It is an exciting time in oncology care as innovative cellular and gene therapies come to market, with many more to come in the near future. While the promise of these therapies is certainly cause for enthusiasm, providers should still keep potential risks in mind, including clinical and financial toxicity and the value of new treatments for individual patients based on their unique clinical and economic situations.
Debate is growing regarding the best ways to evaluate the associated economic impact of these new therapies, specifically in the context of the shift to value-based reimbursement. Various forms of decision health analytic modeling have been used for the last 3 decades to assess potential health economic impact of new therapies. In their Pharma Insight’s piece this month, Philip Cyr, MPH, and Larry Blandford, PharmD, share some of their observations and early learnings in modeling the economic impact (page 36).
I also provide a commentary on this topic, specifically in relation to chimeric antigen receptor T-cell (CAR-T) therapies. In my Viewpoint piece, I explain how the complexities of providing CAR-T therapy will likely highlight another disconnect in the health care system: patient care coordination and navigation (page 38). Patient care coordination and navigation needs to go far beyond that of the physician-patient relationship, as CAR-T therapy will require an active coordination between the physician, patient, and payer.
Bruce A Feinberg, DO, and Chadi Nabhan, MD, MBA, FACP, add their perspective to this issue. In their Counterpoint article to mine, they posit that, as most cancer patients are seen in the community setting, community oncologists will play an instrumental role in patient referral and likely determine the initial adoption of this treatment (page 39). A broader understanding of stakeholder knowledge and perception of these new treatments may be critical to their adoption and use. They also note the history of hematopoietic cell transplantation centers; how these centers have evolved to meet the needs of their complex patients may provide insight for cancer centers.
Rounding out this issue is a Perspectives piece by Tricia Strusowski, MS, RN, that discusses the need for standard metrics for benchmarking in oncology patient navigation programs and for improved communication between oncology providers and navigators (page 42). In 2017, the Academy of Oncology Nurse & Patient Navigators announced 35 national evidence-based oncology navigation metrics. Ms Strusowski expands on the utility of these metrics, how they can be incorporated into other oncology metrics to achieve more integrated care, and how better navigator/physician relationships can increase their value.