The COVID-19 Vaccine: Safe for Cancer Patients?

As we approach the one-year mark of the pandemic, nearly 60 million doses of the two currently approved COVID-19 vaccines have been administered nationwide. However, public opinion differs on the efficacy and safety of these vaccines, and some people have expressed reluctance — or outright refused — to receive one.

For cancer patients and survivors, who are at a high risk of becoming severely ill from a COVID-19 infection, this is an extremely important decision. It is essential that they and their caregivers know all the information regarding these vaccines and whether they are safe to take.

The Safety of the Vaccine

In short, it is safe for cancer patients and survivors to receive a COVID-19 vaccine. Nor does it matter which one they receive.  Vaccines created by both Moderna and Pfizer have been approved by the Food and Drug Administration (FDA) and report an efficacy rate of approximately 95%. Cancer patients and survivors of all ages are encouraged to get vaccinated whenever they can.

The vaccine is also safe for anyone currently undergoing chemotherapy and radiation treatment. However, patients receiving very intensive cytotoxic chemotherapy, such as 7+3 regimen for acute myeloid leukemia (AML), should wait until their absolute neutrophil count (ANC) recovers before getting the vaccine.  Those receiving bone-marrow transplants or cellular therapy such as chimeric antigen receptor (CAR) T-cell therapy should wait at least three months after their therapy has been completed.

There may be side effects to receiving a COVID-19 vaccine, such as pain and swelling at the injection site, as well as headaches, chills and fever. These aren’t expected to be any worse or different for cancer patients and survivors.

Caregivers and Vaccines

COVID-19 is highly contagious, so it is important that caregivers also be vaccinated in order to mitigate the risk of exposing patients or loved ones to infection. It is safe, too, because receiving a vaccine will not turn a caregiver into a carrier.

However, data from trials have shown that while vaccines decrease the incidence of COVID-19 and its ensuing complications, it is unclear if they prevent infection and possible transmission. Consequently, people should continue to wear a mask, maintain social distancing, and wash their hands regularly even after they have been vaccinated.

Cancer patients are also at a high risk of developing serious complications from the flu, so it is important that they and their caregivers receive a flu shot. This is especially true during the pandemic; while the flu shot won’t stave off COVID-19, it will lessen the severity of the flu and ease the burden on hospitals and healthcare organizations that are already overwhelmed treating the millions fighting COVID-19.

Keeping our Patients Safe

Since the pandemic was first declared last March, American Oncology Network (AON) has prioritized the safety of our staff and patients. We continue to do so by encouraging all employees to get vaccinated as soon as they can, which allows us to continue administering top-quality care to our patients right in their own community.

In the future, we hope to be able to administer the vaccines to patients and staff all throughout our network.

Cervical Cancer: How it can be Prevented and Treated

January was Cervical Cancer Awareness Month — and awareness has played a big role in its shift from the leading cause of death among women in the United States to the most preventable of female cancers. This is due largely to the emphasis placed on annual screenings and the emergence of vaccines for the human papilloma virus (HPV), the primary cause of cervical cancer.

While this progress is encouraging, more than 14,000 women are still expected to be diagnosed with cervical cancer in the U.S. in 2021, and more than 4,000 will die. Which is why it is so important to continue educating women — and men — about cervical cancer and how to prevent it.

Causes and Symptoms

The main cause of cervical cancer is HPV, a sexually transmitted disease that infects about 14 million men and women in the U.S. each year. Smoking, multiple sexual partners and taking oral contraceptives for longer than five years can also increase a woman’s risk.

Symptoms of cervical cancer include pelvic pain, abnormal discharge and abnormal periods, fatigue, nausea, weight loss and pain during intercourse. It is also very common for women not to have any symptoms at all, which is why keeping up with annual screenings is so important.

Preventative Measures

The most effective measure in guarding against cervical cancer is an annual Pap smear test, a procedure that involves collecting cells from the cervix and analyzing them for the presence of precancerous or cancerous cells. These annual screenings are crucial because cervical cancer, when diagnosed in the early stages, is very treatable. Too often, by the time symptoms present themselves, the cancer has already metastasized to other areas of the body.

Another effective measure is the HPV vaccine, which is typically given to females from ages 12-15, or before they become sexually active. While cervical cancer occurs only in women with a cervix, HPV can be passed from female to male and male to female, so it is a good idea for boys of the same age to receive the HPV vaccine as well. There are also new HPV vaccines recommended for an older population under the age of 45.

Treatment Options

One common method in the treatment of cervical cancer is the loop electrosurgical excision procedure (LEEP). Often performed in a gynecologist’s office, a LEEP features a heated wire loop that removes the area of the cervix affected with the abnormal cells. This is typically the first stage in treating cervical cancer, and some patients who undergo a LEEP don’t experience a reoccurrence. More advanced treatments include immunotherapy for certain types of cervical cancer, and chemotherapy and radiation when the cancer is more extensive.

Precision therapy is being studied as another possible way to treat cervical cancer. However, its use is not yet widespread because there is not always a genetic component to cervical cancer and its primary cause is a virus.

Power in Partnership

At Zangmeister Cancer Center, we pride ourselves in delivering high-quality care to cancer patients right in their own backyard. Partnering with American Oncology Network (AON) two years ago has enhanced our ability to treat our patients, including those with cervical cancer.

AON provides us with extended resources and enables us to accept a wider array of insurance plans, which allows us to help even more patients. Most importantly, working with AON allows us to expand patient education and provide more in-depth information on all types of cancer. This includes cervical cancer, which, with the right amount of vigilance, is preventable as well as easily treatable in early stages.

Celebrating Women Physicians: An Interview with Dr. Jeanna Knoble

February 3 is National Women Physicians Day, celebrating women’s contributions to healthcare as well as the birthday of Elizabeth Blackwell, who in 1849 became the first woman to earn a medical degree in the United States.

The impact of women on the healthcare industry continues to grow — according to the U.S. Census Bureau’s American Community Survey, the number of women working in healthcare full-time and year-round jumped from 5 million in 2000 to 9 million in 2019. And that number is expected to continue growing as more and more women enroll in medical school.

To celebrate National Women Physicians Day, we spoke with Jeanna Knoble, M.D., a medical oncologist at Zangmeister Cancer Center who was also recently elected as the practice’s managing partner. She is also co-medical director of the breast cancer program at Mount Carmel Health System.

At Zangmeister, Dr. Knoble treats all cancer and blood disorders, but does have a special focus on breast cancer, as well as blood clotting abnormalities. She is also active in the practice’s research program and serves as the principal investigator of several active trials.

Dr. Knoble graduated from Miami University — summa cum laude with a B.A. in Microbiology — and received her medical degree from The Ohio State University Department of Medicine and Public Health. Following her residency at The Ohio State University Medical Center, she completed a fellowship in hematology and oncology at the University of Virginia Health System.

In this interview, Dr. Knoble talks about what led her to oncology, what advice she has for women just starting or considering a career in healthcare and what National Women Physicians Day means to her.

What led you to a career in healthcare? Was oncology always your chosen discipline?

I always found science so fascinating, but I am also kind of a “people person.” I felt like medicine merged the two because you can apply science every day directly to people’s lives. You are guiding and helping patients with the proven principles of science and improvements in care brought by clinical research.  For me, medicine was the perfect confluence of science and helping people.

I didn’t know until my residency that I would fall in love with oncology. There’s a lot of cutting-edge science contributing to the advancement of patient care in oncology. But…the patients are what led me to pursue oncology. Cancer doesn’t discriminate. It’s life-threatening and it can happen to anyone, changing lives in an instant. Taking care of cancer patients is motivating and humbling at the same time. Cancer patients teach you a new perspective on life.

Along with interacting with patients, what are some of the other things you love about your job and working in oncology?

Again, it gets back to the science and the research and the fact that we are seeing progress in real time.  All of medicine is advancing, but in oncology our treatments have really evolved, even since I started practicing 10 years ago. I love the research end of it, and we have a real chance to participate in research here at Zangmeister.

I also find purpose in educating patients about what their cancer means for them so we can develop realistic goals of care and they can prioritize what is most important in their lives.

What accomplishments are you most proud of?

For me it isn’t really degrees or awards — the most important things are knowing you’ve made a difference, that you’re helping people do the right thing in a difficult situation and you’re standing up for people who need to be stood up for, whether it’s a patient or a co-worker. That’s what really makes me want to get up in the morning and keep doing what I’m doing.

I am also proud of the fact my colleagues trust me to represent them as a part of our leadership team here at the Zangmeister Center and also with our multidisciplinary cancer program. It means a lot to be trusted with the opportunity to improve the future for our patients, staff, and my fellow clinicians.

What would you tell other women who are just starting a career in healthcare or oncology?

I love mentoring young women and it is something I am very passionate about. The most important thing I can do is encourage them and give them confidence. I think sometimes women turn away from a career in healthcare because they don’t think they can handle the hard work and the pressure, or don’t think it’s possible to have a demanding career and also raise a family. I don’t have children myself, but many of my female comrades in medicine do. We need to adapt and accommodate that and let women know, “You can do this, you can be a part of this.”

Women make great oncologists — and great physicians in general — because they have unique insight, communication skills, and empathy when it comes to patients. Not more empathy than men, but empathy from a different perspective.  There have been studies that found that women physicians had lower mortality rates and fewer patient readmissions. Many patients have told me, “I just feel more comfortable asking questions and being completely honest with women.”

You mentioned taking pride in mentoring younger women. Who were some of your mentors?

There are several. One who comes to mind is Dr. Manisha Shah, whom I met on my oncology rotation as a second-year resident at Ohio State. She was an independent, strong woman who was very confident and caring. She not only had passion for the research trials she was leading, but equal compassion for each of her patients. Both my intern and I chose a career path in oncology after working with her that month.

At the University of Virginia, our fellowship director, Gail B. Macik, had a very similar personality. She inspired you to be confident and keep moving forward. I was very fortunate to have women like these in my life who have been such great mentors.

What are some of the challenges you’ve encountered in your journey?

Helping patients develop realistic expectations while maintaining some hope and optimism can be one the most difficult challenges, particularly when delivering bad news. It is so important for patients to understand what likely lies ahead, but also find hope in the journey.

Another challenge in oncology is keeping up to date with all the research advancements in care. The field is constantly evolving — and evolving quickly. I not only have to be up on breast oncology, which is an area I focus on, but also on all other subspecialties in oncology and benign blood disorders. It is a wonderful thing that we’re getting more and more therapies out there — but being knowledgeable on all of them can be a challenge.

For women physicians in general, I think maintaining a work-life balance can be difficult. My hat goes off to women that are trying to raise a family and advance their career because it is a huge challenge for them. It’s a challenge for young fathers as well, but it’s almost always more so for women because of the inherent and societal role that motherhood entails.

Studies have shown that only about 34% of oncologists are women. What can the healthcare industry do to help increase that number?

I read where there is now a 50-50 split of men and women in medical school. So hopefully as those numbers go up, the number of women oncologists will go up too. However, there are challenges in oncology and other subspecialties, especially when it comes to women deciding when they are finished with their residency if they want to go out and work or do another three years of a fellowship.

Fellowship programs often require you to move somewhere else and require long hours away from home. For women who want to start a family, that can be a deterrent. I think we need to add more flexibility to our training and give women more time [to complete it] while making sure they maintain integrity and the necessary experience. It’s also important for women to know, even at a young age, that they can have options and flexibility in their education and careers — that they can have a family and still have a career in healthcare and oncology. It is a continued challenge but it is something we’re working on.

What does National Women Physicians Day mean to you?

It means that we are recognizing that women are very important in healthcare and bring a unique perspective and distinct qualities. Most women have faced and continue to face additional challenges and obstacles through training and as attending physicians. It is important to recognize this and work to prevent this from hindering success. This is also true in other professions and with other disparities.

I also think it points out that qualified women need to be a part of leadership in healthcare. The workforce in healthcare is approximately 80% women.  The majority of our patients’ caregivers are women. Having women actively involved in crucial decision making is essential for any health care organization to reach its full potential. Our voices need to be heard and we deserve a seat at any important table.

The Dawn of a New Year: A Message from Our President & COO

As we usher in the New Year, I wanted to take this opportunity to look back on what was one of the most challenging years on record. COVID-19 claimed hundreds of thousands of lives in 2020 and took an emotional, physical, and financial toll on countless others worldwide—and we are not out of the woods yet even with vaccinations underway.

The pandemic has also had a catastrophic effect on cancer care and research. Over the past year, fewer patients scheduled office visits, screenings, biopsies and even surgeries because they feared COVID-19 exposure. It’s an alarming and potentially deadly trend. By causing a decrease and delay in identifying new cancers or discovering new forms of treatment, these pandemic-generated care gaps could accelerate cancer mortality rates for many years.

At American Oncology Network (AON), dealing with the fallout from COVID-19 while providing our patients with top-quality care is one of the many challenges we continue working to overcome in 2021.

Working Through the Pandemic

According to a recent study in JCO Clinical Cancer Informatics, when the pandemic hit its peak in April, screenings for breast cancer (85%), colon cancer (75%), prostate cancer (74%) and lung cancer (56%) sharply decreased from where they were in 2019. And even though stay-at-home orders were lifted (in some cases temporarily) throughout most of the country, the study also reported that fewer patients are having surgery, receiving treatment and scheduling critical follow-up appointments for existing cancers.

This dip in office visits not only has an adverse effect on patients who were undergoing treatment prior to the pandemic, but it also leads to fewer cancer diagnoses—cancers that will eventually be diagnosed at a later stage and require more complex care. Late-stage diagnoses often lessen the chances for a cure, which drives up mortality rates.

While the presence of COVID-19 continues, AON is working with the practices in our network to remind patients to stay on top of their appointments and screenings. Our practices offer telehealth, allowing patients to meet with their providers from the comfort of home.

We also have in place exceptional safety protocols. Days after the World Health Organization declared COVID-19 a pandemic in March, we assembled an emergency task force to identify and monitor protective measures and supplied our clinics and staff with copious amounts of personal protection equipment (PPE) and appropriate cleaning products, thereby ensuring patients who had to come to our clinics could do so safely. And we continue to perform daily temperature screenings on patients and employees across all our locations.

Vaccines will bring us some relief in 2021. But AON will continue to do all we can to prevent and mitigate the spread of COVID-19 to keep our patients safe while getting the care they need and deserve.

Fighting for Our Patients and Practices

We are doing everything in our power to ensure our patients have access to the great care and medications provided by our practices. To that end, we are working with our public policy partners and the Community Oncology Alliance (COA) to put a stop to the Most Favored Nation (MFN) Model announced by the Centers for Medicare & Medicaid Services (CMS).

In accordance with the MFN, Medicare will reimburse only the 38 most used drugs in oncology at a rate below the average sale price. According to COA, these include mainstay breast, lung and prostate cancer drugs, as well as the latest cutting-edge immunotherapies that have had significant results in improving survival rates. The rate will continue to decrease over a five-year period until it hits MFN price — which, according to COA, will be so low that clinics will have to send patients to 340B hospitals for treatment.

One recent study shows that, under the MFN model, out-of-pocket drug costs will be lowered for less than 1% of Medicare beneficiaries. According to COA, CMS estimates that in the first year of the MFN, 20% of seniors will be required to find new oncologists and treatment and nearly half of those will forgo treatment. By 2023, 30% of Medicare seniors may be displaced with 1 in 5 not getting treated.

It appears, however, the MFN may not come to pass. The U.S. District Court in Washington, D.C. is in the process of hearing COA’s complaint, as well as a temporary restraining order and preliminary injunction that have been filed to delay the measure’s implementation.  

Medicare Reimbursement Sequestration

Because of the extensive financial burden placed on patients and clinics by the COVID-19 pandemic, we are also fighting against the extension of the Sequestration on Medicare Reimbursement, which is part of The Coronavirus Aid, Relief and Economic Security (CARES) Act. Extending these 2% cuts, which were enacted by Congress in 2013, will drive up costs for both patients and clinics across the country and no doubt lead to more harmful lapses in care.

The moratorium began on May 1, 2020 and was set to expire on December 31, 2020. Because of the ongoing pandemic, however, it has been extended through March 31, and the 2% Medicare cuts will not be applied in the first quarter of this year.

Despite these challenges, AON’s top priority for 2021 and beyond will always be our patients. We and our participating practices vow to continue to do what we do best — provide top-quality cancer care to patients right in their own backyard.

Advancements in Lung Cancer Treatment

Though lung cancer may not be the most common type worldwide, it nonetheless kills more men and women in the United States each year than any other type of cancer. Thankfully, the number of people dying from non-small cell lung cancer—the most common type of lung cancer—has sharply declined in recent years, according to a study published in the New England Journal of Medicine by Howlader et al. This is a result of both the decline in tobacco use (particularly among men) as well as the increased effectiveness of new lung cancer treatments.

At Zangmeister Cancer Center, we offer all the cutting-edge, Food & Drug Administration (FDA) approved treatments available, as well as investigational treatments being studied through the National Cancer Institute Community Oncology Research Program (NCORP).

The Benefits of Precision Medicine

Precision medicine is an approach for disease treatment and prevention that takes into account individual variability in the genes, environment and lifestyle for each person. It has significantly impacted how cancer care providers help patients with lung cancer. Currently, physicians select the best treatment based on an in-depth analysis of the patient’s tumor. This analysis allows for the search for genetic alterations that could be treated with therapies that target that specific alteration (targeted therapies) and helps sort out patients more likely to benefit from other treatments such as immunotherapy. These targeted therapies and immunotherapies have helped drive down lung cancer mortality rates at an accelerated rate over the last seven years.

Targeted therapies have a high success in controlling disease growth, with shrinkage of tumors that can be seen in roughly 80% of patients using this treatment. This is significant in comparison to a 30%-40% rate of response with chemotherapy treatments — and can add 10-12 months and in some case more than 20 months to a patient’s survival compared to chemotherapy.

Currently, immunotherapy, through drugs called immune checkpoint inhibitors, have firmly established a role in the treatment of advanced non-small cell lung cancer. In this type of treatment, medicines are used to help a person’s own immune system identify and attack cancer cells. One out of every four patients with advanced non-small cell lung cancer receiving these treatments are alive at five years.  Since not every patient receiving these treatments obtains the same benefit, the scientific community is actively looking for different strategies to identify those that would benefit the most, as well as how to increase the number of patients that have good outcomes.

Newer Treatment Strategies Are on the Way

Both immunotherapy and targeted therapies are making inroads in the treatment of patients with locally advanced and early stages of lung cancer, which had previously been treated only with surgery or radiation and/or chemotherapy.  The use of these therapies in early-stage lung cancer seems imminent in the near future. 

While lung cancer CT screens have a significant impact in the reduction of lung cancer mortality rates, the strategy is underutilized due to a variety of reasons such as logistics and cost. Consequently, liquid biopsies are currently being tested as a potential strategy to overcome the limitations of low-dose lung CT screening.

Liquid biopsies could help doctors screen for cancer long before a patient has any symptoms and could also be administered after surgery to check for the presence of any residual cancer. Other screening strategies, such as the analysis of exhaled volatile organic compounds and quantification of lipids in the blood of patients, are currently being tested as well.

Brighter Future for Lung Cancer Patients

Prior to the development of targeted therapies and immunotherapy, a patient with advanced lung cancer had a less than 5% chance of being alive after two years.  Currently, approximately one in four patients with advanced lung cancer can be alive at five years. Newer technologies such as liquid biopsies, artificial intelligence and “omics” approaches are exciting opportunities that could have the potential of further improving the outcomes in patients with lung cancer at all stages.

The Future of Breast Cancer Treatment

Breast cancer is the second-most common form of cancer in women with 13% expected to develop the disease at some time in their life. Breast cancer can also happen to men — though it makes up for 1% or less of all breast cancer diagnoses.

October marks Breast Cancer Awareness Month, the ideal time to not only remind women about the importance of annual mammograms and self-examinations but to also take a closer look at the progress being made in treatments — all of which are helping breast cancer patients live longer and better lives while offering hope for the future.

Newer, More Effective Treatments

Several new medications have been approved for patients diagnosed with both early and late stages of breast cancer. One such treatment is immunotherapy, which helps the body’s immune system identify and destroy cancer cells.

In clinical trials, immunotherapy has yielded positive results and demonstrated increased response rates in patients with both early and late stages of breast cancer. Immunotherapy is approved for patients with advanced triple-negative cancer, which often grows and spreads faster than other types of breast cancer. Treatment options for triple-negative patients have been limited in the past, making the approval of immunotherapy an exciting breakthrough.

Hormonal therapy, which targets the estrogen receptor, and subsequently, the most common type of breast cancer, can be used before or after surgery, reducing the risk of breast cancer recurrence by approximately 50%. Hormone therapy, either alone or in combination with targeted therapies, is also highly effective in the treatment of late-stage breast cancer.

Targeted therapies are developed when researchers identify what causes a tumor to mutate, such as certain proteins that are present or overproduced in cancer cells compared with healthy cells, and then develop a treatment to stop that mutation. Targeted therapies against the HER2 protein, present in 15%-20% of breast cancers, significantly reduce the risk of breast cancer recurrence and improve overall survival in both early and late stages of disease.  Clinical trials demonstrate that targeted therapies significantly reduce the risk of cancer progression and lead to an increased response rate when given in combination with standard therapies or compared with standard therapies.

The Future of Cancer Treatment

Precision medicine refers to treatment based on the genetic understanding of a patient’s disease.

With precision medicine, doctors can use information about a patient’s own genes or tumor mutations to assist with the diagnosis and treatment of cancer. In a patient who has been diagnosed with breast cancer, precision medicine helps to determine whether certain targeted therapies and immunotherapy will be beneficial in their treatment.

Not only can precision medicine help doctors put together very specific plans that often lead to a more accurate diagnosis and more effective cancer treatment, but it can also let a patient know if they are a high risk for developing breast cancer. Having this knowledge allows for a proactive approach to early detection, which includes more frequent and better screening tests.

The Benefits of Community-based Treatment

At Messino Cancer Centers, we use the most up-to-date approved treatments including hormonal-based therapies, chemotherapies, immunotherapies and targeted therapies, and offer patients access to a robust list of clinical-based trials. We have many support services available to our patients including social and behavioral therapy, a cancer-specific dietitian and a care management team.  We also offer the DigniCap Cooling System, which has been clinically proven to help prevent hair loss from certain chemotherapy treatments.

Because we are a community-based practice, our patients don’t have to worry about traveling out of the area for treatment and are able to stay close to their support system of family and friends. It also allows our nurses and physicians to create strong, trustful relationships with our patients, who feel less like a number and more like an individual who is truly cared for.

The strong support of a community-based staff coupled with exciting therapeutic treatment advances give breast cancer patients more hope than ever in their quest to live happier, healthier and longer lives.

Addressing the Financial Concerns of Cancer Treatment

Stress can have an adverse effect on a patient’s cancer treatment. It can weaken the immune system, increase bone pain and exacerbate fatigue. In some cases, the presence of stress can cause a relapse for those whose cancer had been in remission.

That is why, as they embark on the most frightening and worrisome time of their lives, cancer patients shouldn’t have to worry about money. But the reality is that cancer treatments can prove costly, especially if patients must travel far for treatment or are prescribed expensive medications. And that financial burden can create enormous stress.

At Hematology Oncology Clinic (HOC), we do what we can to ease the financial burden borne by our patients to help ensure they are not endangering their health by delaying care, skipping treatments or failing to refill their prescriptions—all of which adds to the stress generated by financial concerns.

Educating Our Patients

Rather than surprising patients with unexpected costs in the middle of treatments, we have them meet with one of HOC’s financial counselors at the outset to go over all pertinent financial information. We review their insurance plans to determine how much will be covered and, when necessary, we connect them with financial assistance and even free medications.

HOC has a five-person staff dedicated to helping patients ease financial concerns by tapping into a myriad of programs designed to help patients who need assistance covering treatment costs. With a decade of experience, our financial support team is intimately familiar with programs that most people aren’t aware even exist, such as grants that can help with copays and assistance programs through non-profit organizations and societies. Drug companies will also supply medications at no cost to patients who meet certain criteria.

We also encourage our patients to call us with any questions about their health rather than rushing to the emergency room when the situation isn’t life-threatening. Avoiding an unnecessary trip to the ER can save them thousands of dollars.

Another aspect of treatment costs is the type of practice a patient chooses for their oncology care. Community-based practices such as HOC can be up to 40% cheaper than hospital-based in- or outpatient programs.

The Financial Benefits of Joining a Network

One of the reasons HOC can help its patients ease financial concerns is its partnership with American Oncology Network (AON). Since joining in September 2018, we’ve seen our costs go down. The power of having a network behind us has opened doors to which a practice our size typically doesn’t have access. This has allowed us to get medications at much lower rates, a savings we can pass along to our patients.

With the help of AON and the willingness of various assistance programs to work with such a network, we were able to access $8.2 million over the past 18 months to help our patients, with about $6 million coming from grants. We were even able to help one of our patients reduce their copay to $0.

Through its participation in the Oncology Care Model, AON has been able to provide our patients with care managers to guide them through the process, including helping determine if a trip to the ER is necessary. This has helped cut out unwarranted expenses. And, because they are in regular communications, our patients feel comfortable calling them with questions rather than racking up extra costs that come from ER and hospital visits.

At HOC we strive to provide the best possible patient experience—providing compassionate and supportive cancer care, close to home. AON’s focus is on keeping community oncology alive, maintaining practice independence and serving patients outside hospital settings. Like us, their whole focus is the care of oncology patients.

AON’s philosophy aligns with ours: Putting the patient first. Through our partnership, we continue providing top-shelf care to our patients without adding unnecessary costs—and stress—at an already stressful time.

Why Care Management Is Crucial to Oncology

Cancer is a complicated disease that takes a significant toll on patients’ physical and psychological well-being, which is why effective treatment encompasses the whole person—body, spirit and mind. Consequently, comprehensive care management services are fundamental to any oncology practice.

Care management allows the care team to focus on both the mental and physical health of its patients. For example, a nurse on the team may act as a liaison for patients throughout their cancer journey, advising on side effects and symptom management, answering questions, addressing concerns, coordinating community resources and lending an empathetic ear to help support the patient’s emotional needs—and those of caregivers.

A Team Effort

Cancer patients are going through a tumultuous and scary time, which frequently gives rise to questions about treatments and possible side effects. They want questions answered quickly but are often reluctant to call their physician. Frustrations can become exacerbated when patients who do call are forced to leave a message and wait for a return call.

Under care management models, patients are assigned to an RN care manager and have access to a nurse 24 hours a day, seven days a week who provides timely answers and advice, calms fears and assuages concerns. These relationships are built on trust and become an important catalyst for preventing unnecessary costs associated with inappropriate trips to the emergency room.

Robust care management programs also include dietitians on the patient’s team. Studies have shown that patients who maintain a stable diet while undergoing treatment are more likely to complete the course, which can be lifesaving. Dietitians are able to tailor nutritional plans for patients who, for example, have difficulty swallowing as a result of treatments for head or neck cancer or for pancreatic cancer patients who cannot digest food normally. Patients experiencing weight gain due to treatments can also lean on dietitians for help.

Care Management During COVID-19

As coronavirus cases continue to surge across the country, many cancer patients are understandably hesitant to leave the house—especially since they are at a high risk for the most severe aspects of the virus.

At AON, our care management team is addressing these very real concerns through telehealth, allowing our dietitians to continue meeting with patients without requiring them to leave their homes. The transition from face-to-face to virtual has gone very well. In fact, more patients are making appointments with dietitians now than they were before the pandemic hit.

The benefit of using telehealth to reach our patients is two-fold. It allows patients to meet with members of their care management team from the safety of their own home, and it keeps them connected to people they trust and can rely on during an incredibly stressful and fearful time. The COVID-19 pandemic has been exceptionally difficult for cancer patients, so it is important for them to know that their care is here for them even if we can’t meet physically.

How A Network Can Help

A lot of work is involved in the implementation of a care management program and some independent practices may not have the manpower or bandwidth to accomplish it properly.

For practices that partner with AON, a care management program is already established for patients who qualify for the Oncology Care Model. Our network’s care management department also offers a variety of support activities, such as refilling medications, meet-and-greet phone calls to new patients to gather information for their clinical team, and managing paperwork. The result is an unprecedented level of care that doesn’t require a practice to add staff or increase costs. With AON alleviating much of the administrative burden, it also allows the practice to focus on its top priority: the patients.

AON also offers an app-based support portal for nurses and dietitians that helps them quickly locate providers of almost any resource they need in their surrounding community. We are currently working on building one that will give patients access to AON’s robust database of resources and community-based services such as housing and assisted living, nutrition, food support, respite care, financial assistance and transportation services.

Treating cancer involves treating the whole patient. A care management program enhances a practice’s ability to do so.

Cancer Care Cost

Cancer is one of the leading causes of death and disease in the U.S. Not only does cancer take an enormous toll on the health of patients and survivors—it also has a tremendous financial impact. Cost differences associated with oncology care in the community setting versus a hospital setting are significant with community oncology practices providing high quality, state-of-the-art care at lower costs to patients.

The Future of Oncology: Value-Based Care

July 2016 marked the start of oncologists looking at a new way to manage cancer care with a shift from fee-for-service to value-based care, prompted by the launch of the Oncology Care Model (OCM) by the Center for Medicaid & Medicare Innovation (CMS Innovation Center). Today, CMS Innovation Center is expanding on this foundation with Oncology Care First (OCF)—a next-generation model that will phase out OCM and further emphasize the benefits of adopting value-based care models that favor care quality and outcomes over quantity of services provided.

Thanks to the success of OCM and other programs, the adoption of value-based care is advancing rapidly, delivering improvements in collaboration, costs and quality that oncology should embrace sooner rather than later.

Enhanced Collaboration

Collaboration is one of the most critical components of value-based care. Enhanced coordination of care among healthcare providers can help improve patient outcomes and lower costs by decreasing unnecessary hospitalizations and eliminating emergency room visits.

Routine interdisciplinary care team meetings allow for enhanced collaboration and communication among members to ensure a patient’s needs are being met and timely follow-up is in place. This team-based approach assures the entire care team is focused on the same goals of care for each individual patient.   

Because value-based care is still relatively new, it is important to discuss with clinical and non-clinical team members the specifics of the model and the importance of collaboration, as well as how it benefits the patient.

Driving Down Costs

There are typically three main cost drivers facing oncology practices: hospitalizations, chemotherapy agents and variable resources. Driving down the costs associated with these drivers, while still providing top-shelf care, is essential to a successful transition to value-based care.

Education is a key component to effective implementation, and the primary focus in this case is the patient. Helping patients understand which symptoms of chemotherapy treatment merit a trip to the emergency room vs. an office visit with their oncologist or primary care physician can decrease unnecessary and costly ER visits. Strategies such as a “Call Us 1st” campaign can be an effective method to encourage patients to call their oncologist or physician first to see which route is better, assuming the situation isn’t life-threatening.

An effective triage system with nurses conducting proactive outreach to high-risk patients is another strategy that can deter the need for higher-cost interventions. Along those same lines, ensuring patients can always reach a live person by phone rather than having to leave a message—then worry about a call back—can also decrease costs associated with unnecessary emergency care.

Other cost containment resources include:

  • Social workers, who can provide oncology patients and their loved ones with invaluable support throughout their cancer care.
  • Nurse navigators, who guide patients and their families throughout the entire oncology care journey.
  • Dietitians, who can educate patients on proper nutrition to lessen the side effects of treatment and improve recovery.
  • Pathway adherence and evidence-based treatment options, such as the National Comprehensive Care Network (NCCN), which can help physicians and pharmacists identify less expensive, but still highly effective, drugs and treatment.

The Role of Data

As important as collaboration and cost containment measures are to the success of a value-based care model, they cannot happen without a solid foundation of data. For example, participating in state health information exchange initiatives carries unique benefits in the value-based care environment, such as the ability to connect with laboratories to access test results in real-time or being able to see when or if a patient was admitted to or discharged from the hospital.

Comprehensive patient data allows oncologists to better evaluate treatment outcomes and determine what, if any, changes could be made to prevent ER visits or admissions. It can even provide the basis for deployment of advanced communications such as texting medication and appointment reminders.

The data challenge is two-fold: it requires the right technological foundation and the understanding of data and how to use it in practice transformation efforts.  

To overcome these challenges, the American Oncology Network (AON) built a Value Based Care team that collaborates with physician champions to review data and make recommendations for continuous process improvements. The development of a quality care committee consisting of representatives from various departments who are champions of the value-based care model has also proven to be effective. This committee of peers can demonstrate the value of data in reducing costs while improving outcomes.

Partnering with a Network

Transitioning to a value-based care model can be difficult and requires a level of infrastructure and manpower that many independent practices do not have—limitations that have forced some practices to pull back from its adoption.

However, partnering with a network such as AON can empower practices to embrace the potential of OCF. AON can provide the support and resources that set the stage for success in a value-based care environment. Among these are the technology and expertise to not only capture and share robust patient data, but also help transform hard-to-read metrics into action items.

Pharmacy services, care management, back-office support and a plethora of other tools are also available to AON practices to help them get—and stay—on the right track with value-based care.

A Proven Approach

While the model itself is relatively new to oncology, value-based care has already proven its effectiveness at improving patient care and driving down costs.

Value-based care isn’t going away. The sooner oncology practices embrace it, the sooner they will realize the many benefits it can deliver.