Myriad new treatment options have extended the survival and improved the quality of life for patients with cancer, but these options are also increasing the complexity of care.
At the 2020 ASCO Quality Care Symposium, Jean Wright, MD, Director of Safety and Quality, Department of Radiation Oncology and Molecular Radiation Sciences, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Washington, DC, advocated for multidisciplinary teams that include the patient as part of the care team.
“Patients and providers are frequently faced with decisions and scenarios that do not have a single obvious pathway,” said Dr Wright. “The choices that we make must consider the patient’s unique circumstances.”
According to Dr Wright, multidisciplinary care can be carried out in a variety of ways. Although some centers have true multidisciplinary clinics, where multiple providers and the patient are involved in a single clinical visit, not every center has the infrastructure that supports such an approach. Regardless, the most important aspect of this care model is communication, she said.
According to Leah Fine, MBA, Senior Director, Excellence in Screening and Care, GO2 Foundation for Lung Cancer, Washington, DC, communication should extend beyond technical and clinical options, although these are critical too. To understand patients’ quality-of-life priorities, it is important to have a conversation with the patient and the patient’s loved ones, who are often overwhelmed during the initial visit.
“The role of the GO2 Foundation and other advocacy organizations is to educate and empower all patients, by providing them with understanding around these many different decisions,” said Ms Fine.
“You’re not just managing a medical emergency when you give somebody a cancer diagnosis,” Ms Fine added. “You’re managing an emotional emergency as well.”
Because patients with cancer are living longer and have higher-quality lives, they need to think beyond short-term treatment decisions. With the help of a navigation team, decisions should be made with long-term survivorship in mind, said Ms Fine.
“The navigation team needs to be the oracle of communication, the place through which all communication flows,” she added. “They can help make sense of what’s best for the patient [and] their family.”
Communication Among Providers and the Support Team
Dr Wright also stressed the importance of communication among providers, who may have different perspectives and even different treatment recommendations. Although disparate opinions should not be common in a high-functioning team, she said, the patient’s voice can help focus these discussions.
“It’s very important to make sure that providers are talking to one another and balancing their thoughts and recommendations with the patient at the center. When we encounter [differences of opinion] among the care team, the key thing is to always come back to what’s best for the patient. That can bring the team together,” said Dr Wright.
Dr Wright emphasized that more aggressive care does not always translate to better outcomes. Therefore, it is critical for physicians to be honest with patients about their treatment choices and what the outcomes are likely to be. This can also mean suggesting that the patient seek a second opinion.
“Every physician should be open and encouraging of the patient going to get another opinion,” said Dr Wright. “If a physician responds negatively to that, you should be wary, because it’s a valuable contribution.”
According to Ms Fine, it’s also important to bring in members of the patient’s support system, which can include family members or caregivers. The emergence of telehealth during the pandemic has helped to facilitate this support.
“One of the silver linings of our new COVID-19 world is telehealth,” observed Ms Fine. “It’s become easier to bring family members who may live in another state into the clinic and into the care discussion.”
“Patients may not always hear the information they need. That’s when having a family member in the room can make a huge difference, and where telehealth has been a huge resource,” she added.
Technology can help fill critical information gaps, while encouraging greater patient and caregiver engagement, but it is ultimately up to patients to become experts in the care they want to receive. Fortunately, there are many resources that can provide this knowledge, Ms Fine concluded.