Mending Disconnects in Cancer Care: Setting an Agenda for Research, Practice, and Policy

Abstract

Cancer in the United States accounts for $600 billion in health care costs, lost work time and productivity, reduced quality of life, and premature mortality. The future of oncology delivery must mend disconnects to equitably improve patient outcomes while constraining costs and burden on patients, caregivers, and care teams. Embedding learning health systems into oncology can connect care, engaging patients and providers in fully interoperable data systems that remotely monitor patients; generate predictive and prescriptive analytics to facilitate appropriate, timely referrals; and extend the reach of clinicians beyond clinic walls. Incorporating functional learning systems into the future of oncology and follow-up care requires coordinated national attention to 4 synergistic strategies: (1) galvanize and shape public discourse to develop and adopt these systems, (2) demonstrate their value, (3) test and evaluate their use, and (4) reform policy to incentivize and regulate their use.

Cancer prevention, risk reduction, and control: opportunities for the next decade of health care delivery research

“…This requires a fundamental reconsideration of health system financing and incentive structures. Third, the field should advocate for investments to support the development, adoption of the use of learning oncology systems that reduce the human burden of care coordination across multi-team systems, employing the strategies identified to foster connected care (see Alfano et al [ 83 ]) [ 81 , 82 ]. In the development of functional learning systems in oncology the measurement of care coordination using a “team of teams” perspective are critical quality indicators.…”

“…In the development of functional learning systems in oncology the measurement of care coordination using a “team of teams” perspective are critical quality indicators. These types of measures appreciate the interdependent nature of the cross-system (e.g., primary care, oncology, and specialty care), and cross-team efforts in the testing and evaluation of functional learning health systems [ 21 , 83 ]. Focusing on these broader goals have the potential to strengthen the translational infrastructure and pathways to support a wide range of evidence-based cancer care health service improvements.…”

Developing personalized survivorship care pathways in the United States: Existing resources and remaining challenges

“…Successful personalized care pathways will require protocols to route low‐complexity survivors to more comprehensive care in the case of abnormal screening results, severe late effects of treatment, or general patient concerns/preferences. Remote surveillance of survivors in the self‐management pathway will require information technology infrastructure and telehealth technology to facilitate communication between PCPs, oncologists, and survivors 20,39 . Applying telehealth to the self‐management pathway, however, may exacerbate inequities based on survivors' access to broadband, familiarity with technology, or comfort with remotely located providers 40 .…”

“…To extend this work and ensure that this tool can be used in practice, this commentary examines how personalized care pathways could be developed and implemented in US health systems in the context of existing resources. Although prior discussions of US survivorship care have either retrospectively evaluated progress toward creating a more structured survivorship care system 19 or focused on forward‐looking research priority setting, 9,20 this commentary is novel in its focus on tangible implementation in practice alongside the development of a tool to guide stratification. For context, we first describe the needs of low‐, medium‐, and high‐complexity survivors and the recommended personalized care pathways for each group.…”

The Cancer Rehabilitation Medicine Metrics Consortium: A Path to Enhanced, Multi-Site Outcome Assessment to Enhance Care and Demonstrate Value

“…This has left a knowledge gap regarding best practices and the individualization of care. The lack of agreement about use of outcome measures limits efforts to improve care as well as demonstrate the value of cancer rehabilitation to patients, oncologists, and payers alike ( 5 , 6 ).…”