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Fighting Cancer: Finding the Right Approach

Joe Cantlupe, for HealthLeaders Media, July 14, 2010
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Key No. 2: Improving outcomes with data

Academic and community oncologists working at the University of Pittsburgh Medical Center formed a Web-based process to collect data on the most unique aspects of cancer care for each patient, based on his or her stage and type of cancer, which has resulted in improved outcomes and reduced costs for oncology practices.

In essence, 15 disease-specific committees of academic- and community-based physicians regularly review and revise the so-called Via Oncology Pathways, based on their evaluation of the latest clinical literature.

"By standardization of care, and driving to the best evidence-based treatments, we've been able to demonstrate not only better care, but also a reduction in the total cost of care compared to practices without the Pathways," says Peter Ellis, MD, medical director at Via Oncology and practicing medical oncologist at UPMC.

For various types of cancer, following the Pathways results in reduced rates of hospitalization, according to Ellis.

Most physicians use the tool throughout the day as they are presented with new patients or patients requiring a new therapy or modification to their therapy due to disease progression or toxicities. Questions about each unique patient are posed to the physician. Based on the answers, the software navigates him or her to the Via Oncology Pathways recommendation. The physician can either order the Pathway therapy or, if appropriate, find an off-Pathway therapy, if the physician sees fit.

A recent collaboration announced in New Jersey among Via Oncology, Horizon Blue Cross Blue Shield of New Jersey, and the Center for Cancer and Hematologic Disease illustrated the plan and the potential for widespread reduced costs. Studies in breast cancer and non-small-cell lung cancer with Highmark BCBS demonstrated a slower rate of growth in the total costs of care in the UPMC/Pathways patients as compared to non-UPMC/non-Pathways patients. While details have not been revealed, Via Oncology officials say savings have also resulted. There are also oncology practices in Pennsylvania, Maine, Florida, and Texas using the program, and Via Oncology wants to expand it nationwide.

The Pathways "define the single best treatment for each state and stage of disease according to a hierarchy of efficacy, toxicity, and cost," says Kathleen Lokay, president of Via Oncology in Pittsburgh. "Thus, when the oncologist determines the exact state and stage of disease for an individual patient, the Pathways provide the best treatment for that patient."

Lokay says the program has "spent a lot of time and money developing platforms that physicians can support. We're trying to find the best therapies for each unique disease. Breast cancer isn't just one disease—it's 30." Via Oncology's content and IT platform are being adopted and implemented by oncologists nationwide. The Pathways portal integrates easily into each oncologist's workflow for rapid implementation, she adds.

Key No. 3: Evaluating medical adherence

Medical adherence is a significant issue in an oncology service line, but one not often specifically addressed. With respect to clinical care, nonadherence limits treatment effectiveness and can contribute to increased costs of care, therapeutic errors, and disruption of the alliance between caregivers and families.

In oncology, it is especially important because a new generation of targeted therapies, with many taken as pills, have transformed cancer treatment for many patients. According to the National Comprehensive Care Network, one third of all chemotherapy agents now are developed for oral use.

The newly created Center for Adherence Promotion and Self-Management at Cincinnati Children's Hospital Medical Center is evaluating the issue for its service line, with the possible reduced costs and improved outcomes as the result. Pediatric oncology is a key focus, one in which there has been particular concern because of medical noncompliance and the need for drugs, says Drotar.

In an experimental program funded by a grant from the National Cancer Institute to test the efficacy of a problem-solving model, the hospital has begun working directly with patients and parents to carry out training on collaborative problem-solving to reduce barriers, such as cultural ones, that interfere with adherence in clinical trials, Drotar says. The approach also includes electronic monitoring and the efficacy of behavioral interventions, such as therapy and family support. "We will be able to describe the prevalence of nonadherence when our baseline data is complete," Drotar says.

Key No. 4: Introducing palliative care

A growing aspect of the service line is palliative care. While most cancer centers in the U.S. have palliative care programs, there are wide variations in the scope of services and how well they are integrated into oncology care.

At the East Jefferson General Hospital in Metairie, LA, palliative care has expanded, with oversight being the responsibility of the hospital medical director, according to Debbie Schmitz, the cancer care navigator at the 450-licensed- and staffed-bed facility. The hospital also has become affiliated with MD Anderson Physicians Network for evidence-based protocols and treatment processes developed by the University of Texas MD Anderson Cancer Center.

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