Patient-Centered Pathways for Advancing Cancer Care

Patient-Centered Pathways for Advancing Cancer Care

02.14.14 | By Randy Burkholder

There's been a lot of discussion lately about the need to control rising health care costs, and the role of new medicines and medical technology. Nowhere has this discussion been sharper than in the area of oncology. At PhRMA, we’ve been joining in many of these discussions, working with other stakeholders to identify solutions to sustain continued progress and support efficient delivery of optimal patient care.

One of these discussions led to an article by Dr. Amy Abernethy, myself, and other key leaders in the oncology community, published online this week in Cancer Clinical Research, that helps point the way forward. In the article, my co-authors and I seek to capture the collaborative work we have undertaken to answer a basic challenge – how can we continue turning the tide against cancer in an era of cost-containment? In the article, we describe the promise of emerging scientific advances to meet this challenge, and identify areas where additional policy work is needed to sustain this progress and efficiently deliver better outcomes for cancer patients.

As we note in the article, sustaining progress against cancer is not only important for patients, but for supporting efficient, affordable delivery of cancer care; “With continued support for science and innovation, we foresee accomplishing in oncology what has been achieved against other major public health problems, such as HIV/AIDS, in which scientific advances yielded major gains for patients and averted a predicted health spending crisis.”

The group identified several key paths forward for sustaining progress against cancer, including three that really resonated with me:  improving patient-centeredness and patient engagement in oncology; developing next-generation tools for value assessment in oncology; and harnessing the power of emerging health information technology tools and continuous learning in cancer.

As noted in the article, “It is important to move beyond traditional approaches to comparative effectiveness research and health technology assessments to achieve better alignment with patient needs and values, as well as with the emerging science and changing clinical practice of oncology.” Because the traditional tools for determining value rely on point-in-time assessments and average study results, they frequently fail to reflect important differences in patient needs, as well as the significant ways research on and use of new treatments evolves over time.

A similar challenge exists in broader payment reform proposals like bundled payment, which often are grounded in clinical pathways or bundles that presume treatment equivalence and are based on population averages. Policy principles recently released by the Personalized Medicine Coalition, for example, note that new payment models like accountable care organizations and bundled payment run the risk of setting policy "based on current standards of care" and could "discourage advances in medical technology and medical practice."

Just as we need new approaches to health technology assessment, it is essential to identify alternative approaches to payment reform that do not, as stated by PMC, "unintentionally undermine the development of and patient access to innovative treatments," and that help physicians tailor care to the needs of each cancer patient rather than imposing a single care pathway or bundle for all patients.

Emerging advances in oncology care hold great promise for turning the tide against cancer; solutions like those proposed in this article can help us make sure we get there. Learn more about pathways forward at


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