majority (82%) reported oncologic surgeries were delayed or cancelled, which was heightened among those treating patients with COVID-19 (87% vs 77%, p=0.001). Conclusions: The COVID-19 pandemic has significantly affected the way cancer care is delivered in globally. Although changes to healthcare delivery are necessary as a response to this global crisis, our study highlights the significant disruption and possible undertreatment of patients with cancer in Latin America that results from COVID-19.[Table: see text]

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