Many aspects of traditional clinical laboratory pathology testing remain rooted to cancer care even as the cancer care industry embraces precision medicine, and digital pathology testing and interpretation

There’s good news for anatomic pathologists worried about the future of the pathology profession. A recent survey of oncology program participants in the United States determined that Precision Medicine—and the need for precision diagnostics—will be one of the top trends that significantly reshape how cancers are diagnosed and treated in the US.

Some of these five trends indirectly impact clinical laboratories and pathology groups by directly affecting the healthcare practices of hospitals and private practice doctors who order medical laboratory tests for their cancer patients.

Lindsey Conway, Managing Director, Research and Insights Division, for The Advisory Board, covered five of the top trends she says will “shape the business of cancer care in 2017,” which MedCityNews reported. They include:

1.     Precision Medicine

2.     Healthcare Consumerism

3.     Telehealth Services

4.     Care Navigation

5.     Payment Reform

One of the trends involves increased use of specialized diagnostic tests that identify genetic mutations to help ensure cancer drugs and therapies are precisely targeted to a patient’s specific needs. This is a critical element of precision medicine.

Here are brief run-downs on each of the five trends:

Precision Medicine in Clinical Laboratory Cancer Care

The Association of Community Cancer Centers (ACCC) in partnership with Advisory Board’s Oncology Roundtable (AB) conducted the survey, which was funded by Pfizer Oncology, according to an ACCC press release.

The survey found precision medicine to be among the top trends impacting the cancer care business in 2017. This will be of particular interest to pathologists and clinical laboratory leaders who provide services to oncologists and cancer patients.

ACCC’s press release states: “By taking the pulse on issues such as program mergers and acquisitions, clinical pathways usage, and precision medicine and immunotherapy, ACCC can continue to provide needed resources to its members.”

The Advisory Board is a respected “think tank” that uses research, technology, and consulting to aid healthcare organizations. And, the ACCC is an advocacy and education organization for cancer care professionals.

“We are all betting big on the promise of precision medicine,” declared Conway, in the MedCityNews story. She noted, however, specific challenges related to precision medicine. They include:

·       Understanding developments;

·       Financing equipment purchases; and,

·       Educating others.

Dark Daily noted similar concerns with precision medicine in an e-briefing on research conducted at the University of Washington School of Medicine in Seattle, where two commercially available next-generation sequencing tests had widely different results for the same cancer patients studied. (See Dark Daily, “University of Washington School of Medicine Study Finds Two Different Next-Generation Genetic Tests Can Produce Widely Different Results in the Same Patient,” May 1, 2017.)

Patient Consumerism in Cancer Care

Drawing on the AB/ACCC findings, MedCityNews noted that about 69% of cancer care consumers who use the Internet in healthcare decision-making are likely to change providers who receive negative online reviews.

These findings are not lost on cancer center administrators and medical directors who, according to an Advisory Board news release announcing the results of a survey of 250 cancer program leaders, have “increased interest in cancer patient consumerism—mainly around how to identify patient priorities and market cancer program services directly to patients.”

Telehealth Takes Cancer Care Virtual

Telehealth (AKA, Telemedicine) involves telecommunications and information technologies (IT), such as video, audio, and Internet-based software, to bring healthcare services to resource strapped remote and rural environments. One example of telemedicine that is focused on cancer care is the Breast Cancer Ally mobile app.  Developed by Michael Sabel, MD, FACS, Associate Professor of Surgery and Chief of Surgical Oncology at the University of Michigan Medical School (U-M), Breast Cancer Ally is “an information and symptom management tool specially designed [to help] patients through every stage of breast cancer treatment.” The app is available for use by U-M Comprehensive Cancer Care Center patients.

“This is disease-specific technology that helps patients navigate the multiple facets of medical care by delivering information and tools based on the appropriate stage of treatment,” U-M noted in a statement.

Navigating the Care Continuum

Driven by a need to guide more cancer patients throughout their treatment, the University of Alabama at Birmingham (UAB) is taking its navigation program to a national level, according to a UAB statement.

UAB’s partner in the Patient Care Connect Program (PCCP) is Guideway Care, a resource for personal guidance in cancer treatment and recovery. Guideway Care offers communication protocols and technology for assisting people following a cancer diagnosis.

According to UAB results, compared to non-navigated cancer patients the PCCP participants experienced:

·       55% less hospitalizations;

·       29% fewer emergency room visits;

·       60% less intensive care unit admissions; and,

·       45% reduction in Medicare costs.

“The PCCP is a model of navigation that supports patients throughout the cancer care continuum and may be a mechanism to extend palliative and support care more fully into the community,” wrote UAB-affiliated authors in a JAMA Oncology article.

“Overall, cost reductions were driven by substantial declines in hospitalizations and clinic-based services,” they concluded.

Ramona Colvin (standing) and Myeisha Hutchinson, patient navigators with UAB’s Patient Care Connect program, work together to help patients through their cancer journey. (Photo and caption copyright: UAB News.)

Healthcare Reimbursement and Reform

Insurance company programs intended to lower cancer care costs that operate concurrent with congressional lawmakers’ healthcare reform efforts are receiving increased scrutiny.

One relevant example of a payer plan aimed at increasing value is Anthem’s Cancer Care Quality Program. It enables participating oncologists to compare cancer care pathways and become eligible for additional $350 a month in reimbursements for each patient being treated.

“Private payers have been on the forefront of designing value-driven ways to pay for cancer care, but we’re not going to arrive at a satisfying payment solution any time soon,” stated Conway in the MedCityNews article.

Trends Can Guide Medical Laboratory Leaders

The findings of the AB/ACCC study affirm the important role that pathologists will have as precision medicine transforms cancer care. After all, it is pathologists who diagnose the primary cancer, and it is pathologists who conduct specialized testing to identify genetic mutations that would make a patient’s cancer vulnerable to a specific drug or therapy. Pathologists also have a role in monitoring the cancer patient’s treatment.

Thus, it is important for clinical laboratory leaders to acknowledge what their cancer care colleagues perceive as trends and topics of interest. Pathologists and medical laboratory leaders who provide services to oncologists and cancer patients should note these trends and related programs and research. Healthcare navigation and telemedicine applications, for example, could be ways for pathologists to collaborate with oncologists in outreach to cancer patients.

—Donna Marie Pocius

Related Information:

Five Healthcare Trends Impacting Cancer Care

ACCC Collaborates with Advisory Board to Conduct Eight Annual Trends in Cancer Care Survey

UAB Expands Cancer Navigation Program Nationally with Guideway Care

Resource Use and Medicare Costs During Lay Navigation for Geriatric Patients with Cancer

U-M Breast Cancer Ally Providing Patients with Effective Disease Management

Advisory Board Research for 2018

University of Washington School of Medicine Study Finds Two Different Next-Generation Genetic Tests Can Produce Widely Different Results in the Same Patient