The Future of Cancer Care

Although I haven’t put up much on here lately, I’m still keeping busy. This is a simple article I put together for Vacaville Magazine (page 64-65).

Writing articles for the magazine is difficult because I have to try to reduce any bias I have from my job. Although it just scratches the surface of the issues facing cancer care – and the entire healthcare system – I think it is a good introduction and an attempt to add a bit of hope. Cheers!

TW


The Future of Cancer Care

Where do we stand now?

It is no secret that the current state of medical care is changing… and at an ever-increasing pace.

"На приеме у врача", 1900, by Vladimir Makovsky. Public Domain. (http://www.wikiart.org/en/vladimir-makovsky/at-the-doctor-s-1900)

“На приеме у врача”, 1900, by Vladimir Makovsky. Public Domain. (http://www.wikiart.org/en/vladimir-makovsky/at-the-doctor-s-1900)

Perhaps the most well known – and least understood – is the effect that the Affordable Care Act will have on the system. There are many promises, but few answers. Only time will tell.

Meanwhile, the costs of healthcare in America continue to increase at great rates.

The Affordable Care Act is estimated to allow millions more Americans to now have access to medical care. However, as the number of patients increases, the number of physicians is decreasing. This is most true in one of the most expensive areas of healthcare: Oncology.

Oncology is the diagnosis and treatment of cancer. Cancers can occur in almost any part of the body. Although once considered a death sentence, the survival rates for cancer are ever increasing. In 1975, less than 50% of patients diagnosed with any cancer survived even 5 years. In 2003, that rate was nearly 70%.

Only 5 decades ago, there were only a small number of cancer treatments that were very hard to tolerate. These new survival rates are increasing do to many factors that include improved prevention, increased access to healthcare, better diagnostics, and an abundance of new treatment options.

At the same time as the rate of surviving cancer increases, so does the demand for cancer care.

  • In less than a decade, there will be almost 18 million people identified as cancer survivors – an almost 35% increase from present. These survivors require continued monitoring, diagnostics scans, and expensive maintenance therapies.
  • Despite advances in cancer care prevention, it is estimated that number of new cancer diagnoses will increase by 45% surpassing all other illnesses as the leading cause of death in the U.S.
  • With the Affordable Care Act providing insurance to an additional 29 million Americans in the next 3 years, newly insured patients are expected to flood doctor’s offices with new and potentially more complex cancers.
  • The increase in patients needing cancer care is estimated to require an increase in oncologists by 42%, but the current rate of doctors entering the specialty is only 28% leading to a bottleneck in treatment. Then add that the number of oncologists in rural communities is declining, further reducing the availability of quality and timely care in those communities.

These are just some of the situations that paint a dire image of the future of cancer care in America. The increases in demand – combined with better FDA scrutiny of manufacturing – are already leading to shortages of advanced and even basic medications. There is even presently a national shortage of IV fluids which affects cancer infusion centers, hospital surgeries, and even dialysis centers. To make it clear, the basic IV fluid is a mixture of salt and water in pre-filled bags ready for use – and yet industry cannot keep up with the full demand.

Where do we go from here?

"Portrait of S. S. Yudin", 1935, by Mikhail Nesterov. Public Domain. (http://www.wikiart.org/en/mikhail-nesterov/portrait-of-s-s-yudin-1935)

“Portrait of S. S. Yudin”, 1935, by Mikhail Nesterov. Public Domain. (http://www.wikiart.org/en/mikhail-nesterov/portrait-of-s-s-yudin-1935)

This is the key question and, no matter what we implement now, we will not know for some time if we picked the right path. So choosing carefully is all the more important. But, like issues of climate change and water conservation, it is also a question we cannot ignore or wait to answer.

Many of these initiatives begin with the National Institutes of Health (NHI), National Cancer Institute (NCI) and other government agencies, but also academic medical centers, local hospitals, non-profit agencies, and private medical offices around the country are working hard to find creative ways to battle the issues at hand and to plan for a brighter future.

First is to be more efficient in care.

Efficiency can often be mistaken for removing the patient from the equation. That is the situation when you, the patient, begin to feel like a number. But efficiency and personalized medicine are possible with care.

Use of smartly designed and wisely implemented electronic health record systems can improve the ability for every member of your care team – from your doctor to your infusion nurse to your pharmacist – to have clearer access to more accurate information on your state of health.

Second, medical offices can improve care by brining more under their own wing.

Although there is a trend for oncology practices to combine or to even join with a hospital, small practices are able to leverage modern technology and well-trained staff to offer more services in one location.

This can be as simple as offering Oncology Nurse Navigating services – where a Registered Nurse helps a patient understand the road from diagnosis through to recovery. And more resourceful offices are incorporating pharmacies, clinical laboratories, and even clinical research all under one roof in order to serve their patients.

Third, the medical industry as a whole must improve quality of care.

CMS – the Centers for Medicare and Medicaid Services – has implemented the Physician Quality Reporting Services (PQRS) which has measures of quality care practitioners must meet in order to either receive incentive payments or to prevent penalizing payment reductions. Although it is far from a perfect system and is largely inflexible to the fluctuating needs of individual communities, it has already pushed many medical offices and hospitals to focus attention on the quality of the care they give.

Specific to oncology is the Quality Oncology Practice Initiative (QOPI) that aids oncology practices to create a culture of self-examination and improvement. The goal is to improve quality of care while preventing or limiting increases in the cost of care, which are too often associated with change.

Improvements in quality start with things as simple as:

  • Providing patients better and faster access to their health information.
  • Giving patients increased access to their healthcare team with tools like secure electronic messaging systems.
  • Improve understanding of and access to quality end-of-life care.
  • Increased access to diagnostic testing to more accurately treat a patient and reduce unnecessary treatments.

These and many more steps are already being taken by private and hospital oncology offices around the country. The results are mixed, but improvements are increasing.

What can you do?

"Family Doctor", 1940, by Grant Wood. Public Domain. (http://www.wikiart.org/en/grant-wood/family-doctor-1940)

“Family Doctor”, 1940, by Grant Wood. Public Domain. (http://www.wikiart.org/en/grant-wood/family-doctor-1940)

The best thing you can do as a caregiver, family, friend, and patient is to keep yourself informed.

Keep aware of your personal health risks by consulting with your primary care and specialty care providers. Prevention is still the best medicine and reducing risk is the best way to prevent cancer and other debilitating health conditions.

And keep aware of changes to the healthcare system – be they with your insurance provider, your healthcare providers, or at the national level. Contact your local, state, and national legislators so that they truly know what you, the patient, want and need. That is the only way they can fully make informed policy to better everyone.

Although the future can be painted black, a lot of bright and determined people around the country are hard at work so that you have a bright light in the darkness and we all have a part in the process.


Figures taken from the American Society of Clinical Oncology’s publication, “The State of Cancer Care in America: 2014”

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