Cancer: The Next Frontier in Chronic Care Management

SIGNS POINT TO CANCER becoming a chronic condition in the near future.

According to a study by Wei Zheng, MD, PhD, and others, published in the Journal of the American Medical Association as reported by Reuters in 2015, “For men and women ages 50 to 64, who were diagnosed in 2005 to 2009 with a variety of cancer types, the risk of dying from those cancers within five years of diagnosis was 39 to 68 percent lower than it was for people of the same age diagnosed in 1990 to 1994, researchers found.”

Increasing survival rates are a leading indication that the future of cancer treatment may start to mirror the treatment of chronic conditions. Such a shift will have massive effects on payers, and will accelerate incredibly difficult conversations and decisions about the value of extending life. Oncology patients on new immunotherapies are demonstrating 3- to 5-year survival rates and 30% remissions.

However, not nearly enough is known about when it is safe for many patients to stop treatment. There exists a massive difference for the continuum between paying $120,000 or more for 1 year of therapy with 6- to 12-month survival rates for cancer patients compared with the same $120,000 per year for an indefinite number of years as treatment efficacy grows.

According to an article by Alice Park in the April 4, 2016 edition of Time, there are currently 3400 ongoing immunotherapy trials in the United States. As reported in late March by the Washington Post, Michael Bloomberg and others recently gave $125 million to Johns Hopkins University for a new institute focused solely on immunotherapy research seeking a cure for cancer.

Concurrent to the growth of immunotherapies for oncology patients, oral oncolytics are also on the rise. But, like a large number of specialty medication therapies, adherence rates are frustratingly low. While many industry experts believe the future of oncology drugs are infused immunotherapeutics, oral oncolytics represent about 50% of oncology drugs currently in use and about 25% of drugs in the pipeline.

Oral oncolytics are convenient for patients who do not have to travel to their oncologist for a session in the infusion chair, and they can be a psychological boost due to the commonality of oral medications. However, that convenience ends with the patient. The physicians no longer have eyes on the patient to assess their condition, and they do not know about true levels of compliance to therapies that can have toxic, swift side effects.

Patient care is further impacted by the financial offset that is absent when physicians cannot bill for infusion time to support the funding of critically needed staff to ensure adherence. Overall adherence to oral oncolytics is in the neighborhood of 50%. There is evidence that suggests for some groups, adherence rates are much, much lower.

The Consequences
As long as immunotherapy requires infusion, the payment responsibility remains, for the moment, on the medical side. This provides the opportunity for oncologists to have close eyes on patients. But oral immunotherapeutics will eventually enter the market; what then?

Payers and pharmacy benefit managers run the greatest risk of bearing the brunt of the financial burden, as cancer shifts toward a chronic condition treated increasingly by oral oncolytics, and eventually, oral immunotherapies. The consequences for payers could be enormous.

If cancer treatment trends toward HIV or hepatitis C, we will see a slew of combination therapies while the industry works steadily towards a 1-pill, once-a-day treatment. If adherence were to remain in the 20% to 50% realm, it would be disastrous for all concerned, and lead to significant increases in the existing $100 billion to $300 billion in wasted health care spending due to medication nonadherence.

What’s Needed to Prepare: A Hard Look at the Chronic Care Management Team
As with any chronic condition, the goals for advanced oncology therapies should be improving outcomes while containing costs, reducing drug waste, and increasing adherence rates. What will be needed is a holistic approach to chronic care management with clinical pharmacists playing a larger role within the entire team.

As we have seen in multiple studies for patients with difficult-to-treat chronic conditions, such as HIV and hepatitis C, enhanced medication therapy management protocols, led by clinical pharmacists and robust patient support services, accomplish these goals.

For those payers and manufacturers seeking the greatest value for ALL stakeholders, their plan sponsors, shareholders and the patients, there are 3 key tools that must be part of the toolbox.

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