Three Facts About Cancer in African American Communities

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It starts by recognizing cancer disparities unique to each population.  

Because of the genetic makeup of tumors, cancer affects individuals differently. Other factors that alter the way an individual experiences cancer include sex and gender, lifestyle, geography and income among others. These are explained as the social determinants of health or, more specifically, cancer disparities. Race is also an underlying determinant that can put certain populations at higher risk of being diagnosed with certain cancers.

Related: Racial Disparities in Cancer Care and Research: The Causes and Possible Solutions

African Americans are part of one of the largest minority populations in the United States (an estimated 46.9 million people). This group also reports the highest cancer mortality rate, despite the decline in cancer incidence rates, of any other racial population. These striking statistics have become the basis for the drive across the healthcare industry to implement initiatives to reduce healthcare disparities and ensure every individual has equitable access to the care they need to treat their disease at every stage.

For example, Black women are more likely to be diagnosed with breast cancer, triple-negative breast cancer, and inflammatory breast cancer. Additionally, they are at higher risk for developing lung and colorectal cancers. Black men are diagnosed more often with lung and bronchus cancer as well as prostate, colon and rectum cancers than other populations.

Here are three facts about cancer among the African American population.

  • This population reports a lower cancer screening rate compared to their counterparts. Frequent cancer screenings, as recommended by physicians, can help detect tumors in the early stage and before they have had time to develop. As a result of delayed and, in some cases no, screenings, late-stage diagnoses are more common, which has allowed time for the tumor to develop and spread. The higher rate of inaccessible and quality healthcare services and being uninsured as well as an increased level of medical mistrust are only just a few reasons why screenings are low for this population.
  • The five-year survival rate for certain cancers is lower for African Americans. Cancer is often found in advanced stages that are more challenging to treat, which increases the risk of mortality. In fact, Black men have a 19% higher mortality than White men, and Black women have a 12% higher mortality rate than their counterparts. The survival rates are impacted by the barriers to timely care and accessible cancer treatment centers in addition to other cancer disparities.
  • There is an underrepresentation of African Americans in clinical trials. Diversity in cancer treatment trials is critical in learning how certain therapies impact specific populations. However, African Americans are less likely to be participants in these studies for various reasons including economic factors, unawareness of available trials and mistrust. Diversifying the participants who enroll in trials provides insights into the efficacy of treatments.

Related: The Benefits of Clinical Trials at Community Practices

Early detection through frequent screenings makes a difference in whether cancer therapies are successful or not. By recognizing the disparities populations face, such as the African American community, physicians and healthcare teams can work toward creating more inclusive services that enhance the health and well-being of many.

American Oncology Network (AON) works to bridge the gap cancer disparities have created by addressing them head-on. Through both innovative initiatives and simple processes such as increasing communication about available clinical trials and providing support and resources to help patients throughout their cancer journey, AON is dedicated to actively closing the cancer care gap — making cancer care and therapies accessible to more Americans.

To locate an AON partner oncology practice, visit aoncology.com/locations/.

In Community-Based Study, Switching to Ixazomib in Newly Diagnosed MM Brought Improved Responses Across Age Groups

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A recent article by The American Journal of Managed Care (AJMC), summarizes an analysis presented during the 64th American Society of Hematology Annual Meeting and Exposition and co-authored by Ruemu E. Birhiray, MD of Hematology Oncology of Indiana showing that patients with multiple myeloma were able to experience improved responses to the proteasome inhibitor ixazomib after switching from bortezomib. Read the article.

What Does the URAC Re-Accreditation Mean for You?

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The pharmacy’s most recent re-accreditation announcement impacts you more than you may think.  

AON’s in-house specialty pharmacy announced it has received re-accreditation through URAC, Utilization Review Accreditation Commission. Established in 1990, URAC is a leading accrediting body ensuring the highest standards of care are achieved in healthcare. The organization currently offers a variety of accreditations and certification programs in the categories of pharmacy, patient care management, administrative management, digital health and telehealth, health plan, and mental health and substance use disorder parity.

Related: American Oncology Network’s In-House Specialty Pharmacy Re-Accredited by URAC

The pharmacy received initial URAC accreditation in February 2020 after working alongside URAC’s experts to align policies and procedures to those outlined for accreditation. In order to achieve accreditation, the pharmacy met the required standards in nine areas: risk management, operations and infrastructure, performance management and improvement, consumer protection and empowerment, pharmacy operations, medication distribution, patient service and communication, patient management, and lastly, reporting performance measures to URAC.

Accreditation is an indication of meeting high standards of care.

Accreditation is not achieved easily. It also can be a process that takes place over several months to a year, depending on the accreditation standards and rigorous review phases. Organizations, such as AON, that pursue and earn accreditation have successfully met multiple outcomes. Learning that an organization or specific department is accredited should confirm that the care and services being provided are of the highest quality and meet the industry’s standards. For patients using an accredited specialty pharmacy, such as AON’s Pharmacy, this should bring peace of mind that the organization providing oral oncolytic medications has spent time ensuring effective processes and procedures are in place.

Accreditation keeps the organization accountable for consistently meeting high standards of care.

Achieving re-accreditation status is a goal that shows the dedication the organization has to be compliant with the industry’s best practices. Allowing lapses in accreditation and not seeking renewal can be troubling signs. Throughout the accreditation years, organizations are required to provide frequent updates and measurements on key outcomes to remain aligned with the accreditor’s standards. If this is not the case, the organization risks losing its accredited status. Maintaining accreditation is an ongoing process that drives accountability from the organization.

While it may seem that accreditation is only a seal indicating effective healthcare measures are in place to ensure safe patient care standards, it carries more impact and influence on you as either an AON physician, a member of the care teams or a patient. Here is what to know according to AON Senior Pharmacy Director Doug Braun.

What is specialty pharmacy accreditation?

It is an accreditation designed specifically for pharmacies providing an advanced level of pharmacy services and disease management for patients using medications that require special handling, storage and distribution requirements. This accreditation demonstrates a pharmacy’s emphasis on quality improvement, safety, delivery of patient-centric care management and regulatory compliance.

Why obtain multiple accreditations?

In 2017, only 24.5% of specialty pharmacies achieved accreditation. As competitiveness and insurance contract requirements expand, achieving secondary accreditation has become necessary.

“To assure we meet the requirements of payers and to demonstrate the superior service we provide as a healthcare entity, obtaining and maintaining triple specialty pharmacy accreditation status is vital,” said Braun.

How does maintaining specialty pharmacy accreditation demonstrate AON Pharmacy’s commitment to excellence?

The achievement of accreditation ensures relevance, value and integrity to patients, providers and payers. It helps pharmacies meet payer requirements for financial reimbursement and stand out from competitors. It also demonstrates an ongoing commitment to excellence.

Related: The Benefit of a Centralized Pharmacy

Striving for the highest standards of patient care and safety is the top priority for AON, and accreditations are a means of building trust with patients who come to AON practices for their cancer care and treatments.

“We will continue to pursue relevant accreditations across all departments of the organization,” said James Gilmore, AON Chief Pharmacy and Clinical Services Officer. “We firmly believe in patient-centered care and safety. When we are able to meet the standards required for accreditation, we hold ourselves accountable for delivering exceptional care and services. It is my hope that our patients, physicians and staff understand the importance of the accreditations we seek and help us meet the objectives successfully.”

To learn more about AON’s in-house specialty pharmacy, visit aoncology.com/pharmacy/.

Related: National Pharmacy Technician Day: The Integral Role of the Pharmacy Technician on the AON Care Team

Diagnosed With Breast Cancer? Ask These Eight Questions

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One in eight women will receive a breast cancer diagnosis in her lifetime, according to the National Breast Cancer Foundation. While treatments for the disease have advanced and survival rates are improving, the National Breast Cancer Foundation also reported that breast cancer remains the most common cancer for American women and approximately 287,500 new diagnoses will be made by the end of 2022.

Early detection and prevention plans are important for slowing the progression of the disease and increasing the rate of survival. Additionally, asking the right questions when diagnosed with cancer is critical, providing essential information for patients who are beginning their journey to recovery.

Below are eight questions to ask upon receiving a breast cancer diagnosis.

  1. What type of breast cancer and receptor status do I have? Learning more about the type of cancer along with the receptor status can give patients clarity about their diagnosis and a better understanding of their current health status. Patients need to know their diagnosis because it encourages follow-up questions and the opportunity for accurate information to be discussed between the oncologist and patient.
  2. How is the type of treatment decided? Women are different and so are cancers and their characteristics. That is why treatments are individualized to the patient and targeted to the specific type of cancer. Certain therapies that work for one patient may not be as successful for another.
  3. Do all breast cancer patients require chemotherapy? Chemotherapy is a common treatment chosen for many cancer patients because of its aggressive nature. However, depending on the type of cancer, chemotherapy may not be recommended as part of the treatment plan for breast cancer.
  4. How will my cancer and treatment plan affect my quality of life? Cancer and cancer treatments can disrupt many aspects of life. Patients can struggle with cognitive performance and pain management, for example. It is important to share concerns with the oncologist throughout the cancer journey, from the start of the diagnosis to post-treatment. Oncologists do their best to ensure quality of life is maintained, and if it is not, sometimes there are changes that can be made to help patients in this particular area of concern or additional remedies that can be recommended.
  5. Will I be able to continue working or take care of my family while undergoing treatment? While many cancer patients find treatments lead to nausea, fatigue and weakness, each patient experiences their treatments differently. Discussing with the oncologist symptoms and side effects of the cancer diagnosis and associated treatments helps patients determine what is to be expected, allowing them to make needed adjustments in their day-to-day routine — whether that is at work or at home.
  6. Will I need to make any nutritional changes? Eating well and ensuring proper nutrition is maintained play important roles in a patients’ cancer journey and recovery, which is why a  dietitian is often part of the care team. There are several foods that patients will want to consume and others, such as raw fish and unpasteurized dairy products, that need to be avoided.
  7. How do I tell my children I have breast cancer? Sharing news of a life-threatening disease is difficult and emotionally taxing. Patients should share their diagnosis with children when they are ready and have received accurate information to avoid misleading the conversation. Many patients have found it helpful to rehearse what is to be said with a spouse, family member or close friend.
  8. Are there support groups available to help patients and their families? Having support throughout the cancer journey is important because cancer can take a toll mentally, physically and emotionally. Support systems have been shown to positively influence cancer outcomes, and patients should establish their support systems early on. Start with creating a support group of family and friends and then branch out to local and national groups such as those provided by the American Cancer Society to find additional resources.

These questions provide transparency into a complicated disease. Knowing not only the type of breast cancer but more about the treatment options available and lifestyle changes that may be required helps patients understand their diagnosis, make better-informed health decisions and feel involved in their care plan.

Natural Hazard Preparedness: Your To-Do List as a Cancer Patient

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Five tasks to complete to keep your health in order when dealing with a natural hazard.

Natural hazards include severe storms, hurricanes, tornadoes and the like. These situations can easily cause anxiety, stress and even fear of what is to come. These feelings may be heightened if you happen to have a disease or illness that requires specialized medications and medical equipment to manage.

If you are finding yourself in a state of panic because Mother Nature decided to send a biological or geological hazard your way, take a moment to breathe and complete the recommended steps to find some peace of mind:

  1. Notify your physician and care team: Contact your care team to let them know of your situation including if you are planning to evacuate the area. They will also be able to answer any questions you may have about managing your health during the unprecedented time and provide additional care guidance.
  2. Ensure you have enough medications for several days. Take count of how much medication you have on hand, and if needed, request from your physician some additional days’ worth just in case you happen to be relocated and are unsure of when you can return. You’ll want to have enough medications to last you for at least seven days.
  3. Make sure you have a list of your current medications. In times of panic, you may forget your medications while hurriedly leaving or may run out. Have a few lists of your medications, the dosage amount, instructions and prescriber name and information available and accessible in at least two places. For example, you may have a list made out on your phone and a paper list in the car or your purse. Be sure to take this list with you no matter where you go.
  4. Connect with your caretakers. If you rely on a caretaker, such as a family member or friend, who helps you manage your health, reach out to them immediately and request help. Share with them any new learnings from talking to your care team and update them on your current medications and quantity. Additionally, discuss a plan early on in case evacuation is required.
  5. Have important phone numbers accessible in at least two places. Important numbers for your physician, care team, preferred pharmacy, health plan, caretakers and family should be readily available in at least two places in case of emergencies. You’ll want to keep this information close to you in case you need to relocate.

In addition to the five tasks, listen to and follow the recommendations from state and local officials.

Impressive Results with the Oncology Care Model (OCM)

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Despite the program’s closure on June 30, 2022, the Oncology Care Model (OCM), an initiative by the Centers for Medicare & Medicaid Services (CMS), provided participating clinics the opportunity to pioneer a value-based care model focused on decreasing the healthcare costs for Medicare beneficiaries undergoing either chemotherapy or hormonal therapy treatments. These treatments are often costly yet necessary, leaving many patients to struggle financially. Nineteen AON community oncology clinics were part of the initial 200 practices across the nation that were approved to participate in the OCM after successfully meeting the criteria required by the CMS.

To learn more about AON’s successes with the OCM, read the full article “Impressive Results with Oncology Care Model Confirm American Oncology Network at the Forefront of Patient-Centered Cancer Care.”

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Patients With Cancer May Need Help Changing Their Eating Approaches

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In an interview with Oncology Nursing News, Caitlin Benda, MBA, MS, RD, CSO, LDN, a clinical oncology nutritionist supervisor at American Oncology Network, comments on different ways oncology nurses can assist patients in reaching their overall caloric intake. Read the article.

Pivoting Toward Oncology’s Future: Perspectives Based on My COA 2022 Experiences

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I had the recent honor and privilege to once again co-Chair the Community Oncology Alliance (COA) annual Community Oncology Conference, which featured two days packed with medical updates, legislative updates, best practice patterns, patient advocacy efforts, and networking with colleagues and thought leaders.

As our largest conference to date with over 1,500 attendees, it was a hugely impactful meeting, highlighting and addressing the issues currently facing community oncology practices. This blog shares what I considered to be the main take-aways from the conference, including the challenges and opportunities that lie ahead.

340B

Old story, new verse. We engaged in extensive discussions regarding the ongoing abuses of the 340B Drug Pricing Program.

Although initially developed to improve patient access to care, the 340B program has been hijacked by numerous health systems to fund expansion of hospital-owned physicians and infusion centers. It has, paradoxically, increased patients’ costs due to higher site-of-service fees and subsequent drug price increases issued by Pharma to offset the 340B subsidies to these institutions, thereby actually limiting patient access to care.

Additionally, these 340B-based health systems leverage excess drug margins, pressuring community oncology practices to capitulate and join their fold, again resulting in limited sites of service and higher costs for more patients. This erodes the community oncology platform that repeated studies have shown to be a more efficient and cost-effective means of providing oncology care.

Though Congress has issued some cuts to 340B reimbursement, we as Community Oncology must remain diligent and united in continuing to shed light on program abuses as a major cost-driver in oncology care.

PBMs

The evolution of pharmacy benefit managers’ (PBMs) influence in oncology and specialty care is almost beyond comprehension. They have always been among the most egregious offenders in terms of patient access issues through their use of step-edits, prior authorizations, limited formularies, out-of-network exclusions, and veiled rebate systems which drive price increases.

DIR fees PBMs charge to pharmacies and dispensing practices have increased over 1000% in the past few years with little to no transparency regarding the justification for, or utilization of, these funds.

The vertical integration of PBMs within payers shows how valuable they are as a profit center. The consolidation in this space has left us with only three PBMs managing approximately 80% of prescribed medications in this country – limiting competition, which results in further price increases and even more limited access.

A concerning trend is the exclusion of high-cost drugs from formularies, with PBMs expressly directing the patient and provider to apply for compassionate/free drugs from Pharma. This has become almost epidemic.

Deadly Duo

An unconscionable development is the alliance of PBMs and 340B institutions, which are joining forces to gain access to 340B discount pricing on PBM managed drugs.

Multiple Pharma companies have boycotted this effort, which will undoubtedly drive prices higher. Stay tuned as this will be decided in the courts later this year

OCM and Value-based Models

Another significant issue discussed at COA was the sunsetting of the Centers for Medicare and Medicaid Services’ (CMS) Oncology Care Model (OCM). Though the published data for this model suggested overall minimal financial benefit to CMS, the value to our patients is unquestionable.

Oncology practices throughout the country have dedicated millions of dollars in resources to reposition their practices as value-based sites. Through additional patient support networks and improved 24-7 access to their oncology caregivers, this effort was clearly successful in minimizing high cost, low benefit emergency department visits, hospitalizations, and improving timely access to palliative care services.  

The funding for these patient touchpoints is in jeopardy unless a new value-based model is enacted by CMS. Appropriating funding for incentives that improve access to and reduce the cost of care should continue to be a high legislative priority. In the meantime, a pivot to professional case management, transitional care management, and chronic care management programs supported by CMS may offset some of these expenses.

Precision Medicine

No longer a “pie-in-the-sky” quip, precision medicine is rapidly becoming a reality in oncology.

The most cost-effective treatment for our patients will always be the “right” treatment, which is best defined with NGS biomarker panels, whole exome sequencing, RNA/transcriptome sequencing, germline testing, and pharmacogenomics. The complexity involved in the analysis of this tidal wave of data, coupled with the exponential development of targeted agents, creates a challenge for the community oncologist. This data needs to be codified and quantified in a usable format that can be integrated within our EHR’s to power therapeutic decision-making, treatment selection, and monitoring for our individual patients in multiple lines of therapy.

We will likely need to employ the help of artificial intelligence (AI) based solutions to achieve this goal. I strongly believe that Community Oncology will lead the way in this endeavor.

Stay Tuned

The continued growth and success of Community Oncology will be driven by our response to these challenges. How we react to adversity rather than the adversity itself will define our path forward.

Resilience has long been the cornerstone of community oncologists. Fueled by innovation, ingenuity, and a commitment to patient-centered care, we can and will create a brighter tomorrow for our patients and their families.

Pathologists’ Role in Precision Oncology Care

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My experience delivering diagnostic pathology services within the laboratory and in the patient exam room have made clear the importance of pathologists serving alongside oncology care teams. The success of these collaborations is driving change in the pathologist’s role in providing precision care.

A complete and accurate pathology report is crucial to diagnosing patients and deciding on the best treatment plan. Pathologists are highly skilled and experienced members of the care team, specializing in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. We use state-of-the-art equipment and the most advanced techniques to analyze tissue samples.

As part of my journey, I’ve participated in diagnosing multiple challenging and interesting cases and have collaborated with our network’s oncologists by providing crucial laboratory results that determine an array of cancer therapeutic decisions.

Pathology Reports Are Not Always Clear

Pathologists’ important work on the oncology care team can often be obscured by reports that are not meant for patient consumption. In particular, pathology and ancillary test reports are not written at a level most patients can understand. It can be discouraging for the diligent and engaged patient who proactively seeks out detailed information about their lab results and what these might mean for the prognosis.

According to the Association of Community Cancer Centers, these reports may also be organized in ways that are confusing to both clinicians and patients. While some patients may meet or speak with pathologists, most pathologists don’t have the time or training to explain their findings directly to patients – a significant hurdle in today’s healthcare environment.

However, as calls for advancements in precision medicine grow louder, so too are calls for ensuring information from pathology is presented in a consumable, patient-friendly manner. The National Academy of Medicine recommends “good communication about key findings” of the reports for patient use. “Pathology report and ancillary test results are integral to patients fully understanding their disease, treatment options, and participation in shared decision-making. Put another way, when patients can access the key information from their pathology and ancillary test reports, in patient-accessible formats, patients can be empowered to understand their disease and treatment options better and engage in the shared decision-making process with their care team.”

Delivering Consumable Pathology Reports for Patients

To deliver the highest level of consumable information about the precise nature of a patient’s condition, some steps to take may include giving the patient a list of reliable sources for additional information about their cancer, connecting patients to cancer-specific advocacy and support groups, and providing patients with patient-centered education and resources for additional information, such as clinical trials.

Clinicians have access to experts and resources designed to help them better understand the information contained in pathology and ancillary test reports. Paired with the reports prepared by pathologists, which they can use to guide shared decision-making conversations about treatment plans, patients can use this information to refresh their memory about the details of their condition before speaking with clinicians.

The role of pathologists is increasingly vital in the practice of precision cancer medicine because of the continuous advances in genomic and molecular testing and the transformation of the traditional exclusively high-level practice of pathology into a more molecular-based medical specialty, as well as the desire for more consumable information related to precision medicine.

Continuously adapting with the newest medical discoveries to provide the most accurate and informative cancer diagnoses for our patients remains paramount, but it’s only one of our charges. By integrating pathologists into patient care teams, we can provide more comprehensive strategies for managing information sharing and meeting the requirements of precision medicine for all patients in our network.

Engaging patients in portions of their care, even those areas that can be difficult to translate and communicate, is a step toward holistic, whole-person care.

Value-Based Care and OCM: The Federal Program Ends, but our Focus on Value-Based Care Continues

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Before 2016, there was little going on regarding value-based care in oncology. That changed with the introduction of the oncology care model (OCM), the intention of which was to better align financial incentives to drive improvements to care coordination and appropriateness, as well as expand access to care for patients undergoing chemotherapy.

After six years, the pilot program is at its end. OCM encouraged participating practices to improve care and lower costs through an episode-based payment model that financially incentivized high-quality coordinated care. Fine in theory, but not so easy in practice.

Despite its demise, OCM significantly impacted the practice of oncology, and great strides in patient care were nonetheless realized.  

The Benefits of OCM

Participating in OCM helped transform practice operations within the AON network to focus on patient experience more than ever – rather than simply delivering care. Additionally, the investments we made in services and a quality-based care infrastructure to support associated OCM program requirements will continue to deliver value to our patients and practices.

OCM required the delivery of care plans directly to patients, which our physicians did excellently.  Before OCM, most in oncology care were not driven to provide care plans and documentation directly to the patient. Oncology was about care delivery less than it was about coordinating or including the patient in the care. OCM required that patients received information about their care plans in a shareable format that patients could use as they wanted.  

With the cessation of OCM, the most significant disadvantage for patients is that they may face a more difficult task of acquiring patient information in which they can act upon. For example, when a patient is newly diagnosed with cancer, they typically retain very little of the information discussed around prognosis, treatment options and treatment plans. Compliance with OCM data guidelines helped patients retain this knowledge.

In fact, the required care plans were one of the best things to come from OCM because they easily translated to meaningful, patient-friendly paper documents outlining all the information a patient needs to understand their diagnosis and treatment. Though this information has always been in the patient’s chart, through OCM they also had something tangible to share with their families and loved ones. This shareable information led to patients being more engaged in their care and asking questions related specifically to their treatment plans rather than engaging in a more nebulous manner. That’s been a positive impact, useful for patient navigation.

What’s Next

Participating in a large value-based care arrangement like the OCM has been invaluable for AON, our practices, physicians, and patients. While participation was voluntary, most who took part did so by embracing it fully. That is why I don’t believe value-based care practices or the principles of OCM are going away – nor do I believe any other healthcare providers want it to go away.

Unfortunately, the most significant problem before OCM was that payers were not fully prepared for how to address value-based care in oncology. Treating cancer is very expensive and oncology drug prices are unpredictable, which is likely a significant deterrent for some commercial payers when it comes to developing any type of shared savings program for community oncology practices. The overwhelming challenge faced by payers is alignment of interaction and reimbursement. It is a complicated, detail-driven challenge where various payment models and contracts created roadblocks to streamlining payment mechanisms. 

When OCM officially concludes on June 30, 2022, there is no other quality program coming online in its place – making it a challenge to maintain an oncology value-based care program. Outside of organizations like AON, there are likely some very real challenges ahead for practices as they attempt to do so. Most invested in services and infrastructure to support participation in OCM, and will likely lose at least some momentum without another value-based model to follow, especially regarding data collection and dissemination.

However, for practices within the AON network, basing care on quality over all else remains a priority. We continue working with our practice partners to ensure training and education related to value-based care. We make clear the benefits and put in the work to prove the value of value-based care for patients and practices. We’ll continue to follow the structure of OCM – every practice transformation effort that we put into place will continue – because it is flourishing. We will not revert to pre-OCM care.

Our patients are the ones who win in the end, and that’s why we’re here – to provide the very best care for our patients, with or without a formal OCM program.