The American Society for Clinical Oncology (ASCO) conference, the world’s largest cancer meeting, recently occurred. Let’s take a closer look at the ASCO 2020 highlights with a focus on patient oriented news.
As the world continues to come to terms with the havoc created by the severity of the SARS-COV-2 virus and its associated COVID-19 disease, we have integrated a little more of the virtual world. Schools have developed distance learning schedules, offices have adopted video calling platforms, and conferences have gone virtual.
The American Society of Clinical Oncology (ASCO)’s annual meeting, which usually claims to have 35,000-40,000 global attendees each year, went virtual as well. While the scientists, physicians, nurses, patients, and patient advocates could not meet in person, the information that was presented and shared remained top notch. Here are some ASCO 2020 highlights.
QUALITY OF LIFE
Keeping Cancer Patients Out of the Emergency Department
The University of Colorado Anschutz Medical Campus has developed a unique cancer care delivery model that caters to oncology patients who need urgent care for adverse effects or complications associated with their cancer treatment. Led by advanced practice providers (APPs)—non-physician professionals such as nurses and physician assistants—the CARE (Clinical Assessment and Rapid Evaluation) Clinic aims to prevent emergency department (ED) visits and rehospitalizations of cancer patients for acute symptoms that can be treated in a regular clinic.
Cancer patients who experience severe symptoms related to their treatment can receive intravenous fluids, anti-emetics, opioids, antibiotics, as well as blood or platelets as needed. When surveyed, majority of patients who visited the clinic stated pain and nausea as the reason for their visit, and 33% said they would have ended up in the ED if the CARE Clinic was not available.
At-Home Care to Reduce Hospitalizations/ED Visits
A similar objective, but with a different approach. The Huntsman Cancer Institute in Utah has developed a Hospital-at-Home program for cancer patients who need acute medical or post-surgical care. The program provides some at-home treatment access for those who need medical care for symptoms related to cancer progression or treatment—care that would otherwise need hospitalization or an ED visit.
A majority of patients who were evaluated for this study had advanced cancer, with colon, gynecologic, prostate, and lung cancer being the most common. The program was found to reduce hospital stay, unplanned hospitalizations, and ED visits.
Lack of Awareness of Young-Onset Colorectal Cancer
A social media survey conducted by the Colorectal Cancer Alliance has found a gap in awareness among health care professionals as well as young adults about the growing incidence of young-onset colorectal cancer (CRC).
CRC numbers have been rising in the U.S. and globally in the younger (20-49 years) age group. While the causes are still being researched, the Alliance decided to explore awareness and quality-of-life experiences among the young-onset CRC patients and survivors. The median age at diagnosis among the 885 participants was 42 (+/-7) years, much lower than the recommended screening age of 50 years. Some key findings included:
- 63% of respondents were not aware that CRC can affect people younger than 50 years
- Majority of patients waited >3 months to visit a doctor despite noticing symptoms
- 23% of patients waited >12 months to visit a doctor despite noticing symptoms
- 75% of patients visited >2 doctors before being diagnosed with CRC; 11% among those visited >10 doctors!
- Significant number of patients reported that their doctors were dismissive of their symptoms
- Patients indicated that fertility preservation was not discussed
The outcome of this delayed diagnosis? 77% of patients were diagnosed with advanced-stage disease, which required aggressive treatment and subsequent impact of their quality of life due to neuropathy, sexual morbidity, clinical depression, unemployment, and financial burden.
Treatment-Related Financial Toxicity at ASCO 2020
Immunotherapy uses a person’s immune system to fight diseases including cancer. This includes boosting the body’s natural defenses or developing components of the immune system in a laboratory and injecting them into the patient. While several promising immunotherapy treatment options have been developed over the past few years, survey results presented at ASCO this year found patients experienced a financial burden related to their immunotherapy.
The 205 participants had an age range of <50 to >60 years, and a majority were female. The most common cancer diagnosis was lung, followed by malignant melanoma, kidney, colorectal, and bladder cancer. Pembrolizumab, ipilimumab, nivolumab, and durvalumab were the most common immunotherapies administered among the surveyed patients.
Only 172 patients completed the entire survey and reported:
- 48% (82 patients) confirmed financial toxicity associated with their treatment
- 29.3% of those (24/82 patients) said their care team had shared financial toxicity information with them while 70.7% (58/82 patients) had not received this information
Most common reported financial toxicities were:
- High medical copayments
- Loss of income
- High drug and treatment copayments
[What is copayment? Find information on insurance-related terms here.]
Covered by Medicare, Medicaid, or other HMOs (Health Maintenance Organizations), a majority of patients dipped into personal savings to cope up with treatment costs. Others reported receiving help from family members and friends or cutting down on household expenses.
This study affirms the need for physicians to bring up the financial impact of immunotherapy care prior to treatment initiation.
Interventions Can Reduce Financial Toxicity
Researchers at the Memorial Sloan Kettering Cancer Center explored patient feedback on the type of interventions that can help reduce cancer treatment–related financial toxicity. Survey respondents were gynecological cancer patients, 32-87 years old. Similar to the patients in the survey above, the 87 participants reported:
- Reducing leisure activities (41%)
- Using savings to pay medical bills (39%)
A small number (7%) also reported skipping a prescribed medication in the previous year due to cost. Participants recommended the following interventions as being helpful in reducing their financial hardships:
- Transportation to and from appointments (39%)
- Knowing cost of care upfront (36%)
- Minimizing appointment wait times to reduce time away from work (33%)
- Access to free food during or around appointments (25%)
[There is patient article in our archives written by a young woman who beat breast cancer, “The Secret to Beating Cancer on a Budget“]
Access to Care: Telemedicine
In the climate of the COVID-19 pandemic, telemedicine—the remote delivery of health services and information using technology such as video calls—is particularly relevant. Research studies presented at the ASCO meeting showed that telemedicine can play a vital role in cancer care as well.
Delivery of telemedicine services within the radiology clinic at the Memorial Sloan Kettering Cancer Center in New York had a significant impact on the time to biopsy, travel time, and cost for patients. The visits were conducted by a physician or an advanced nurse practitioner between November 2017 and October 2019. The study found:
- A reduction in time from referral to biopsy compared to in-person visits (12 days vs 17 days, respectively)
- Patients were saved of the travel time to Manhattan for an in-person visit: 367 less hours in total for all the patients in the study
- The visits resulted in patients saving $14,652 due to reduced travel costs and avoiding time off from work
Another study used a mobile health intervention to easily capture patient symptom data for a timely intervention that could prevent treatment-related symptoms from escalating. Remote patient monitoring was conducted by resident nurses and nurse practitioners. Patients could report daily symptoms on a patient portal that allowed staff to review the information and also securely communicate with the patients. The 100 high-risk patients who enrolled in the program between October 2018 and July 2019 had solid tumors and lymphoma and were initiating anticancer treatment.
During the 6-month follow-up period:
- 56% of patients provided daily assessments
- 93% generated a severe symptom alert
- 5,010 symptom-related secure messages were shared on the portal
- There was a 17% reduction in ED visits
The insights from ASCO 2020 show some innovative approaches to the long standing issues facing cancer patients.
- ASCO meeting abstracts can be found her: https://meetinglibrary.asco.org/.
- ASCO’s advocacy measures can be found here: https://www.asco.org/advocacy
Patients Rising University acknowledges the important contributions of Surabhi Dangi-Garimella Ph.D. in this article. Improving patient access is our mission and we’re happy to utilize a variety of experts to carry that out.