Dr. Patricia Ganz, BCRF investigator and member of the Scientific Advisory Board, was recently honored by the American Society of Clinical Oncology (ASCO) for her enduring work in finding ways to improve patient quality care through research, clinical practice and patient advocacy. Dr. Ganz received the inaugural Joseph V. Simone Award and Lecture for Excellence in Quality and Safety in the Care of Patients with Cancer during the ASCO Quality Care Symposium, held in Phoenix, Arizona, on February 26 and 27.
Speaking to ASCO, Dr. Ganz commented, “One of the most important aspects of oncology is ensuring patients have the best quality of life possible.”
In her award lecture, Dr. Ganz pointed to the important progress in patient care that has been achieved in the last 50 years through randomized clinical trials. Some of these include breast conserving surgery, adjuvant chemo- and endocrine therapies, tailoring therapies to specific breast cancer types, and the development of predictive assays, such as the OncotypeDx® recurrence score that can help doctors identify patients with ER-positive breast cancer who can forego the addition of chemotherapy.
Other signs of progress came from two important Institute of Medicine (IOM) reports (1999 and 2013) that were very instrumental in bringing the issue of perceived quality care versus the actual patient experience to the forefront of the medical community. The recommendations from these reports led to initiatives by ASCO, the American Cancer Society, government agencies and cancer advocacy groups to address issues around quality of cancer care, including disparities in health care delivery.
In spite of the progress, much needs to be done to ensure appropriate care for all patients. Some of the challenges persist, such as increasing costs of drugs, reaching patients in community or rural settings, who do not have access to clinical trials or comprehensive cancer care facilities, and maintaining funding support for clinical trials that have been so important in advancing quality care.
Dr. Ganz noted recommendations from the most recent IOM report on quality care, released in 2013. These focus on a patient-centered approach, in which the patient is engaged in his/her care from diagnosis through treatment and end of life care and emphasized the importance of multidisciplinary oncology teams and better coordination of care among all clinicians involved in the cancer patient’s care.
“The hope,” Dr. Ganz noted in a conversation with BCRF, “is to personalize care and be able to better predict and manage side effects, to not only increase lifespan with more effective therapies, but improved the quality of life for patients after treatment has ended.”
Understanding the challenges in effective team oncology care
In theory, the multidisciplinary oncology care team provides coordinated care involving many different types of providers from physicians, nurses and support staff, to ensure the optimum patient care. In practice, however, there are many challenges to achieving the goals of team oncology care.
To understand how oncology teams function, or not, ASCO collaborated with the National Cancer Institute to bring together community-based and oncology team researchers in a workshop to identify strategies to improve team-based approaches to cancer care delivery. Findings from the workshop were discussed at the ASCO Quality Care Symposium and BCRF investigator, Dawn Hershman who served as a reviewer and panel co-chair discussed some of the challenges in delivering quality team oncology care.
One of the major challenges comes from the complexity of the teams, particularly for patients with breast cancer. In addition to the oncologist, a breast cancer care team will include radiologists, surgeons, pathologists, nurses, social workers and counselors, and administrative support staff. The effective coordination of care within these multidisciplinary teams can be hampered by a variety of factors, resulting in fragmentation of care, including:
– Lack of leadership: Because of the different specialties involved, team leadership is not defined. Quality care depends on the commitment, engagement and accountability of each member. The concept of team oncology care is relatively new and many of the physicians and team members have not been trained to work on teams. – Communication: Communication between and within care groups is critical to delivering the best care for each patient, but is difficult to achieve for a variety of reasons.As a result, patients may get conflicting or confusing information or recommendations from different members of their care team.
In conversation with BCRF, Dr. Hershman pointed to the opportunity to learn from business models in team management in guiding the development and evaluation of oncology care teams. “There are a lot of moving parts,” she explained. “Each patient requires a well-oiled machine of coordinated care.”
More research is needed to determine how to achieve the best patient care with a team approach. “We need to pay attention to how we deliver care,” she continued. “If we don’t focus on how we implement care we can’t improve outcomes.”
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