Looking for Value in Cancer Care? Start Here

Looking for Value in Cancer Care? Start Here

Yousuf Zafar, MD, MHS

May 29, 2015

“Value” will be front and center at the ASCO Annual Meeting this year, so much so that it has earned its own search category as a cross-cutting theme in the ASCO Meeting iPlanner. While the word itself is now ever-present in our discussions of advancing cancer care, defining value is not so easy. Frame of reference is critical. That which is valued by the individual is not necessarily valued by society, and vice versa. With so much attention paid to value at this year’s Annual Meeting, I hope some light will be shed on the following questions: First, how do we define value in oncology? Second, once we define it, how can we best deliver high-value care, as defined by both patient and society? And third, once we deliver value, how do we measure it? This year you will find multiple (sometimes overlapping) sessions addressing cost, value, and quality. Here are my picks of must-see sessions to help you wrap your head around value in cancer care (for detailed information on all sessions, please visit the iPlanner for the 2015 ASCO Annual Meeting):


When More Is Not Better: How to Integrate Goals of Care in Conversations about Stopping Chemotherapy

8:00 AM - 9:15 AM
Location: S100a

Value is not just about cost curves. How can we provide patients high-value care if we don’t understand their goals? This session gets to the issue at the heart of assessing patient goals: effective communication. When done well, effective communication should help to assess patient goals without taking up excessive time in clinic. The panel will focus on how to approach goals of care conversations with a focus on evidence-based communication strategies.

Health Services Research and Quality of Care Oral Abstract Session

1:15 PM - 4:15 PM
Location: S102

This session will be chock full of great data on costs and value in care. I’m looking forward to Ryan David Nipp, MD and colleagues’ data on patient financial burden resulting from clinical trial participation. This is particularly important as payers tighten up their provider networks, making it harder for patients to seek care at referral centers. In addition, look for Aileen B. Chen MD and colleagues’ presentation on how to estimate costs of care attributable to cancer. Finally, when it comes to value, we know little about why patients and physicians make treatment decisions that might be contrary to prevailing evidence. Allison Nicole Lipitz Snyderman, PhD and colleagues will present data on how physicians (rather than patients?) are probably driving the use of low-value care.



Navigating Racial and Economic Disparities in Cancer Care Delivery

8:00 AM - 9:30 AM
Location: S504

This session is part of the Health Services Research and Quality of Care Clinical Science Symposium. I’m excited to hear more from the same group that brought us the Health Affairs paper demonstrating a link between cancer diagnosis and the risk of declaring personal bankruptcy. Their new analysis of this data goes a step further and suggests declaring personal bankruptcy after a cancer diagnosis is a risk factor for mortality. I have the daunting task of discussing this abstract, with the hopes of answering the question, “What are our next steps in research related to financial toxicity of cancer care?”

The Value Proposition in Oncology: Different Approaches to Understanding Value in Cancer Care

11:30 AM - 12:45 PM
Location: S102

Using a case-based approach, this session will focus on defining value from the patient, provider, and payer perspectives. A key question I’d like answered by the end of this session: How do we resolve “value conflicts” between those three stakeholders? Also, expect to hear more about ASCO’s Value Initiative at this session.

Of course, this is by no means a comprehensive list. To dig deeper, check your favorite disease tracks for disease-specific sessions focused on delivering high value care (colorectal cancer and ovarian cancer both have such sessions). And take a walk through the Health Services and Quality Research poster session (Monday, 1:15pm). This short list is a start, but in a meeting with 1.4 billion attendees and 64,000 sessions (or so it feels sometimes!), you gotta start somewhere. 


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