Addressing Cost and Quality Issues in Novel Treatment Strategies for Non–Small-Cell Lung Cancer: Where Is Our Focused Factory?

August 2011, Vol 2, No 5 - Commentary


Ira M. Klein, MD, MBA, FACP

By Ira M. Klein, MD, MBA, FACP

Senior Medical Director, Clinical Consulting, Strategy and Analysis National Accounts, Aetna.


Evidence-based medicine and a focused clinical orientation are key elements to delivering the right care at the right time to the right person. The recent findings reported at the 2011 American Society of Clinical Oncology annual meeting regarding the use of novel therapies and strategies in the treatment of non–small-cell lung cancer make achieving these goals harder than ever.

Each year, treatment approaches become more complex and variable, and translating protocols that demonstrate positive outcomes into daily community practice seems more difficult than ever.

Beyond the waste and nonbeneficial care for those not well-matched for treatment,we face the additional problemof sizing and comparing treatment efficiencieswithin a disease state.How would experts in process control and quality improvement from other industries handle this issue?

Oncology care in the United States today reflects 2 dramatic contrasts. Although admirable in its application of molecular biology (the pinnacle of science), oncology care is still very nonsystematic and inconsistent in the way new discoveries and practices are being incorporated into the patient care realm.

If data are the drivers of quality improvement, how do we collect and measure that quality information in real-life cancer care?Auniversal oncology care data repository does not exist today. Without the regular application of agreed upon gold standard National Comprehensive Cancer Network– derived pathways, the typical community oncology practice, even if verbally espousing commitment to best practices, is practicing “mass inspection” for quality rather than building quality into the product in the first place.

Academic oncology practices should also not be given a pass on this issue, because quality is more than a glossy advertising campaign.

We are in dire need of decision support and data storage tools that address oncologists’ needs in real time. We also need reporting that helps us all learn what is the most effective and efficient care at an aggregate level.

Without this, we will never know whomight be better servedwithmaintenance therapy, when to use erlotinib, and how we can apply companion diagnostic testing (to detect mutations in, for example, epithelial growth factor receptor, EML4-ALK, heat shock protein 90, and toll-like receptor 2) to the right patients so that theymay benefit from more targeted agents.

Finally, the application of aggressive end-of-life care will surely decline when all treating oncologists have more data-linked confidence in the “best care options.” When this happens, we will have our “focused factories,” and the gods of process control will be smiling down upon us.