The public comment process is a huge part of what makes our recommendations work. We want everyone who is interested, but especially patients, to read our recommendations and let us know what works, what doesn’t work, what makes sense, and where we should push our healthcare system even further.
Our Oncology Care workgroup has been meeting since May of last year to develop focused recommendations for our healthcare community. These recommendations are open for your feedback! We have created a short online survey to gather your comments, but feel free to send any additional comments or ideas to me at GWeir@qualityhealth.org. Deadline for feedback is 5pm on February 26, 2016.
Cost and quality of cancer care vary greatly in the United States. Significant variation in diagnosis, treatment, and supportive care for patients promotes poor outcomes and excessive cost for patients and the health care system. While evidence-based guidelines exist, adoption has been inconsistent. To address this, our workgroup developed two primary focus areas:
1. That all clinics follow the American Society of Clinical Oncology’s (ASCO) Choosing Wisely recommendations:
– Do not use PET [positron emission tomography], CT [computed tomography] and radionuclide bone scans in the staging of early prostate cancer at low risk of spreading.
– Do not use PET, CT, and radionuclide bone scans in the staging of early breast cancer that is at low risk of spreading.
2. That palliative care be offered alongside active anti-cancer care, as needed. Oncology care should be aligned with a patient’s individual goals and values and follow ASCO’s position statement of key elements for individualized cancer care. Patients should be apprised of the harms, benefits, evidence, and potential impact of chemotherapy and radiation at all stages in their illness trajectory.
Unnecessary advanced imaging for staging of low-risk breast and prostate cancer exposes patients to excess radiation, can show false positives that lead to unnecessary treatments, and be costly to the patient and to the overall health care system. Adoption of the Choosing Wisely guidelines has been inconsistent. Barriers to adoption of the ASCO Choosing Wisely guidelines can stem from individual clinician belief and behaviors and from organizational behaviors and structures. Additionally, the larger health care structure can also incentivize clinicians to over-use imaging through fee-for-service reimbursement.
We encourage clinicians and care teams to regularly ask patients, their family members, and friends to discuss their goals of care and work with the care team to tailor care to patient goals. Integration of palliative care as valued part of overall patient care can help facilitate these discussions and supports patients mitigate negative side effects of treatment. However, many health care systems struggle with the growing need for palliative care and face capacity issues. Barriers to integration of palliative care include clinician belief, reimbursement, and current standard practice.
This Report discusses methods of addressing barriers to alignment with ASCO’s Choosing Wisely recommendations for advanced imaging and for integrating palliative care alongside active anticancer therapy including implementation strategies for multiple health care stakeholders.
We hope to hear from you!
Ginny Weir, MPH
The Dr. Robert Bree Collaborative