Change is a good thing, a necessary thing. At the same time, I have to ask how many realize how much change is happening so quickly in oncology and cancer care? And I wonder even more how we are going to separate change that is valuable from change that is simply, well, for the sake of change.
What brought about this moment of reflection was my attendance at a conference this past week sponsored by the American Cancer Society Cancer Action Network focused on the future of health care. The specific topic was “The Role of Technology in America’s Shifting Health Care Landscape.”
After spending a day listening to discussions of change in cancer care—led primarily by emerging data analytics and health information technology—I was struck how the cancer landscape might be shifting quickly in ways that many of us don’t understand, and in fact can’t fathom. Putting the pieces of this puzzle together in a rational way in my opinion is beyond the capabilities of many of us, even those who have devoted our lives to understanding cancer.
The overarching theme of the many discussions that day was a connected future with reams of data and technology impacting the care of cancer patients. There was a lot of “blue sky” thinking: where we may be headed if we harness these new technologies and information resources. But there was also a lot of commentary about what we can accomplish right now. Stunning thoughts abounded about what we can learn today if we harness the health information already available to us; information that is ready for the analyses that will answer what many currently think are unanswerable questions, if only we could figure out how to get our hands around it.
If we are going to deliver the best care to the right person at the right time, we are going to need to inform those decisions with the data and information that gives us the clues to which care in fact IS the best care. And we have to figure out a way not only to pay for that care, but to use the payment system to encourage care health professionals to do the right thing for their patients. “Value based payment”–where doctors receive reimbursement based on providing the appropriate care for a particular patient while minimizing tests and services that don’t impact outcome–is coming soon to an oncology practice near you, probably much sooner than you realize. And traditional fee for service may not survive much longer if those who see into the future are correct.
Not to be lost in this equation is the topic of monitoring the quality of cancer care. How we measure quality cancer care and what influences outcomes for cancer patients is almost antiquated in this era of “big data” and data analytics, relying on measures that are perhaps not as globally reflective of real-time care as one would like. It is another area of cancer care that is ripe for disruption through the use of high powered data analytics.
We still rely on points in time to tell us whether the care is right, such as whether or not a patient got a PET scan or had enough lymph nodes examined in a surgical specimen. Our data systems could (should???) theoretically be so robust as to look at all the elements of a particular patient, such as their sex, their age, where they live, their other medical conditions, their support systems–whatever you can dream of–to assess whether the decision made for that individual was the correct decision, or what range of treatment options should be offered.
Through all of this sea change patients are supposed to get the best and most appropriate care for their cancers, doctors are supposed to offer that care, and scientists are supposed to advance the research that will improve that care. And while this cancer universe is grinding along, the innovation part of the equation is not standing still. In fact, it is accelerating rapidly.
The reality is that we no longer have the luxury of getting familiar with even one element of the process before it suddenly starts to change. Multiply that by the many elements of cancer care, and you begin to understand the daunting complexity that so many cancer professionals are starting to face every day.
This is building the plane while we are flying it. And I haven’t even mentioned the now several cancer moonshots or the Precision Medicine Initiatives currently underway, examples of how the research world is being upended as well.
These are dramatic changes. When it comes to cancer–understanding it, treating it, paying for it–we are heading in many different directions, all at the same time. Perhaps “miraculous chaos” best describes where we find ourselves at this moment in time.
Change happens to all of us. It is a constant of our lives. What is changing it is that it is coming at us more rapidly than we could have imagined, in ways we could not have predicted, with outcomes and impacts that remain to be understood or measured. But one thought remains: we must embrace change, and we must move forward. We have never had anything near this opportunity through the history of cancer. We have more science, we have more technology, we have more awareness, we should have more understanding of how care is delivered and paid for. We must do better.
Our children and grandchildren will grow up in a different “cancer” world than we did. One speaker at the meeting on predicted that one day in the not distant future cancer will be as controllable as infectious diseases became with the arrival of the antibiotic and vaccine eras.
I think it is fair to say that is one change that cannot come soon enough.