Improving Quality and Value of Cancer Care for Older Adults, with Erika E. Ramsdale, MD, and Andrew E. Chapman, DO, FACP

August 16, 2017
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In today’s podcast, Dr. Erika Ramsdale and Dr. Andrew Chapman discuss new options for improving care for older adults with cancer, including online tools and telecommunications options. Dr. Ramsdale is a board-certified specialist in geriatric medicine and medical oncology at the University of Rochester Medical Center. Dr. Chapman is the co-director of the Jefferson Senior Adult Oncology Center and a board-certified medical oncologist and hematologist at Thomas Jefferson University.

Transcript: 

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ASCO: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.

You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors who care for people with cancer.

This podcast is part of a series featuring articles from the 2017 ASCO Educational Book. Published annually, the Educational Book is a collection of articles written by ASCO Annual Meeting speakers and oncology experts. Each volume highlights the most compelling research and developments across the multidisciplinary fields of oncology.

In today’s podcast, Dr. Erika Ramsdale and Dr. Andrew Chapman discuss new options for improving care for older adults with cancer, including online tools and telecommunications options. Dr. Ramsdale is a board-certified specialist in geriatric medicine and medical oncology at the University of Rochester Medical Center. Dr. Chapman is the co-director of the Jefferson Senior Adult Oncology Center and a board-certified medical oncologist and hematologist at Thomas Jefferson University.

ASCO would like to thank Dr. Ramsdale and Dr. Chapman for discussing this topic.

Dr. Ramsdale: Hello, my name is Dr. Erika Ramsdale from the University of Rochester Medical Center.

Dr. Chapman: And I am Dr. Andrew Chapman from Thomas Jefferson University in Philadelphia. In this podcast, we will be sharing some key points from our 2017 ASCO Educational Book article titled, “Improving Quality and Value of Cancer Care for Older Adults,” and talking about its implications for patients, especially older adults, and their loved ones.

Cancer is a disease of aging. The incidence and prevalence of cancer is increasing in older adults. By 2040, about 73% of cancers will be diagnosed in patients older than age 65.

Costs to deliver cancer care are unsustainable. In 2004, cancer cost the nation $72 billion. In 2010, this amount rose to $125 billion. And in 2020, the cost is projected to be $173 billion. As these costs are passed on to patients, fewer people can receive treatment. Older adults are also likely to have other conditions or diseases in addition to their cancer that may require a large number of medications. Older adults require supportive treatments like psychosocial support, physical rehabilitation, and caregiver support. These large care teams are composed of many different types of health care professionals. To complicate matters, the number of geriatric care experts is too small to meet the projected demand. In 2008, there were 7,000 geriatricians, the projected need is 36,000 practitioners by the year 2030.

We, as a nation, are not prepared to meet these patients’ health care needs. So how are physicians ensuring that older adults will receive high-quality cancer care at accessible costs?

To provide the best and most cost-effective care for older patients with cancer in the future will rely on a patient-centered approach. The approach heavily relies on: clear and consistent communication between providers, patients, and caregivers; and seamless transitions along the care continuum from diagnosis to survivorship. In a patient-centered environment, the care team rallies around the patient and closely attends to his or her wants, needs, and preferences.

To help ensure clear communication between practices and providers, the Centers for Medicare and Medicaid services launched the Oncology Care Model in 2016. The goal of this model is to make practices more successful at capturing reimbursements, enhancing patient and caregiver satisfaction, and furthering the dedication to quality, safety, and cost control. The payment model encourages medical practices to improve coordination across all aspects of the oncology care team with an additional monthly reimbursement. Although this model won’t begin to affect payments until 2019, many practices are starting to make the transition.

Clear communication between all parties involved in cancer care is very important, but the most critical factor in the patient-centered oncology care for older adults is gathering enough data to ensure a seamless transition from being a patient with cancer to becoming a cancer survivor.

Dr. Ramsdale: The growth of information technology is key to getting the data we need to create the most effective care plans for older adults with cancer. Historically, there haven’t been a lot of data because older adults are often excluded from clinical trials. Information technology may provide a foundation for the overcoming gaps in services and fulfilling the promise of quality and value of care for this vulnerable and growing population. As technology gets smarter, care plans will improve.

For example, physicians can now use electronic medical records to communicate and share data in large quantities. There are also many online decision-making tools in development or early stages that pull together population-level data. These tools could allow providers and others to analyze trends and overall quality metrics, and using them at the patient level promotes better decision making and personalized therapies.

Technology could also help fill in the gaps in the small workforce and increase access to care for patients who are not able to travel to a large medical center. Telemedicine could expand access to specialty care for older adults with cancer, with limited investment in technology. For example, all that is needed is a stable internet connection and video-conferencing software. Telemedicine has successfully been used to deliver high-quality multidisciplinary care to older adults with other complex health conditions, such as Parkinson disease.

There is a lot that needs to be done to ensure high-quality, affordable care for older adults with cancer in the future so that quality is high but costs are reasonable. Restructuring provider payments and using information technology to inform and expand access to care are two of the major ways that physicians are addressing this challenge.

To learn more, please view our article online at asco.org/edbook for an in-depth discussion of this topic. Thank you.

ASCO: Thank you Dr. Ramsdale and Dr. Chapman. Please visit ASCO.org/edbook to read the full article. And for more expert interviews and stories from people living with cancer, visit the Cancer.Net Blog at www.cancer.net/blog.

Cancer.Net is supported by the Conquer Cancer Foundation, which is working to create a world free from the fear of cancer by funding breakthrough research, sharing knowledge with physicians and patients worldwide, and supporting initiatives to ensure that all people have access to high-quality cancer care. Thank you for listening to this Cancer.Net Podcast.