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Cancer Care “Without Walls”: Disruptive Innovation to Transform Care Delivery

March 05, 2020

The opening session at the ACCC 46th Annual Meeting & Cancer Center Business Summit (March 4-6, 2020; Washington, DC) featured Susan Dentzer, a senior policy fellow at Duke-Margolis Center for Health Policy.

Ms Dentzer spoke first about how health care, and cancer care specifically, is moving outside the conventional walls of institutions and practices. This shift is enabled and driven by multiple factors, including data and technology, and it is time for a call to action to meet the needs of this shift, she asserted.

Much of health care is no longer “laying on of hands,” but rather involving a virtual exchange of information. Ms Dentzer stated that telemedicine applications are not necessarily new concepts; there were applications being tested but not heavily adopted as early as the 1960s and 1970s. Thus, she posed the question that for health care that mainly involves exchange of information, why isn’t more of it virtually done today?

She proposed a hypothetical patient case example that would utilize available technology or telemedicine services for a rural patient. The patient could receive genetic sequencing for tumor tissue and have these digital images sent to a clinician; the clinician could provide an artificial intelligence-enabled treatment review and consultation; targeted therapeutic agents could be e-prescribed and dispensed from a specialty pharmacy; and the agents could be delivered via drone to a critical access hospital close to the patient. However, these applications are hardly used in practice today.

There are challenges in cancer care worth noting, including a likely shortage of oncologists in the US, an uneven geographic distribution of overall cancer labor force, and a projected rise in cancer incidence due to the aging population. However, opportunities exist to mitigate these challenges, including the transition of care to more distributed settings (oral cancer drugs and immunotherapies administered on an outpatient basis), and opportunities among other spots along the spectrum of care, including screening, diagnosis, treatment, symptom management, and palliative care.

Ms Dentzer went on to  provide examples of how technological evolutions in cancer care can drive improvements in care at home, tele-oncology, tele-genetics, symptom management, provider education, access to clinical trials, and palliative care. A particularly sound example of effective care outside of the hospital is the Huntsman at Home model from the University of Utah. Since 2018, the model has admitted more than 800 people living within a 20-mile radius with cancer to the program. The typical patient admitted is on active therapy, encounters multiple major side effects that puts him or her in the ED or hospital, and reports quality-of-life issues. Results of the model are in the process of publication, and the model is extending into three rural counties in southeastern Utah.

Another example highlighted by Ms Dentzer of technology evolutions improving symptom management is occurring at the Seattle Cancer Care Alliance. Patients regularly “push” symptom information via a web-based system that triggers a response from their care team. The system enables practices to triage patients who can be managed over the phone vs seen in the clinic.

In her concluding remarks, Ms Dentzer noted multiple obstacles to overcome before artificial intelligence, machine learning, and more distribution of care can occur. State laws and regulations on licensure and scope of practice still impede activities, data privacy and security are still concerns, and there is a lack of high-speed broad band access, internet, and 4G/5G connectivity in much of the country. Nonetheless, “when it comes to disruption or evolution of cancer care, the status quo is not an option,” she said.—Zachary Bessette

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