Over the last few days at the Annual Meeting, much discussion has occurred on the topic of value in cancer care, and many different aspects of this issue have been explored. In reviewing the data (and sometimes staggering projections) presented and carefully listening to different stakeholder perspectives, it appears that the many stakeholders in this debate do share some common ground which is good news. Yet, understandably, in certain aspects of this issue, a great divide remains.
While there are many key points to reflect upon, the following seem to resonate quite loudly:
- The current health care/cancer care cost trajectory is not sustainable.
- Cost does not necessarily translate to value or quality.
- The patient’s determination of value may differ from that of the clinician or society, and the patient’s perception of value may evolve over time.
One step ASCO has taken to help address the rising costs of cancer care is to contribute to the American Board of Internal Medicine Foundation’s Choosing Wisely campaign both in 2012 and 2013. Similarly, ASCO has multiple initiatives and resources directed toward the delivery of evidence-based quality care, including the Quality Oncology Practice Initiative, clinical guidelines, and the development of CancerLinQ.
To speak to the last of the key points, I think Diane Blum summarized this nicely in The Patient Perspective on Value saying, “Value is a dynamic process for the patient as hopes and expectations change through the continuum of the illness.” At the cornerstone of understanding what value means to a patient is the understanding of the goals of the patient, and through application of evidence-based medicine and shared decision making, how these goals can be accomplished. As value is not a static entity to a patient, this underscores the need to revisit discussions of the patient’s goals of care on a regular frequency.
While establishing a greater platform of common ground amongst all stakeholders may be a difficult undertaking, there are certain actions that can and need to be taken now to ensure we are providing the highest quality care with the resources we have, eliminating waste in the system, and that the benefits of treatment, spectrum of toxicity, and cost are a part of the discussion with each patient.