Improving Quality and Value of Cancer Care for Older Adults

Abstract

The concepts of quality and value have become ubiquitous in discussions about health care, including cancer care. Despite their prominence, these concepts remain difficult to encapsulate, with multiple definitions and frameworks emerging over the past few decades. Defining quality and value for the care of older adults with cancer can be particularly challenging. Older adults are heterogeneous and often excluded from clinical trials, severely limiting generalizable data for this population. Moreover, many frameworks for quality and value focus on traditional outcomes of survival and toxicity and neglect goals that may be more meaningful for older adults, such as quality of life and functional independence. A history of quality and value standards and an evaluation of some currently available standards and frameworks elucidate the potential gaps in application to older adults with cancer. However, narrowing the focus to processes of care presents several opportunities for improving the care of older adults with cancer now, even while further work is ongoing to evaluate outcomes and efficiency. New models of care, including the patient-centered medical home, as well as new associated bundled payment models, would be advantageous for older adults with cancer, facilitating collaboration, communication, and patient-centeredness and minimizing the fragmentation that impairs the current provision of cancer care. Advances in information technology support the foundation for these models of care; these technologies facilitate communication, increase available data, support shared decision making, and increase access to multidisciplinary specialty care. Further work will be needed to define and to continue to tailor processes of care to achieve relevant outcomes for older patients with cancer to fulfill the promise of quality and value of care for this vulnerable and growing population.

Models of Care in Geriatric Oncology

“…[16][17][18][19] Therefore, especially with the increased adoptions of bundled payment models, the hiring of dedicated staff to support the GA can be justified from a financial standpoint because of the expected drop in expenditure. 50 Figure 1 depicts a potential workflow and the additional time needed for the different components of the GA.…”

A long-term retrospective observational study at a medium-sized medical oncology service in Switzerland: comparison of overall survival with a national cohort and adherence to treatment guidelines

“…Focusing on cancer care, the National Comprehensive Cancer Network in the United States has elaborated a list of quality measures for endorsement [3]. Many of these goals are certainly part of daily management by medical oncology providers in Switzerland, but there is a lack of universally accepted definitions, methods, and ways to measure and report them to the public [4,5].…”