How We Deliver Cancer Care: Time For A Change?

One cannot ignore that fundamental change is coming to how we deliver cancer care. And although we don’t know how all of this will work out, we should be concerned that with change we run the risk there will be folks who could be left behind. And that is not a good thing.

This past week’s annual conference for the National Comprehensive Cancer Network—an organization I admire for its efforts to keep cancer treatment guidelines up to date in real time—gave some hint as to how these shifts are taking hold.

Usually this is a meeting chock full of updates on the latest advances in cancer treatment. And although there were certainly plenty of insights into the latest cancer therapies there was also plenty of time devoted to topics that weren’t about the newest drugs or surgical approaches to cancer.

Access to care, the evolution of telemedicine in oncology, equity in cancer care, the impact of state legislation on payments for drugs and strategies to improve the access of newly diagnosed cancer patients were also on the agenda. These topics all reflect the fundamental forces impacting how the typical person with cancer receives their care.

When major cancer centers around the country decide that it is time to get genuinely engaged with disadvantaged communities to improve access to clinical trials or improve the customer experience for a newly diagnosed patient seeking care or figure out how to give chemotherapy at home you have to take notice that there really is change in the air.

The traditional way we have received our medical care has been through a “bricks and mortar” approach: you are the patient, you need to see a health professional, you go to the doctor’s office (which more frequently is now at a hospital or an outpatient facility owned by a hospital or large medical group), you have a short visit with a physician or other clinician, and then you head back home.

Much of what we consume as health care is centered around a location and a process that may not exactly be convenient to your personal needs: You may live far away from the office; you may have to take public transportation—in some cases 2 or 3 different buses or subways to get to your appointment; you may have to find parking (I actually know of one clinic where the shortage of parking is leading to significant delays at “the office” as patients can’t find a parking space); you and/or your caregiver have to take extra time off work to make that trip and the appointment. The list goes on, and you get the idea: this experience is certainly not built around you.

In short, medical care has what I call an “edifice complex”: big buildings, lots of people, big budgets—and leave consumers to pay the cost directly or indirectly through their insurance or their government. Even a little change around the edges to make things more convenient would be welcomed by many.

The situation gets more complicated when you have a serious illness like cancer. You are not alone if you wonder why it has taken so long for organizations like medical clinics to start thinking of alternative approaches to caring for you, the patient. Frankly, the need for change seems obvious and long overdue.

The pandemic has certainly had an impact: Cancer clinics had to start thinking of alternative approaches to care for folks as the pandemic took hold. Now that we have a brief respite in COVID cases, things are going back to usual patterns in many ways however some of those new approaches, such as the use of telehealth to supplement care, have had some staying power.

And then there are new approaches to care, such as home administration of cancer medications. What a novel idea: bring the treatment to the patient instead of the patient to the treatment.  It is not a brand-new concept, but it certainly hasn’t been one embraced by many oncology practices.

Part of that hesitancy apparently has to do with doctors’ concerns about the quality of care. Part has to do with concerns about the risk of unexpected side effects. Part of it has to do with the fact that it represents a major change in the way we deliver cancer care, moving it from the bricks and mortar of a facility to the convenience of the patient’s home. And part of it has to do with the fact that taking treatment out of the doctor’s office means the doctor will make less income.

No matter: at least one prominent cancer center—the University of Pennsylvania—has made a concerted effort to establish a program of home administration for intravenous cancer drugs. And although it has taken a lot of thought and effort, the reality is it works—and is appreciated by both patients and caregivers.

Another major center highlighted their efforts to improve the experience of newly diagnosed patients calling the center for an appointment, trying to streamline that first contact and helping patients get in the door as promptly as possible. Not an easy process, given all the information that must be gathered and evaluated, but at least someone is trying to make the life of a cancer patient just a bit easier.

As you might imagine, the list of possible “innovations” in cancer care is long, and it is clear we have not done such a great job for our patients with cancer when it comes to making their lives easier and maybe a bit less stressful.

But what is going to happen to the large number of folks who aren’t comfortable with these changes–which are frequently enabled by technology? What about those who can’t access technology, or are older and more resistant to change? What’s going to happen to them?

The short answer is that we simply don’t know. We have seen the digital divide grow in health care, and many experts are rightly concerned about long term impact. That question is going to loom larger and larger as this effort gains momentum.

One thing is certain: change is coming and is inevitable. How we deal with that change and enable all to take advantage of that change must be top of mind and a test of our success.

So welcome to the new medical landscape: Different expectations, different approaches, different technologies. Together they are going to increase the pressure to recreate the health care experience. Telemedicine, more focus on customer care, cancer treatment in the comfort of your home: these are just the first steps in what is going to be fundamental, structural change in how we deliver cancer care.

When it comes to our health, it will no longer be business as usual, nor should it be. Consumers deserve and should demand better.

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