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Oct 18, 2018

ASCO Daily News Podcast Title: ASCO Quality Care Symposium: Key Takeaways from the Meeting with Ethan Basch, MD

Welcome to the ASCO Daily News Podcast. I'm Lauren Davis. And joining me today is Dr. Ethan Basch of the University of North Carolina. He's both a medical oncologist and a health services researcher. Dr. Basch has clinical expertise in prostate cancer. And his research includes patient-reported outcomes, drug regulatory policy, and comparative effectiveness research. Dr. Basch, welcome to the podcast.

Nice to be here.

So you've just returned from the Quality Cancer Symposium. How was this event different from previous years?

The symposium this year was really superb. It was very well attended by a mix of quality officers, clinicians, and researchers. And to me, what was really striking about this year's meeting is that people are really doing applied projects that are multidisciplinary. And what I mean by this is that, in prior years, we'd see very small pilot projects in very narrow areas. We would see projects that maybe were being done just by researchers or projects just being done by community clinicians.

But what we're really seeing now is this coming together of research and practice with a focus on value-based care. And the projects that are being done are very sophisticated and are spanning the continuum from identifying a problem in practice to developing a quality project to measuring and then modifying the outcomes. And so that's really a very exciting development, where we see the research and practice coming together.

What would you say are some of the take-home messages about innovations in care delivery that resonated with you or folks that you spoke with?

I'd say the biggest message from the meeting this year is, it can be done. When there are quality projects that focus around some of the value-based care topics that have risen to the top at this meeting, it was very clear that it is feasible to set up programs and to enlist stakeholders and to actually execute in these areas. For example, there were projects focused around financial toxicity and counseling, around reducing low quality treatment, around navigation, coordination of care, unnecessary ER visits and hospitalizations. And in all of these areas, there was the ability to gather data, develop programs, implement those programs, and collect data. So it could be done.

I think the other take-home message is that there is an increasing number of quality roles in health systems for using data. It used to be that these kinds of roles around value-based care delivery and quality were maybe performed by those who were doing other functions within an organization. And there are an increasing number of dedicated personnel for carrying on this work.
Financial toxicity, you just touched on, affects all aspects of cancer care. Are there areas where quality of care is improving despite costs of treatments and services?

So I think that that's a challenging question to answer, because it is a heterogeneous landscape. I mean, certainly, there are areas where quality continues to improve that's disconnected from cost. But what's clear is that it's becoming harder and harder to devote resources to improving quality of care when cost is going up. And of course, when we think about value, value is quality over cost. And so as your cost increases, you have to improve quality that much more in order to provide value.

There were interesting data presented at the meeting showing that more than half of patients with cancer experience substantial financial distress that affects their decisions and compliance, their workplace, and the way that they conduct their lives. And there were practical examples of financial navigation programs that can be integrated into practices to help patients, both to deal with their financial situations and also to deal with their distress that they feel due to financial pressures.

However, it's pretty clear from the evidence that was provided that if costs do not start to become contained, it will become not only difficult to continue to be able to devote resources to quality-- because the resources will be going elsewhere-- but it will be very difficult to help patients to manage their own distress or to ensure that people will be compliant with treatments that require increasing out-of-pocket costs.

Absolutely. In your clinical experience with patients who have cancer, do you think people speak up enough about their needs and expectations?

So unfortunately, research has shown that we, as providers, remain unaware of many of the needs and expectations of our patients. There actually was terrific work from a group in Canada presented at the meeting, at the Quality Symposium, presenting some new quality metrics around patient-centeredness that moved beyond our typical patient satisfaction or patient experiential questionnaires that many of our hospital systems use.

And these metrics look at the extent to which patients feel that their needs and their expectations are being understood and acted upon by care teams. And they found, actually, quite a bit of variability between practices. And they are now intervening at individual practice levels in order to try to see if enhanced navigation services can improve that dimension of care delivery.

That's great. So in our modern age, we have so many communication devices and apps at our hands. But what would you say is the best way to find out how patients are doing and experiencing treatment?

Well, there's a lot of interest in patient-reported outcomes and other electronic communication approaches that can connect practices to patients. As I alluded to in the prior question, it's very common that the practices aren't aware of how patients are feeling, either their side effects of treatment or other symptoms related to disease. And these are missed up to half the time. And so this is a big opportunity.

At this point, I think it's unclear what approach is going to prevail in the end. Will this be part of the patient portal that people can download onto their smart device? Will this be standalone programs that can then send messages to providers? I think it's very early in the days of these kinds of technologies.

But I think that what's exciting is that so many patients are using various kinds of devices to track themselves or to communicate with providers. And I think what we'll see in the years ahead is practices and health systems capitalizing upon this Fitbit culture in order to harness that information for clinical care. But again, I think we're really in early days of this movement.


That's great. Again, my guest today has been Dr. Ethan Basch. Thank you for joining us.

Thank you. I would just like to thank my colleagues, who were instrumental in putting the meeting together, including my colleague, Dr. Monika Krzyzanowska, who was this meeting's chair-- this year's meeting chair-- Dr. Michael Neuss, who was last year's chair. And the two of them were really key to putting together the agenda, as well as our entire group for planning. But I'd also like to thank Carli Gurtshaw and Tony Schweizer at ASCO, who were the staff members who really brought the whole meeting together.

And to our listeners, thank you for tuning in to the ASCO Daily News Podcast. If you're enjoying the content, we encourage you to rate us and review us on Apple Podcasts.