On March 2, 2022, ACCC convened its members, sponsors, and industry partners in person for the first time since the dawn of the COVID-19 pandemic. Participants in ACCC’s 48th Annual Meeting and Cancer Center Business Summit (AMCCBS) could choose to attend either in person in Washington, D.C., or via live-streamed sessions, enabling more people to participate in ways in which they were most comfortable.
AMCCBS Spotlights Survivorship
A day before the official opening of AMCCBS, expert panelists took to the stage to discuss the current landscape of survivorship care in oncology and how cancer programs and practices across the U.S. should rethink their current models of care. Panelists agreed that the key to effective survivorship care is smooth collaboration between a patient’s oncologist and primary care provider (PCP). Panelists also agreed that while multidisciplinary team-based models of survivorship care are more financially feasible than others, considerable barriers exist to employing them. Resolving obstacles to obtaining reimbursement for survivorship care services and defining different provider roles (e.g., the responsibilities of a PCP versus those of an oncologist) are key to improving how cancer programs and practices transition their patients from cancer treatment to survivorship care.
Setting the Tone
In opening the conference on March 3, ACCC 2021-2022 President Krista Nelson thanked attendees for their dedication to quality cancer care throughout the COVID-19 pandemic. “I believe that the magic is in welcoming,” she said, explaining, “it's not that welcoming means that we have to accept everything or that we can't advocate for what is right. But we can welcome life’s challenges as a part of this complex world and strive to uncover what might work for us to cultivate some sense of peace.” In her unique way, Nelson opened AMCCBS by invoking a sense of calm through a group mindfulness activity that invited attendees to focus not on the often-unsettling current events of the world, but rather on being open to new ideas for the next two days.
Keynote speaker Cary Gross, MD, professor of medicine and director of the Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center at Yale School of Medicine, addressed the many ways in which the American healthcare system has failed patients. By enabling the private sector to determine the cost of drugs and the nature of healthcare delivery, said Dr. Gross, the system no longer has patients at its center. Our healthcare system distributes its resources inequitably, he said, leading to wide disparities in treatment and outcomes. As a result, two out of five patients with cancer in America drain their savings within two years of being diagnosed. “We need to prioritize equity in everything we do,” Dr. Gross affirmed.
Dr. Gross elaborates his arguments in two chapters he co-authored in the newly published book, A New Deal for Cancer Care: Lessons From a 50-Year War. The book, written by several experts in cancer care, further makes the case that by truly placing the patient at the center of cancer care, treatment, and prevention, the healthcare system will start to reform itself. For example, Dr. Gross states that there are “too many cancers, too many treatments, and too high of costs for those treatments.” This causes the quantity of care to outpace the quality of care. For example, said Dr. Gross, resources are often wasted on the overdiagnosis of non-progressive or very slow-growing cancers, resulting in unnecessary, expensive treatment and fewer resources for effective preventive care. Dr. Gross added that one of the most effective ways to avoid wasting resources on ineffective treatments is to develop targeted cancer screenings that can decrease mortality rates for all cancers.
Dr. Gross closed his keynote address by discussing what he believes is oncology’s top issue when addressing poor patient outcomes: a strict focus on a cure and a skewed government-funded research agenda that does not place patients at the center. “The concern is that if you keep only focusing on the cure for cancer, you are going to ignore other important things, like prevention research,” said Dr. Gross. To truly help patients with cancer, even before they begin treatment, Dr. Gross suggested that oncology needs to “double down on prevention;” develop more targeted screenings; develop new vaccines; lower drug prices; and employ alternate payment models that reward payers for efficient, effective care.
Continuing the discussion about the importance of adopting a patient-centric focus in oncology care, Mark Liu—director of Strategic Initiatives, Oncology Service Line at Mount Sinai Health System & Tisch Cancer Institute—described how Tisch’s early mobility program for hospitalized patients with cancer helps saves beds for those who need them and improves clinical outcomes. “We wanted to increase our patient bed capacity and provide the right level of care in the right setting at the right time,” said Liu.
Liu said that more than 33 percent of hospitalized adults who are 70 years old or older are discharged with a disability they did not have prior to their admission. And these disabilities can be detrimental when compounded with active cancer treatment. To decrease the odds of this, Liu and his team launched a program aimed at keeping hospitalized patients in the cancer ward more mobile and less fragile.
Using clinic-ready standardized assessment tools, the hospital’s cancer care team targeted patients who would benefit from being mobilized at least twice a day. In collaboration with the physical therapy department, the team introduced mobility aides as part of their inpatient staff to keep patients moving and thereby reduce their average length of stay, increase available beds, and improve outcomes. “The time doesn’t exist for our nurses to do this, so they were very appreciative of the mobility aides in helping patients,” said Liu. He further reported that since the program’s inception in 2019, there has been no increase in patient falls associated with the use of mobility aides. However, there has been an increase in hallway traffic, as patients are now more able to get out of their hospital beds and walk the halls.
A Librarian in the Cancer Ward
In 2017, Levine Cancer Institute hired a “consumer health librarian” to establish a digital library of patient education handouts, including links to approved cancer information websites, which are available to all clinicians and staff through Levine’s Microsoft SharePoint site. The librarian, Mindy Ozan, edits and formats all of Levine’s patient-facing documents so they are written in plain language and at a sixth-grade reading level.
The end goal of this effort is to help patients with cancer understand their disease and treatment so they can participate more fully in shared decision-making with their providers. Ozan explained to conference attendees that once patient-facing documents are reviewed and approved, she makes them easily downloaded and printable, so providers can share them with patients without technology being a barrier. “Many people don’t have cell phones or access to internet,” said Ozan. All patient resources are uploaded to Levine’s digital patient education library, where they are easy to access and organized by individual diagnoses or treatment.
Consisting of members from diverse clinical roles and backgrounds, Levine’s Oncology Patient Education Committee reviews and approves any customized patient education materials produced by Ozan and her team. Committee members review these materials for appropriate reading level, accuracy of clinical content, and ease of access. Several additional patient-focused tools have come out of this committee, including the patient care notebook and care alignment tool, which can better enable clinicians and patients to discuss goals of care and treatment options.
Stay tuned to our next blog post on the final day of ACCC’s 48th Annual Meeting and Cancer Center Business Summit.
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