Preparing for Future Trends in Cancer Care

April 2011, Vol 2, No 2 - ACCC Conference

Washington, DC—Oncologists must plan for and invest in future trends and expected growth using available evidence- based information, said Rebecca Booi, PhD, Director of Cancer Solutions at Sg2, during the 2011 Association of Community Cancer Centers 37th Annual National Meeting.

The boom in cancer survivors, already near 12 million today, will be a crucial factor in reshaping the face of cancer care. The survivorship population is expected to grow by 80% over the next decade, as cancer treatments improve and the baby boomers age and join Medicare (the population most susceptible to cancer).

The settings where care is delivered will also change, according to Dr Booi, with technological advances driving treatment from inpatient to outpatient settings.

“It will also expand the number of treatments that are given,” she says, “as we look at more multimodality treatments and more complex interventions.”

Epidemiologic trends in relation to cancer are mixed—smoking is down, but obesity continues to rise, and both trends will have an impact on cancer rates and outcomes, considering the link of these conditions to cancer.

Growth in Technologies
Two technologies have particular growth potential—interventional oncol ogy, which speeds recovery and lowers the risk for complication, will be a “huge opportunity for growth and a great source of program differentiation for cancer centers.” Stereo tactic body radiation therapy, allowing for highdose and high-accuracy treatment, is the second anticipated growth area.

Screening. The recession has depressed the use of certain cancer treatments, most notably preventive screening for colorectal cancer and mammography. However, the healthcare reform has eliminated patient cost-sharing for many preventive screenings, so utilization of these services can be expected to grow. Dr Booi predicts a 39% increase in mammography utilization over the next decade.

Surgical intervention. Increased screening and an aging population will, in turn, boost surgical intervention. “This is a big revenue opportunity,” she says. “The performance strategy for colorectal cancer is to increase your screening rates, because this is going to drive downstream utilization of surgical resections, which we know have favorable margins.”

Chemotherapy. Chemotherapy is another opportunity for growth. Evidence also suggests that chemo therapy will grow by 38%, thanks to more “complex and targeted” therapies.

“What does this mean for planning? I think on the inpatient side, it means be careful; don’t overplan for demand that you may not see. And on the outpatient side, it means also be careful, but in terms of efficiency,” Dr Booi said.

Imaging. Positron-emission tomography (PET) will also likely see robust growth. After the National PET Registry study determined that PET improved treatment planning, the Centers for Medicare & Medicaid Services expanded coverage for PET.

Dr Booi expressed skepticism over the prospects for proton beam therapy. “Is adopting proton beam therapy a performance strategy for cancer centers?” she asked. Her reference to the $100-million to $150-million imaging machines provoked a laugh from the audience. “Well, maybe. Maybe not.”

Coordinated Care and Utilization
Dr Booi predicts that the increasing pressure to move toward coordinated care models such as accountable care organizations and bundled payments will ultimately decrease utilization, because improved communication will result in fewer duplicate tests and better outpatient self-care.

“If you’re communicating better, if you’re improving hand-offs, then your patients are probably better managing their diseases, they’re not being exposed to duplicate or unnecessary tests, and they’re probably being better educated about managing their symptoms in the outpatient setting. So they’re not being readmitted for complications like nausea or dehydration as a result of their treatment.”

Dr Booi endorses the utilization of “time frames” to diminish wasteful backlogs in the treatment process and reduce patient anxiety. This is something that cancer centers can market to patients; “we’ll get you in and out quickly.” She cited Gundersen Lutheran Center in La Crosse, WI, which reduced treatment to turnaround time to 7 days, resulting in fewer negative biopsies.

In Memphis, TN, the Baptist Hospital for Women decreased turnaround times without adding staff or equipment by establishing an online preregistration portal and shifting business hours to better meet patient demand.

The Cleveland Clinic, which suffered from long wait times for chemotherapy, introduced targeted scheduling to address inefficiencies in infusion suites. The patient satisfaction rate soared to 98%.

Technology-Driven Oncology
Dr Booi anticipates strong growth in seeking treatment for prostate cancer, especially in the outpatient setting; much of this will be made up with reimbursable electronic visits, she expects. “I can imagine that this is kind of hard to grapple with. But think about 2 years ago, could you have imagined an iPad if you weren’t Steve Jobs? And could you have imagined that today, iPads are being used for check-ins at cancer centers, for patient education, to keep patients entertained during treatment?”

Dr Booi strongly believes that technology will revolutionize cancer care. “There are a lot of opportunities in this technology revolution that we can incorporate into the way we deliver care,” she said.