Oncology treatments get more complex every day. Pairing subspecialists with community oncologists improves patient access to the best possible treatments while keeping their care close to home.
As recently as 1980, the sum total of medical knowledge doubled approximately every 7 years. New doctors could be confident they could rely on much of what they learned in medical school, and most doctors could keep up with the medical advances their patients needed for best-in-class care. For 2020, medical knowledge was projected to double every 73 days.
The oncology field is considered one of the most complex areas of medical care. Cancer is not just one disease – it’s thousands of increasingly individualized diseases with more than 100 major cancer categories. Today’s cancer treatments can take the form of surgery, chemotherapy, radiation, targeted therapy, immunotherapy, stem cell transplant, bone marrow transplant, hormone therapy, and observation. Depending on the patient and the cancer subtype, an individual treatment plan can include any number and any combination of therapies.
Cancer is complex. So are cancer guidelines.
The National Comprehensive Cancer Network (NCCN), an alliance of 33 leading cancer centers, has developed expert panels for more than 50 cancer types – and each of those types has subtypes. NCCN’s evidence-based guidelines have become a critical tool to help all oncologists ensure their patients receive treatment that will lead to the best outcomes.
Only a decade ago, for example, the NCCN’s guidelines for breast cancer covered 20 to 30 pages. Today, each guideline averages more than 200 pages. That adds up to more than 10,000 pages of information, with updates made almost daily.
Community oncologists care for the large majority of cancer patients – approximately four of every five – treating all types of cancer and playing a key role in keeping patient care close to home. While they have access to the NCCN guidelines, the review process is manual and inefficient. The volume and complexity of these guidelines make it unrealistic for community oncologists, who are not affiliated with academic medical centers, to discern every nuance for each patient they see.
Consultations bring expert care to patients
Despite the volume and complexity of today’s oncology guidelines, data show that nearly 80% of oncology care follows NCCN guidelines. The remaining 20% of cases represent the most rare or complicated cancers, raising challenges for community oncologists.
Fortunately, support is available from programs pairing subspecialized oncologists, who dedicate themselves full-time to specific types of cancer (including breast cancer, leukemia, multiple myeloma, ovarian cancer, and more) with community oncologists when needed. For example, by leveraging proprietary technology and prior authorization as a critical access point, Evernorth identifies patients with complex cancers who are most likely to benefit from a consultative review, then invites the patient’s community oncologist to connect with a cancer subspecialist at an NCI-designated cancer center at no cost to the patient or the oncologist. As part of this additional consultation, the subspecialist conducts an in-depth review of the patient’s case, including pathology slides, radiology images, genetic studies, genomic test results, and prior and current treatment plans.
The benefits of this program are illustrated by the results of a pilot with select health plan customers. The subspecialized oncologists recommended alternate tests and therapy choices in 40% of the cases they reviewed, all while keeping the patients close to home and their families, in the hands of their trusted community oncologist.
I’ve had the opportunity to connect with many oncologists who participated in this peer review service, and their appreciation has come through loud and clear. A physician in a rural area of Texas described it as “a godsend for a community oncologist like me, here in the middle of nowhere.” As a physician in Arizona recently shared: “At the end of the day, we all want to do the best for our patients.”
For plan sponsors, bringing together the right partners in the oncology community can improve health outcomes for members diagnosed with cancer. This also leads to reducing waste and lower costs, because community oncologists are guided to the right treatments.
Originally published on 5/23/22 and updated on 2/8/24.
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Guided Cancer Care
Evernorth Guided Cancer Care helps plan members get the right care early enough in their cancer journey to have a positive impact on both health outcomes and costs. Our comprehensive approach combines two unique solutions: Concierge Cancer Support and Cancer Consult Service. Concierge Cancer Support is designed to quickly identify where we can add the most value for each member and provides members a single point of contact – a Care Advocate. Care Advocates provide personalized care plans for each member, serving as a resource to guide and support members through their entire care journey from diagnosis, to treatment, to survivorship. Additionally, we help ensure that members with the most complex cancer cases receive an accurate diagnosis and optimal treatment plan options through our Cancer Consult Service.