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.
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