Incorporating Patient-Reported Outcome Measures into Breast Surgical Oncology: Advancing Toward Value-Based Care

Abstract

Value in health care is defined as the health outcome achieved per unit of cost. For health care systems, improving value means achieving better outcomes at lower costs. Improving outcomes, including patient-reported outcomes (PROs), as well as more established metrics such as mortality and complication rates, ensures high-quality care. This is particularly true in breast cancer surgery, where survival and recurrence rates are comparable across different surgical approaches. Outcomes reflecting survivorship quality may therefore better inform decision making regarding surgical approaches. PROs can be assessed using validated instruments known as patient-reported outcome measures (PROMs). They are obtained directly from patients reflecting their health-related quality of life (HRQOL).Ongoing initiatives strive to define PROMs that accurately reflect HRQOL and demonstrate value, with the goal of establishing benchmarks for quality of care. Clinicians caring for patients with breast cancer are well positioned to be involved in defining meaningful measures of value-based breast cancer care. This article reviews value-based breast cancer care in the context of locoregional therapy, with attention paid to the work done by the International Consortium of Health Outcome Measures in which a "standard set" of value-based patient-centered outcomes for breast cancer for international use is defined. In addition, an overview is provided of relevant PROMs and previously reported scores. Recommendations and future challenges for implementation of routine collection of PROs are also discussed. The Oncologist 2020;25:384-390 Implications for Practice: Opportunity exists to act as early adopters of the routine collection of longitudinal patientreported outcome data for breast cancer, allowing transition of current care to value-based cancer care.

Time-Driven Activity-Based Costing in Breast Cancer Care Delivery

“…Encouragingly, work is underway nationally and internationally to systematically capture patient-centered outcomes. 7 , 19,23 By combining these elements with a clear understanding of costs, we can truly define value in breast cancer care delivery and work towards evidence-based VBHC.…”

Head and Neck Cancer, Precision Medicine and Health Related Quality of Life: The Patient Is the Keystone

“…Because side effects do exist, unfortunately, both individual perception of the disease, and the development of different treatment options contribute to the wide range of HRQoL impacts [8]. PRO that reflect head and neck cancer patient HRQoL and that demonstrated value in oncology healthcare, are being used as helpful metrics to support both politian's and decision makers in order to establish benchmarks for the quality of care [6,9]. The value of PRO-as prognostic, or stratification factors in research across head and neck cancer-has been highlighted and emphasizing the importance of domains such as physical functioning, global health and global quality of life as significant determinants for prognostic prediction [10].…”

The predictive value of patient-reported outcomes on the impact of breast cancer treatment-related quality of life

“…PROs can complement clinical outcomes of BC treatments, mainly overall survival (OS) and disease-free survival (1,3). Because survival rates of early BC have continuously improved over the last decades and are similar across care settings (4), addressing PROs alongside clinical outcomes could facilitate informed decision-making and enhance patient treatment by adapting care pathways.…”