Is disease management right for oncology?

Are there opportunities to improve care as patients transition through the cancer care continuum? A scoping review

PURPOSE

Patients with cancer experience many Transitions in Care (TiC), occurring when a patient's care transfers between healthcare providers or institutions/settings. Among other patient populations, TiC are associated with medical errors, patient dissatisfaction and elevated healthcare use and expenditure. However, our understanding of TiC among patients with cancer is lacking.

OBJECTIVE

To map and characterise evidence about TiC among patients with cancer.

PARTICIPANTS

Adult patients with cancer at any stage in the cancer continuum.

INTERVENTION

Evidence sources exploring TiC among patients with cancer were eligible.

OUTCOME

Evidence sources exploring TiC among patients with cancer using any outcome were eligible.

SETTING

Any setting where a patient with cancer received care.

DESIGN

This scoping review included any study describing TiC among patients with cancer with no restrictions on study design, publication type, publication date or language. Evidence sources, identified by searching six databases using search terms for the population and TiC, were included if they described TiC. Two independent reviewers screened titles/abstracts and full texts for eligibility and completed data abstraction. Quantitative data were summarised using descriptive statistics and qualitative data were synthesised using thematic analysis.

RESULTS

This scoping review identified 801 evidence sources examining TiC among patients with cancer. Most evidence sources focused on the TiC between diagnosis and treatment and breast or colorectal cancer. Six themes emerged from the qualitative evidence sources: the transfer of information, emotional impacts of TiC, continuity of care, patient-related factors, healthcare provider-related factors and healthcare system-related factors. Interventions intended to improve TiC among patients with cancer were developed, implemented or reviewed in 163 evidence sources.

CONCLUSION

While there is a large body of research related to TiC among patients with cancer, there remains a gap in our understanding of several TiC and certain types of cancer, suggesting the need for additional evidence exploring these areas.

Are there opportunities to improve care as patients transition through the cancer care continuum? A scoping review protocol

INTRODUCTION

Transitions in Care (TiC) are vulnerable periods in care delivery associated with adverse events, increased cost and decreased patient satisfaction. Patients with cancer encounter many transitions during their care journey due to improved survival rates and the complexity of treatment. Collectively, improving TiC is particularly important among patients with cancer. The objective of this scoping review is to synthesise and map the existing literature regarding TiC among patients with cancer in order to explore opportunities to improve TiC among patients with cancer.

METHODS AND ANALYSIS

This scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Review Extension and the Joanna Briggs Institute methodology. The PubMed cancer filter and underlying search strategy will be tailored to each database (Embase, Cochrane, CINAHL and PsycINFO) and combined with search terms for TiC. Grey literature and references of included studies will be searched. The search will include studies published from database inception until 9 February 2020. Quantitative and qualitative studies will be included if they describe transitions between any type of healthcare provider or institution among patients with cancer. Descriptive statistics will summarise study characteristics and quantitative data of included studies. Qualitative data will be synthesised using thematic analysis.

ETHICS AND DISSEMINATION

Our objective is to synthesise and map the existing evidence; therefore, ethical approval is not required. Evidence gaps around TiC will inform a programme of research aimed to improve high-risk transitions among patients with cancer. The findings of this scoping review will be published in a peer-reviewed journal and widely presented at academic conferences. More importantly, decision makers and patients will be provided a summary of the findings, along with data from a companion study, to prioritise TiC in need of interventions to improve continuity of care for patients with cancer.

Trends and issues in oncology costs

Approximately 18% of US gross domestic product is spent on healthcare and 5% of that is for cancer care. With rapidly increasing oncologic drug prices, growth in cancer spending will likely far outpace overall healthcare spending growth. Developing cost-saving strategies is imperative, but economizing must not compromise patients' well-being. Providing quality care at the most economical price is the main aim. This article summarizes trends in rising cancer costs, and reviews cost-management strategies, including those proposed in the Affordable Care Act. Many programs economize by correcting inefficiencies, preventing therapeutic failures and eliminating errors. Process improvement is important, but in oncology, medications substantially drive costs. Identifying the most effective and economical treatments requires cost-effectiveness research. At the current pace, the US payers cannot continue to afford increasing costs for cancer treatments. Research on maximizing patient outcomes for reasonable costs is essential. More analyses of quality of life assessment and cost-effectiveness can support future decisions about cancer care.