According to the World Health Organization (WHO), cancer is now the leading cause of death worldwide, with approximately 14 million new cases and 8.2 million fatalities annually, which is predicted to grow by 70% over the next 20 years. (World Health Organization , 2015) Four problems profoundly impact cancer clinical outcomes in the world today: (1) non-adherence, because of increasing use of oral cancer agents; (2) coordinating care, because cancer care is team-based across disparate providers (poly-pharmacy & poly-provider); (3) drug-drug interactions, because at least 2.24 million cancer patients annually experience serious interactions, and 89,600 die as a result (van Leeuwen RW, 2013) and, (4) patient education, because cancer care is complex, and targeting and delivering information largely impacts clinical outcomes.
Oral cancer therapies are increasingly the treatment of choice for cancer, and require longer treatment plans. Medication non-adherence rates for oral cancer agents range from 21% (2.94 million) to 28% (3.91 million). Moreover, 69% of cancer patients have been found to rely on caregivers whose estimate adherence at 99%, but are incorrect 50% of the time. (Stefan Feiten, 2016)
Because American adults now see and average of 19 providers in their lives (28 for those over age 65) coordinating care across disparate health systems or pharmacies is increasingly necessary and difficult. (Practice Fusion, 2016) The American Society for Clinical Oncology has noted the “…increasing emphasis on use of the medical home model for delivery of care is driving greater emphasis on team-based care by health providers from a variety of backgrounds and specialties, including primary care physicians, urologists, gynecologists, pathologists, pharmacists, genetic counselors, mental health specialists, pain and palliative care specialists, and advanced practice providers.” (American Society of Clinical Oncology, 2016) However, as noted by the Institute of Medicine, the “fragmented cancer care system…impedes coordinated care and the development of comprehensive treatment plans.” (Institute of Medicine, 2011) Moreover, because cancer is a collection of diseases, and not one disease, customizable treatment plans are critical.
Personalized targeting and delivery of information is also critical in cancer care. Studies have found 96% of patients specifically wanted to know if they had a type of cancer, and 79-96% of patients wanted as much information as possible; however, a plethora of studies indicate serious deficits by providers in accurately assessing and delivering information about their care to patients. (Aoife Drew, 2002) The intervention strategies recommended by treatment leaders, including:
(1) Practice guidelines for oral cancer agents via patient monitoring and feedback in real-time, a multi-component intervention (e.g., text reminder devices, targeted provider feedback), education, and depression by identifying it via assessment surveys and referring it to healthcare teams for treatment; (Spoelstra, 2015)
(2) Coordinates care, optimizes, and reconciles medication regimens; and, (Cutler, 2010)
(3) Insures patients neither miss doses, nor incorrectly take them. (Walker, 2015)
Works Cited
American Society of Clinical Oncology. (2016). The State of Cancer Care in America: 2016. Alexandria: American Society of Clinical Oncology.
Aoife Drew, T. F. (2002, April 1). Responding to the information needs of patients with cancer. Nursing Times, pp. https://www.nursingtimes.net/responding-to-the-information-needs-of-patients-with-cancer/199393.article.
Cutler, D. (2010). Where are the health care entrepreneurs? The failure of organizational innovation in health care. Innovation Policy and the Economy, https://dash.harvard.edu/handle/1/5345877.
Institute of Medicine. (2011). Patient-Centered Cancer Treatment Planning: Improving the Quality of Oncology Care. Washington DC: National Academies Press.
Practice Fusion. (2016, September 12). Survey: Patients See 18.7 Different Doctors on Average. Retrieved from PRNewswire: http://www.prnewswire.com/news-releases/survey-patients-see-187-different-doctors-on-average-92171874.html
Spoelstra, S. (2015). Putting Evidence Into Practice: Evidence-Based. Clinical Journal of Oncology Nursing, 60-72.
Stefan Feiten, R. W. (2016). Adherence assessment of patients with metastatic solid tumors who are treated in an oncology group practice. Springerplus, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777967/.
van Leeuwen RW, B. D. (2013). Prevalence of potential drug-drug interactions in cancer patients treated with oral anticancer drugs. Br J Cancer, http://www.ncbi.nlm.nih.gov/pubmed/23412102.
Walker, J. (2015, December 31). Patients Struggle With High Drug Prices. The Wall Street Journal, pp. http://www.wsj.com/articles/patients-struggle-with-high-drug-prices-1451557981.
World Health Organization . (2015). Cancer Facts & Figures 2015. Geneva: World Health Organization.
