“Patient-centered care” and “care coordination” are the buzzwords of healthcare today, leading physicians across the country to reevaluate how they deliver care. Nowhere is the application of these terms more urgent, however, than in the treatment of cancer patients.
On Oct. 30, the leading minds in cancer care gathered at Fordham’s Lincoln Center campus for a roundtable discussion on improving care both for patients whose cancer is active and for patients whose cancer is in remission.
“It’s a question of measuring the value of health, and not just good healthcare,” said Falguni Sen, PhD, director of Fordham’s Global Healthcare Innovation Management Center, which co-sponsored the event. “Value,” he continued, means increasing the quality of care while keeping costs under control.
A critical component of enhancing value is to coordinate care across all aspects of a patient’s treatment, said panelist Randall F. Holcombe, MD, professor of medicine at Mt. Sinai’s Icahn School of Medicine and deputy director at the Tisch Cancer Institute.
Cancer is a complex illness, he said—it entails multiple treatments over long periods of time, and it often involves multiple treating physicians, rather than a single oncologist. In addition, patients with cancer experience a high “symptom burden,” meaning that both the cancer and its treatment have steep physical and emotional tolls on patients.
Because of cancer’s complexity, it is critical that all members of the treatment team coordinate the care they provide, Dr. Holcombe said. Doing so can have marked benefits, for instance, reducing the number of emergency room visits and unnecessary hospital admissions. Quantitatively, this means lower costs; qualitatively, it means patients spend less time in a hospital and are spared the radiation-related toxicities of excessive imaging and scans.
The roundtable also touched on the importance of continuing care for patients once their cancer is in remission. This involves not only continuing medical care, but also complementary services such as nutritional counseling, psychosocial support, and rehabilitation services for late effects of the illness.
Patients may also need help grappling with the reality of having experienced a life-threatening illness and what this means going forward—a concept known as patient survivorship. Many patients embrace the term “cancer survivor” as a positive identity, while other patients are ambivalent about the term, and still others eschew it altogether.
“For many of our cancer patients, every day or every minute they’re reminded that they had cancer,” Dr. Holcombe said. “There is the constant concern that the cancer will come back, and that they’re not really ‘well.’ And they often have specific reminders of their cancer, such as neuropathies or other long-lasting toxicities.”
“One survivor told us that cancer survivorship needs to be looked at as if it is a chronic condition like diabetes, and it’s not,” said panelist Mandi Pratt-Chapman, director of the George Washington University Cancer Institute and co-PI for the American Cancer Society’s National Cancer Survivorship Resource Center. “Another told us that he had to go from the mindset of a ‘cure’ to one of ‘control,’ because he doesn’t know if he’ll ever be fully cured.
“There are some people who embrace survivorship, and others who don’t want to think about it or be reminded of the experience they had.”
The roundtable was sponsored by the Emblem Health Value Initiative, a partnership between EmblemHealth Inc. and the Global Healthcare Innovation Management Center at the Gabelli School of Business.