ASCO Urging Oncologists to Consider Value in Patient Care
Hollywood, FL—At the Third Annual Conference of the Association for Value-Based Cancer Care, Sandra M. Swain, MD, FACP, President of the American Society of Clinical Oncology (ASCO) and Medical Director of Washington Cancer Institute in Washington, DC, described efforts by ASCO to enhance the quality and cost-effectiveness of the cancer care its members provide.
ASCO’s Focus on Quality and Cost
Speaking for ASCO’s membership, Dr Swain said, “Oncologists have always wanted to provide the best care for their patients, but the discussion about value and quality is not something that we had in medical school.”
ASCO has carved out approaches to address the needs for quality and value in oncology, by creating a task force, communication tools, and performance measures. “We are showing oncologists that we are being proactive about the cost of care,” Dr Swain said. She outlined the following ways in which ASCO is demonstrating value through performance measurement:
- Implementation of ASCO’s Quality Oncology Practice Initiative (QOPI) as a national platform
- Transparent, flexible, and meaningful measures
- Specialty society leadership can enhance provider buy-in
- Outreach to payer community, including Centers for Medicare & Medicaid Services
- ASCO led development of multispecialty consensus on criteria for quality-focused registries—hope is that these can satisfy physician quality reporting system requirements.
ASCO recognizes that providers should not shy away from discussing costs with patients. In 2007, ASCO established the Cost of Cancer Care Task Force to develop strategies related to cost. In 2009, ASCO expanded this to their Guidance Statement on Cost, which maintained that “communicating with patients about cost is a key component of high-quality care.” This was followed up with a booklet for patients, Managing the Cost of Cancer Care, that was written to help guide these conversations.
“We are committed to providing tools to physicians to discuss cost with patients. It is important, with all the turbulence in the healthcare field, for them to understand healthcare plans,” she pointed out.
Currently, a pilot “treatment regimen tool” for physicians is nearing completion; this assesses the benefit, toxicity, and cost across regimens and will serve as support for patient–physician decision-making. Physician education about cost of care is also provided through ASCO University webinars. In 2010, ASCO issued a guidance statement on advanced cancer, which encourages earlier conversations about patient options and preferences for end-of-life care. In a joint effort with C-Change, an organization comprised of key cancer leaders, ASCO is promoting greater uptake of palliative care and hospice.
Choosing Wisely Program
ASCO is particularly proud of its new Choosing Wisely program, which guides physicians in the “stewardship of limited resources,” Dr Swain noted.
The Choosing Wisely program developed by the ASCO Cost of Cancer Care Task Force asks physicians to question 5 common practices that are not typically cost-effective, as outlined in the Table. The next 6 questions will be unveiled later this year.
Quality Oncology Practice Initiative
ASCO’s QOPI is an oncologist-led, practice-based quality improvement program aimed at promoting excellence in cancer care by helping practices create a culture of self-examination and improvement. The oncologists perform chart reviews of their practices, comparing their performance on 150 quality core measures to national or regional aggregates. To date, 167 practices have become QOPI-certified.
ASCO hopes to unveil a digital version of QOPI by the end of this year.
Most of the evidence basis for cancer treatment is generated from clinical trials, but only approximately 3% of patients with cancer enroll in trials. Therefore, real-life results are often different from those seen in clinical trials.
A new database called CancerLINQ (Learning Intelligence Network for Quality) will collect and analyze cancer care data from patient visits to create a knowledge base that can be accessed in real time by clinicians, researchers, and patients. “We want to generate data based on these 95%. Every patient will become a knowledge donor,” Dr Swain stated (Figure). “Oncologists who access CancerLINQ will receive the right decision support at the point of care, to help them select treatments for individual patients,” she added.
A pilot program of patients with breast cancer confirmed the program’s feasibility. In the prototype, more than 100,000 anonymous patient records have been supplied by participating practices, yielding millions of data points (eg, on patient characteristics, treatments, and outcomes) that will ultimately be aggregated into a usable format. This should be particularly helpful in the case of patients who have rare tumors or who have unusual histologies.
Applied to oncology, a rapid learning system through CancerLINQ “will revolutionize the way oncology practices measure and improve the quality of the care,” Dr Swain maintained.
A New Value Task Force
“Most efforts are currently around cost, but we know it’s also about toxicity, quality of life, and so forth,” Dr Swain noted. ASCO’s board has recently created a Value Task Force to define a value-based framework for cancer care.
A working group will explore a categorical model with weighted value components, including efficacy, toxicity, cost, and patient preference. The plan is to include a wide range of stakeholders to develop and to disseminate the program.
“We plan to look at this issue during the next year and to eventually be able to measure the value that gives the best quality of life,” Dr Swain concluded.