scholarly journals An analysis on medical expenses of multidisciplinary cancer care under health insurance

2021 ◽  
Vol 64 (10) ◽  
pp. 711-716
Author(s):  
Myungjin Jung ◽  
Byungyul Jun
Keyword(s):  
Health Insurance ◽  
Cancer Patients ◽  
Cancer Care ◽  
Treatment Plan ◽  
Multidisciplinary Care ◽  
Therapeutic Modality ◽  
Patient Treatment ◽  
Medical Expenses ◽  
Hospitalization Costs ◽  
Treatment Plans

Background: Cancer has been the leading cause of death in Korea for more than 40 years. As the aging population in the country increases, this trend is expected to continue. Cancer care is also being subdivided into specialties according to the development of medical technology. This division of care has made it difficult for a single physician to set up a complete cancer treatment plan. As a result, the call for multidisciplinary care has risen. Multidisciplinary cancer care allows physicians to share opinions and choose optimal patient treatment plans across multiple specialties. In August 2014, the Ministry of Health and Welfare designated a set number of approved multidisciplinary treatments and has included them under its health insurance coverage. As a result, multidisciplinary care is rapidly increasing.Current Concepts: An analysis on cancer care was conducted from 2014 to 2018, which examined the average medical expenses, hospitalization costs, and surgery costs per person according to therapeutic modality. Findings showed that multidisciplinary care decreased the overall cost of medical care in cancer patients compared to segmented care provided by single specialty physicians.Discussion and Conclusion: This study predicted that multidisciplinary care would be effective in reducing medical expenses. Cancer patients do not need to be treated by individual subspecialty physicians when personalized care treatment plans through a multidisciplinary approach is possible. The results of this study show that the Korean government should expand health insurance premium support and coverage for multidisciplinary cancer care.

Public reporting outcomes of multidisciplinary cancer care: Conceptual issues.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 280-280
Author(s):  
James Austin Talcott
Keyword(s):  
Cancer Patient ◽  
Patient Outcomes ◽  
Cancer Care ◽  
Treatment Plan ◽  
Multidisciplinary Care ◽  
Collective Responsibility ◽  
Public Reporting ◽  
Analytic Description ◽  
Eligibility Criteria

280 Background: Patient outcomes are the most valid measures of quality of care. Public reporting makes them available to patients, referring physicians and payers. Our institution has committed to reporting all cancer patient outcomes. In carrying out that objective, we encountered novel analytical issues arising from differences between the usually reported treatments, surgical procedures, and multidisciplinary cancer care. We present important conceptual issues we identified. Methods: Analytic description of methodological issues encountered in publishing cancer patient outcomes. Results: Issues include: (1) Assigning responsibility. Patient outcomes of multidisciplinary cancer care can be influenced by multiple oncology specialties and institutions. While providers directly control only the treatment they provide, providers share collective responsibility for executing the treatment plan, coordinating care and vouching for the quality of collaborating providers. Therefore, reporting outcomes of one element of multidisciplinary care is incomplete and inadequate. (2) Claiming responsibility. Providers with institutional affiliations but no involvement in quality improvement or reporting processes should be excluded from public reporting. Minimum requirements to qualify for public institutional affiliation should be enforced and “free riders” identified. (3) Defining and presenting valid comparison populations. Treatment trials’ eligibility criteria and recruitment practices exclude poorer prognosis patients, producing biased comparisons to complete “registry” populations that distort patient expectations. Publishing outcomes of well-characterized subpopulations improves valid results and provides more individualized information. Conclusions: Reporting patient outcomes after multidisciplinary cancer care raises novel conceptual issues. We discuss our response to three important issues.

The impact of multidisciplinary cancer conferences (MCC) on the treatment of metastatic rectal cancer (MRC) at the Ottawa Hospital Cancer Centre (TOHCC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14686-e14686
Author(s):  
Tanya Di Valentin ◽  
Timothy R. Asmis ◽  
Rebecca Ann C. Auer
Keyword(s):  
Treatment Plan ◽  
Retrospective Chart Review ◽  
Multidisciplinary Care ◽  
Standard Of Care ◽  
Ottawa Hospital ◽  
Patient Demographics ◽  
Relative Risks ◽  
Included Patient ◽  
Treatment Plans ◽  
The Impact

e14686 Background: There is significant controversy surrounding the management of surgically resectable MRC. The use and timing of neoadjuvant chemotherapy, pelvic radiation, and relative risks and benefits of a combined surgical resection are areas of debate among surgeons, medical, and radiation oncologists. The TOHCC multidisciplinary Cancer Conferences (MCC) provide an opportunity to discuss these cases and propose treatment plans for these patients. Methods: We conducted a retrospective chart review of all the cases of MRC which were discussed at MCC at the TOHCC from November 2007 until October 2009. Information collected included patient demographics, site of metastases, the treatment they received prior to their case being discussed at MCC (past surgeries, chemotherapy, radiotherapy), the treatment plan discussed at MCC, treatment actually administered post MCC discussion, and patient outcome at 6 months. Results: Forty-two patients with MRC were reviewed. The most common sites of metastases were liver (45.2%) and lung (31%). Once diagnosed with metastatic disease, prior to the MCC, patients had received the following treatments alone or in combination: chemotherapy (33.3%), radiotherapy (21.4%), surgery (19.0%), no treatment (n=57.1%). After their case was presented, 38 patients (90.5%) received the treatment recommended at the MCC , while 4 (9.5%) did not. Treatment post MCC included: chemotherapy (neoadjuvant: 38.1%; adjuvant: 23.8%; palliative: 28.6%), radiotherapy (neoadjuvant: 14.3%; adjuvant: 7.1%; palliative: 7.1%) and surgery (31.0%). Conclusions: There is no standardized approach to the management of MRC. Given its complexity, many cases are reviewed at MCC, which allow coordination for multidisciplinary care of these patients. The results of this study suggest that in a majority of cases, the recommendations brought forth at MCC are indeed acted upon. Given that these meetings have a significant impact on the treatment plan and outcome of patients with MRC, they should represent the standard of care when treating this disease.

scholarly journals Psychological Support and Telehealth Options for Patients with Cancer during the Covid-19 Pandemic in Saudi Arabia

2021 ◽  
Vol 8 ◽  
Author(s):  
Manal Banaser ◽  
Sami Alshammary
Keyword(s):  
Cancer Patients ◽  
Support Groups ◽  
Cancer Care ◽  
Healthcare Delivery ◽  
Psychosocial Care ◽  
Multidisciplinary Care ◽  
Psychological Support ◽  
Registry Data ◽  
Cancer Center ◽  
Healthcare Delivery System

Background: COVID-19 concerns are associated with an increase in symptoms of depression and anxiety among cancer patients. Telehealth services hold incredible potential for providing psychological support to cancer patients. In a technology-assisted intervention for telehealth, hotline services are a valuable tool to provide psychosocial care. This paper examines the use of hotline services to offer psychological support to cancer patients. Methods: A retrospective analysis of hotline calls patient registry data was conducted. Data were collected from a single cancer center in Riyadh, from May 2020 to March 2021, with a random sample of 877 callers to cancer hotline services. Responses of a satisfaction questionnaire were linked to call-related concerns of registry data.  Results: A total of 877 calls were received, the majority of which came from Riyadh locals. Patient disease complaints accounted for 210 calls (24%), while retake medicine requests accounted for 251 calls (28.62%). 143 (16.31%) calls were about scheduled new appointments, 261 calls (29.76%) were about psychological issues induced by Covid-19, such as worry, fear, and anxiety symptoms, and 12 calls (1.37%) having to do with Covid-19. Seven hundred seventy-two callers (88 %) indicated satisfaction with the services call attended. Discussion: Hotline services in cancer care have been identified as a key resource telehealth service that positively influences patient satisfaction and meets cancer patient needs in the face of the pandemic. This study also highlighted the need for other telehealth services, such as mental health mobile applications, virtual multidisciplinary care, and online support groups, which can provide an excellent option for providing psychological support to cancer patients. Conclusion: This study found that providing Cancer Care Hotline services during a pandemic improves patient-centered care and a more efficient healthcare delivery system. 

scholarly journals Traditional & narrative practices of treatment for depression and depressive symptoms in older adults

2022 ◽  
Vol 9 (1) ◽  
pp. 14-15
Author(s):  
Courtni Jeffers
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Organizational Climate ◽  
Organizational Context ◽  
Treatment Guidelines ◽  
Positive Impact ◽  
Treatment Plan ◽  
Patient Treatment ◽  
Treatment Plans ◽  
Self Discovery

An analysis and evaluation of the literature regarding traditional treatment methods for depression among older adults compared the effectiveness of the results to the benefits of a treatment plan that integrates the narrative practices of storytelling and reflexive writing. Priority was given to peer-reviewed journal articles from 2008 forward, though some earlier information was used for clarification and foundation building. The formation and implementation of individual patient treatment plans for depression and depressive symptoms are impacted by many variables such as: Confusion surrounding provider treatment guidelines, social organizational context, organizational climate and the differing definitions of depression that exist among providers and patients. Patients often struggle to self-identify or put words to depressive symptoms and the process of reflexive writing is transformative and increases narrative competency, which strengthens a patient’s ability to give an account of oneself, aiding in self-discovery and personal symptom awareness. An imbalance of power exists in the clinical encounter and the practices and principles of the discipline of Narrative Medicine can have a positive impact on strengthening the therapeutic alliance and treatment outcomes. Older adults with depression and depressive symptoms have a lower quality of life and often feel less productive in their communities. Traditional pharmacologically based depression treatment plans are one-dimensional and often fail to address personal patient context and preference. Older adults living with diagnosed depression and depressive symptoms can be better served with treatment plans that include narrative techniques that increase alliance, affiliation, self-awareness and self-discovery.  

Coordination and timeliness of care by insurance status in a gastrointestinal (GI) multidisciplinary care (MDC) program.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 272-272
Author(s):  
Laurence E. McCahill ◽  
Jamie Kokko ◽  
Alan T. Davis ◽  
Wendy K. Taylor ◽  
Coralyn Martinez ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Cancer Care ◽  
Multidisciplinary Care ◽  
Insurance Status ◽  
Chi Square ◽  
Exact Test ◽  
Diagnostic Studies ◽  
Nurse Navigator ◽  
Timeliness Of Care ◽  
The Impact

272 Background: Patients with newly diagnosed GI cancers require diagnostic studies and evaluations by physicians that may delay initiation of cancer care. Uninsured populations are particularly vulnerable. A Nurse Navigator (NN) can help decrease barriers and improve timeliness of care. This study aims to compare timeliness of cancer care received by patients referred to a GI MDC Program by the patient’s insurance status at the time of referral. Methods: Patients referred to the GI MDC are assigned a NN who evaluates medical history, diagnostic studies, and coordinates further testing and physician evaluations. Timeliness measures assessing milestones in cancer care initiation are collected prospectively. Descriptive statistics are presented and average times for measures are compared by insurance status (insured vs. uninsured) using t-tests, chi-square tests, and the Fisher’s Exact test. Results: 366 patients were evaluated between January 2010 and June 2012. 70% (255/366) were for new cancer diagnoses. Median age of cancer patients was 64 years (range 29-94), 63.1% of patients were male, and 94.1% of patients had insurance. Major cancer diagnosis types were colon/rectal (19.2%), esophageal/gastric (25.1%), hepatobiliary (12.8%) and pancreatic/ampullary/duodenal (35.7%) and 1.6% other. The table describes timeliness and care coordination measures by insurance status. Conclusions: Uninsured cancer patients in our health system appear to receive care in a timely fashion which does not differ from patients with insurance. The impact of a dedicated GI NN in avoiding disparate care for uninsured warrants further study. [Table: see text]

scholarly journals Clinician Perspectives of COVID-19-Related Cancer Drug Funding Measures in Ontario

2021 ◽  
Vol 28 (2) ◽  
pp. 1056-1066
Author(s):  
Rohini D. Naipaul ◽  
Rebecca E. Mercer ◽  
Kelvin K. W. Chan ◽  
Lyndee Yeung ◽  
Leta Forbes ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Cancer Care ◽  
Online Survey ◽  
Clinical Care ◽  
Cancer Drug ◽  
Funding Policies ◽  
Funding Program ◽  
Treatment Plans ◽  
The Cost ◽  
Dosing Intervals

The COVID-19 pandemic has a significant impact on cancer patients and the delivery of cancer care. To allow clinicians to adapt treatment plans for patients, Ontario Health (Cancer Care Ontario) issued a series of interim funding measures for the province’s New Drug Funding Program (NDFP), which covers the cost of most hospital-delivered cancer drugs. To assess the utility of the measures and the need for their continuation, we conducted an online survey of Ontario oncology clinicians. The survey was open 3–25 September 2020 and generated 105 responses. Between April and June 2020, 46% of respondents changed treatment plans for more than 25% of their cancer patients due to the pandemic. Clinicians report broad use of interim funding measures. The most frequently reported strategies used were treatment breaks for stable patients (62%), extending dosing intervals (59%), and deferring routine imaging (56%). Most clinicians anticipate continuing to use these interim funding measures in the coming months. The survey showed that adapting cancer drug funding policies has supported clinical care in Ontario during the pandemic.

Quantifying the utility of a multidisciplinary neuro-oncology tumor board

2020 ◽  
pp. 1-6
Author(s):  
Adham M. Khalafallah ◽  
Adrian E. Jimenez ◽  
Carlos G. Romo ◽  
David Olayinka Kamson ◽  
Lawrence Kleinberg ◽  
...  
Keyword(s):  
Nervous System ◽  
Treatment Plan ◽  
Demographic Data ◽  
Image Interpretation ◽  
Multidisciplinary Care ◽  
Tumor Board ◽  
Eligibility Criteria ◽  
Tumor Boards ◽  
Treatment Plans ◽  
A Prospective Study

OBJECTIVEThere has been limited research on the efficacy of multidisciplinary tumor boards (MDTBs) in improving the treatment of patients with tumors affecting the nervous system. The objective of the present study was to quantify the utility of MDTBs in providing alternative diagnostic interpretations and treatment plans for this patient population.METHODSThe authors performed a prospective study of patients in 4 hospitals whose cases were discussed at MDTBs between July and November 2019. Patient demographic data, diagnoses, treatment plans, and eligibility for clinical trials were recorded, among other variables.RESULTSA total of 176 cases met eligibility criteria for study inclusion. The majority (53%) of patients were male, and the mean patient age was 52 years. The most frequent diagnosis was glioblastoma (32.4%). Among the evaluable cases, MDTBs led to 38 (21.6%) changes in image interpretation and 103 (58.2%) changes in patient management. Additionally, patients whose cases were discussed at MDTBs had significantly shorter referral times than patients whose cases were not discussed (p = 0.024).CONCLUSIONSMDTB discussions led to significant numbers of diagnostic and treatment plan changes as well as shortened referral times, highlighting the potential clinical impact of multidisciplinary care for patients with nervous system tumors.

Prospective study of an AI enabled online intervention to increase delivery of guideline compliant cancer care, on the ground.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2011-2011
Author(s):  
C S. Pramesh ◽  
Bhawna Sirohi ◽  
Shona Milon Nag ◽  
Sudeep Gupta ◽  
Benjamin O. Anderson ◽  
...  
Keyword(s):  
Prospective Study ◽  
Primary Tumor ◽  
Cancer Care ◽  
Treatment Plan ◽  
Online Intervention ◽  
Expert Review ◽  
Treatment Plans ◽  
Tumor Distribution ◽  
To Receive

2011 Background: Despite survival benefits of guideline compliant cancer care, under treatment and over treatment are prevalent. Navya is an AI enabled online intervention that matches a patient’s medical record with NCCN and NCG guidelines (National Cancer Grid, India) and layers live multidisciplinary expert review to recommend actionable treatment plans. It was developed to standardize care and mitigate morbidity and mortality, by delivering on-t ime, guideline based expert treatment plans. Methods: From July 2019 to January 2020, all patients who received a Navya treatment plan based on guidelines and live expert review were included. Intended treatment plans were prospectively collected from the patient. Compliance of intended plans with NCCN (including Resource Stratified Framework) or NCG was measured. Noncompliant intended plans were categorized as overtreatment or undertreatment. After delivery of Navya plan, prospective phone follow up assessed whether noncompliant intended plans were changed to guideline compliant care. Results: Of 1707 consecutive patients who received a Navya plan, 1549 intended plans were available. Patients were diverse with respect to geographic, socioeconomic, and primary tumor distribution: West of India: 28%, North: 26%, East: 21%, South: 15%, Central: 7%, International: 3%; 35% of patients with income < $300/month; GI: 23%, Breast: 14%, Head & Neck: 11%, Thoracic: 10%. Of the 1549 intended plans, 441 (28.47% (95% CI ± 0.26%)) were not compliant with NCCN or NCG. Undertreatment was 35%, overtreatment 26%, incomplete staging workup 28% and 11% could not be categorized. Of 441 patients with noncompliant intended plans, 80.19% (± 0.97%) shared the Navya plan with their treating oncologists and 50.40% (± 0.88%) changed their intended plan to receive the Navya treatment plan. Intervention with Navya increased on-the -ground guideline compliance by ~15% (from 71.53% ±0.42% to 85.87% ± 1.73%). Conclusions: Guideline compliant care ensures best achievable clinical outcomes with existing therapies. A technological earthshot that significantly increases adoption of guideline based care is the first step towards cancer moonshots.

Financial burdens of insured adolescent and young adult cancer patients: A need for crowdfunding platforms, fundraisers, financial grants, and cost conversations with their cancer care team.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 83-83
Author(s):  
Karely Mann ◽  
Austin R. Waters ◽  
Perla L. Vaca Lopez ◽  
Nicole Ray ◽  
Tomoko Tsukamoto ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cancer Patients ◽  
Cancer Care ◽  
The United States ◽  
Care Team ◽  
Adolescent And Young Adult ◽  
Structured Interviews ◽  
Patient Navigators ◽  
Financial Safety Nets ◽  
Out Of Pocket Costs

83 Background: Cancer patients in the United States often experience distress surrounding out of pocket costs from treatment. Adolescents and young adults (AYA) are more likely to be underinsured, skip care due to cost, go into debt, and file for bankruptcy after a cancer diagnosis than patients diagnosed at older ages. We conducted semi-structured interviews with AYA cancer patients and survivors to evaluate their experiences with health insurance, cancer costs and use of crowdfunding. Methods: Eligible participants were ages 18-39, diagnosed with cancer, and currently insured. Recruitment occurred largely through patient navigators at two large cancer centers from October 2019 to March 2020. Data was collected via individual semi-structured telephone interviews, which were analyzed for content. Questions were asked pertaining to crowdfunding platforms, fundraisers, satisfaction with current health insurance policy, and cost conversations with their cancer care team. Interviews were analyzed applying two rounds of thematic content analysis. Summary statistics were calculated for demographics. Results: Twenty-four interviews were completed, with more than half of participants being female (58%), most participants being Non-Hispanic White (79%), mean age at 26.5, and currently receiving cancer treatment (79%). Three themes emerged about AYAs’ experience with treatment costs and health insurance: 1) Even with insurance, cancer care was unexpectedly expensive and burdensome on financial wellbeing; 2) Conversations about cost with cancer care teams were brief and rare and 3) Crowdfunding platforms, fundraisers or financial grants were often used as financial safety nets, and did not cover all out of pocket costs. More than half of participants expressed interest in having cost conversations with their oncologist, nurse or social worker. All participants expressed a need for education on managing cancer costs and a particular interest in educational information on appeals and out of pocket costs. Conclusions: AYAs with cancer report unexpected costs and are interested in discussing this with their cancer care team. AYAs often receive money from fundraisers, financial grants or crowdfunding platforms to assist with the expenses of treatment. Discussions between cancer care teams and AYA patients about health insurance policies and cost saving mechanisms may help reduce out of pocket costs and reliance on external financial mechanisms.

Patient and caregiver’s satisfaction with multidisciplinary vs. serial lung cancer care in a community setting.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 200-200
Author(s):  
Huibo Shao ◽  
Nicholas Faris ◽  
Meghan Brooke Taylor ◽  
Carrie Fehnel ◽  
Anita Patel ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Cancer Care ◽  
Care Delivery ◽  
Financial Burden ◽  
Treatment Plan ◽  
Hospital System ◽  
Team Members ◽  
Lung Cancer Patients

200 Background: Few existing studies examined lung cancer patients and caregivers’ satisfaction with the team-based multidisciplinary care (MD) in comparison to the usual serial care (SC). We hypothesized that MD, by providing early and concurrent input from key specialists collaborating as a team with patients and caregivers to develop a consensus care plan, can improve patients and caregivers’ satisfaction with care, compared to SC, in which multiple specialists independently screen, diagnose, and treat patients through a fragmented sequence of referrals. Methods: Data on newly diagnosed lung cancer patients, enrolled in a prospective matched cohort comparative effectiveness trial of MD or SC between Oct. 9th, 2014 and July 5th, 2017 in a Mid-South community hospital system, were collected at baseline, 3- and 6-month periods to assess patient and caregiver’s satisfaction with these two care-delivery models. Measures of satisfaction were adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Multivariate mixed linear models were used to examine the cross-group differences, the time-related variances, and how the interaction between groups and time-periods influenced patients’ and caregivers’ satisfaction. Results: Compared with SC (N = 297), patients in MD (N = 159) were older (66 vs. 69 years), more in an early cancer stage (33% vs. 41% in stage I or II), and lower in performance score (35% vs. 45% asymptomatic). Demographic and social-economic characteristics of caregivers in MD (N = 97) and SC (N = 122) were not significantly different. Patients and caregivers in MD were more likely than those in SC to perceive their care to be better than that received by other patients (p =.003 and p <.001 respectively). Greater satisfaction with their treatment plan at 6-month was observed among the MD patients (p =.004). Also, MD patients reported better overall satisfaction with team members (p =.038). Consistent with the findings among the patients in MD, caregivers in MD were more satisfied with the quality of care (p <.001) and with care received from team members (p <.001) than that reported by caregivers in SC. Conclusions: Coordinated MD care improved patients and caregivers’ satisfaction with lung cancer care in a community healthcare system. Further research will compare the quality of life and financial burden on patients in the MD and SC treatment models to provide more evidence for stakeholders to refine cancer care models.

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