Industry Voices—Addressing breakdowns in the cancer care journey

Cancer care is highly complex. This can lead to delays in care that greatly affect health outcomes for a condition where timely diagnosis, treatment and support matter.

Oncology is also one of the costliest therapeutic categories, with recently developed therapies costing up to $500,000 per patient per year. In 2020, total costs of cancer care reached $150 billion in the U.S., and that number is predicted to rise by 34% by the end of the decade based on population growth alone.

Helping patients access quality care and clinically effective treatments efficiently while supporting their overall health is critical given the complexity and cost of oncology care today. The healthcare system must work together to address these challenges and offer better patient support.

First, we have to start patients on the most appropriate therapy regimen for their diagnosis as expeditiously as possible. Second, we need to support patients throughout their treatment to help them stay adherent and manage symptoms and side effects. And finally, it’s critical to minimize unnecessary medical spending by proactively engaging patients with their care to help avoid adverse events.

Research shows these efforts can make care simpler and more accessible while preventing wasteful spend.

Unlocking more personalized and more efficient care

A recent study presented at the annual meeting of the American Society of Clinical Oncology (ASCO) showed how a collaborative payer-provider approach could support both providers and patients. The study evaluated automated prior authorization integrated with regimen-level National Comprehensive Cancer Network guidelines. Findings suggested that encouraging providers to align with the latest standards supports more efficient care. Further, the approach could reduce overall costs of care, while getting patients started on their treatments faster, by 27%.

A separate analysis of the study data also found that doing so improved compliance with guidelines from a current industry standard of 60% to 81%, meaning more patients were getting the most appropriate treatments for their diagnosis.

While this study focused on non-small cell lung cancer, these findings may hold promise for increasing efficiency and lowering costs in treating other types of cancers.

Supporting patients and avoiding costly complications

As important as it is to start patients on the right treatment regimen, it’s equally critical to support them along what are often challenging journeys. For example, giving patients the ability to contact their care team, including specially trained nurses, anytime over the phone or digitally can help them manage their care and treatment between provider visits. Nurse-led interventions can also help avoid costly adverse events like emergency department visits.

Another study presented at ASCO evaluated data from patients with cancer who sought emergency department care. Of the total number of emergency room visits, 76% were from patients presenting with oncology drug-related side effects, and 36% led to hospital admission. The study showed patients with certain demographic indicators, as well as those with specific cancer types, were more likely to be admitted following an emergency visit.

Findings also showed that people who presented with certain primary complaints—sepsis, pneumonia, medical complications, white cell disorders, metastatic cancer and fractures—were significantly more likely to be admitted for a hospital stay. These insights can inform proactive care management and more targeted interventions.

Additionally, nurse-led care management can monitor patients’ mental health, which is critical when up to one-third of patients with cancer deal with mental illness in some form. Understanding where intervention is most needed can help patients and caregivers monitor for signs of mental health changes.

A whole-person approach to the cancer care journey

Advancements in diagnostic tools and treatments continue to offer hope for people managing cancer, along with their caregivers and loved ones. However, with rising costs of cancer drugs and overall care, coupled with complex treatment plans, oncology management must put the patient first with a firm focus on care quality and cost control.

Such an approach must identify and act on all opportunities to improve health outcomes while lowering costs across the care journey. Collaborating with providers, ensuring therapy alignment to clinical guidelines, improving access to the most clinically appropriate precision treatments and proactive care management are all essential to ensuring the best possible outcomes for everyone involved in patient care.

Roger Brito is the divisional head of enterprise oncology at CVS Health and a medical oncology specialist.