Daniel R. Verdon

When it comes to cancer care and survivorship, the U.S. healthcare system should take immediate steps today to avoid a volume problem in the near future.

While the number of diagnosed cancer cases remain flat each year at 1.7 million, there is a growing population of cancer survivors expected to surpass 18 million in 2020. Cancer survivors have their own unique needs to maintain optimal health, explains Catherine M. Alfano, PhD, of the American Cancer Society at the American Society of Clinical Oncologists (ASCO) Annual Meeting in Chicago. In the United States and worldwide, Alfano says, we are experiencing provider shortages and increased patient volumes. The impact is creating a self-perpetuating cycle of stress, overload, and burnout for physicians. Costs of cancer care are also climbing, and health care is shifting from fee-for-service to value-based care.

“It is a perfect storm,” Alfano adds.

These trends are fueling the need to reinvent care delivery models to accommodate this growing segment of the population, adds Deborah Mayer, PhD, RN, ACON, FAAN, of the University of North Carolina at Chapel Hill School of Medicine. Successful future models will require more deliberate coordination with primary care and various specialists throughout the healthcare continuum.

These issues, and more, were addressed during a panel discussion at the American Society of Clinical Oncologists (ASCO) in Chicago titled “Implementing Risk-Stratified Cancer Follow-up Care: How, Why, and What Is the Return on Investment.”

Alfano moderated the discussion. Other panelists included: Jane Maher, MBBS, FRCP of McMillian Cancer Support in London, and Michael Jefford, MBBS, MPH, PhD, of the Peter Macullum Cancer Centre in Melbourne, Australia.

The panel discussion sought to describe the logistics of developing and implementing risk-stratified follow-up cancer care delivery.

We know that cancer death rates have been declining, Mayer says, and survivorship has been climbing. “But we know far less about the health impacts on longer-term survivors. There are ways to look at lower and higher risk patients, Mayer says.

Risk stratification is one viable option to improve care delivery and patient outcomes, she adds.

In fact, a summit from the American Cancer Society/American Society of Clinical Oncologists identified strategies to advance personalized follow-up care, including:

•    Develop a candidate model (or models) of care delivery to test in various healthcare delivery sites.

•    Model the effects of personalized follow-up care pathways on patient outcomes, workforce, and healthcare resources. At the same time, future models need to assess utilization and cost outcomes.

•    Create consensus-based guidelines for the delivery of personalized follow-up care pathways.

•    Identify research gaps to identify and implement personalized follow-up care pathways.

The actions, recommendations that physicians can pursue:

•    Clearly communicate the role of specialist and primary care physicians at the time of diagnosis. Inform cancer patients that their care will likely transition to primary care providers.

•    Examine current patient rosters, clinic utilization patterns, and new patient visit slots. Consider how shifting care of low-risk/low-need survivors to primary care or advanced practice practitioners would affect these factors.

•    Reinforce expectations about follow-up care by ongoing communication throughout cancer treatment.

•    Shift follow-up appointments after treatment.

•    Support patients who are doing well in self-managing their health.

•    Build collaborative bridges with primary care providers.

Shifting the model of follow-up survivorship care is part of the solution but needs to be based on risk stratification collaboration between primary care providers and oncologists, team-based care, and supported self-management.

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Trends in cancer survivorship, the shift to value-based care are fueling the need to reinvent care delivery models to accommodate this growing segment of the population.

Author | Daniel R. Verdon

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