Delivering Collaborative Breast Cancer Care in the Oncology Medical Home

October is National Breast Cancer month and many supporters will be indulging in pink and racing for the cure.  According to the Department of Health and Human Services (HHS), breast cancer is the second leading cause of cancer death in women and the most common cancer among women in the U.S.  For Hispanic women, it is the most common cause of death, while it remains the second leading cause of death for Asian, American Indian, African American and Anglo women.  With early detection and treatment, breast cancer can be beat.  In an alarming tr

October is National Breast Cancer month and many supporters will be indulging in pink and racing for the cure.  According to the Department of Health and Human Services (HHS), breast cancer is the second leading cause of cancer death in women and the most common cancer among women in the U.S.  For Hispanic women, it is the most common cause of death, while it remains the second leading cause of death for Asian, American Indian, African American and Anglo women.  With early detection and treatment, breast cancer can be beat.  In an alarming trend, however, it appears that the number of individuals seeking mammograms has tapered off since 2001.  And with limited access, knowledge and resources, many women have been putting this critical preventive measure off.

While it remains imperative to continue the campaign to increase awareness and prevention, I have to wonder if a vital piece of the puzzle is missing?   With millions being spent on marketing campaigns, is there no better substitute than your primary care provider being the first line of defense in this rigorous battle?  And with the mounting evidence pointing to the success of medical homes and accountable care organizations, would there not be value in shoring up communication between primary care providers and oncologists in order to catch symptoms in the earliest stage possible?  Better yet, what if oncology providers formed medical homes for the purpose of promoting evidence based care and enhanced communication?  As noted here, the National Committee on Quality Assurance is taking a stance, having developed the Specialty Practice Recognition (SPR) 2013, scheduled to be piloted in 14+ practices next year.  Through this new mandate, NCQA is hoping to invigorate specialist referral response, care coordination and evidence based practice alignment.

And with the new standard, quality reporting measurements will be developed in efforts to improve the standard of care while simultaneously reducing the amount of variation and unnecessary cost.  How will this be done?  Similar to current medical homes, developing patient registries and cancer specific evidence based pathways, allows for best practices to be utilized and generic drug recommendations to be made when appropriate.  Furthermore, in keeping with patient specific treatment plans, advanced technology also offers the opportunity for more meaningful dialogue with the patient by delivering key information in a variety of formats.

Will this be enough to close the loop?  Though the jury remains out, there is promising news from the ASCO Breast Cancer Registry Pilot Program, funded by Susan G. Komen for the Cure.  During this study, 20 practices implemented a web based registry for newly diagnosed patients and generated one of two patient specific treatment plans for future assessment of care quality/research initiatives and patient and practices’ perceived burden, value, usefulness, and effectiveness of discussions regarding treatment and survivorship using the treatment plan and summary reports.  Participants were surveyed via electronic and telephonic means and a majority felt that the process improved communication between patient/providers and physician to physician and, ultimately, provided greater piece of mind.

While not affiliated with the ASCO program, Oncology Physician Resources’ Lesli Lord illustrates below how evidence based pathways will facilitate the future delivery of quality oncology care in a collaborative and cost-efficient manner.