Kathy is a 42-year-old woman with newly diagnosed stage IIB (T2N1M0), ER–, PR–, and HER2– breast cancer.
She has talked with several friends, noted the range of treatment options discussed in an online forum, and tells her oncology nurse that she really wants to move forward with any treatment option but chemotherapy because she doesn’t think she really needs it. Kathy says she understands that doctors have many treatment options they can offer and that she’d like a doctor who will support her idea that she doesn’t need chemotherapy.
What Would You Do?
Standard of care for stage II, ER–, PR–, and HER2– breast cancer typically includes combination chemotherapy. Furthermore, National Comprehensive Cancer Network standards stipulate that combination chemotherapy should be recommended or initiated within four months of diagnosis.
You understand that the evidence supports that treating hormone receptor negative, HER2 receptor negative disease with combination chemotherapy improves overall and disease-free survival. Ask Kathy why she wants to avoid having chemotherapy. Does she have concerns about side effects, scheduling, being able to work, or other barriers? Discuss the pros and cons of treatment options with Kathy and help to alleviate her concerns.
How Well Does Your Practice Measure Up to the Standard of Care?
The Oncology Care Model (OCM) is a payment model designed to test the effects of better care coordination, improved access to practitioners, and appropriate clinical care on health outcomes and costs of care for Medicare beneficiaries with cancer. By adhering to the standard of care and providing patient-centered care, your practice has the best opportunity to reduce cost while maximizing patient outcomes. In other words, using standards to drive care results in high-quality, cost-effective, patient-centered care.
The OCM has several quality measures that address using standard of care for many aspects of cancer care. In Kathy’s care situation, the OCM offers a measure that assesses whether combination chemotherapy was recommended or administered within four months of diagnosis to women younger than 70 years of age who have stage IB–III hormone receptor negative breast cancer.
Your practice doesn’t have to participate in the OCM to treat patients with evidence-based regimens. You also don’t have be an OCM participant to use quality measures to determine whether you’re offering and administering evidence-based care to the right patient, at the right time, for the right reasons. ONS offers quality improvement tools, including a Qualified Clinical Data Registry, that facilitate practice improvement and optimal patient outcomes.