Advancements in Lung Cancer Treatment

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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

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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

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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 Coordination Is Crucial to Oncology

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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 coordination services are fundamental to any oncology practice.

Care coordination 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 coordination 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 coordination 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 Coordination 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 coordination 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 coordination 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 coordination program and some independent practices may not have the manpower or bandwidth to accomplish it properly.

For practices that partner with AON, a care coordination 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 coordination program enhances a practice’s ability to do so.

Cancer Care Cost

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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.

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The Future of Oncology: Value-Based Care

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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 coordination, 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.

Stomach and Esophageal Cancer Q&A

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While cancers of the stomach and esophagus are rare, these cancers are usually advanced by the time they are detected. An expert medical oncologist sheds light on diagnosis, risk factors and treatment.

How are stomach and esophageal cancers diagnosed?

Patients diagnosed with esophageal cancer often start with concerns about difficulty or pain during swallowing, weight loss or a cough and hoarseness. Those diagnosed with stomach cancer often first notice a general discomfort in the stomach, loss of appetite, weight loss and vomiting. Screening generally includes an upper endoscopy, a procedure in which a thin scope with a light and camera is used to look inside the upper digestive tract.

Why do stomach and esophageal cancers occur?

Smoking, heavy alcohol consumption, and diets rich in fats and salt and lacking in fresh fruits and vegetables can lead to these cancers. Increasing age, gender (men are more likely to develop these cancers than women), obesity and lack of physical activity are also potential culprits.

Once diagnosed with stomach and esophageal cancer what are the treatment options?

Multimodality treatment (surgery, radiation and chemotherapy) is often used. Sequencing of treatment is determined by the stage, size and location of the tumor.

What types of surgeries are performed for stomach and esophageal cancer?

A process known as “endoscopic mucosal resection” removes the cancerous area through an endoscope. Subtotal gastrectomy, removal of part of the stomach, is used for cancer located in the upper part of the stomach. If the cancer has spread throughout the stomach, a total gastrectomy will remove the stomach and rework the digestive tract. For esophageal cancer, surgery may remove some or most of the esophagus through an esophagectomy.

How are radiation therapies used?

  1. Prior to surgery if the cancer is localized to the esophagus. Studies show the survival rate is improved when chemotherapy and radiation therapy are given together before surgery
  2. With stomach cancer and occasionally esophageal cancer, if patients undergo surgery without getting radiation or chemotherapy prior to surgery, it is sometimes advisable to give chemotherapy and radiation therapy after surgery to help clean up the cells that may have been left behind at the time of surgery.
  3. Radiation therapy can sometimes be used to control pain or bleeding from cancer. In this case a short course of radiation therapy is given, usually without chemotherapy, for local control of a tumor that is causing pain or bleeding even if patients have metastatic disease.

What is the best chemotherapy regimen for stomach and esophageal cancer?

Chemotherapy treatment options usually include between one and three drug combinations. The three-drug combination tends to induce the highest responses but also has the highest rates of side effects.

Why do some people have radiation therapy and chemotherapy while others just have chemotherapy?

Radiation therapy is used when cancer is localized to one area like the esophagus or stomach.  When cancer spreads outside the local area to the liver or lungs it usually spreads through the blood.  When this occurs, the cancer is no longer localized and other treatments are needed. 

What are the benefits of adding chemotherapy to radiation therapy?

Adding chemotherapy to radiation therapy augments the effects of radiation therapy. Chemotherapy also helps control cancer cells that might be trying to escape into the blood.  When given alone or in combination with radiation therapy, chemotherapy may help alleviate symptoms related to stomach cancer. In patients with more advanced stomach cancer in whom surgery is not possible, chemotherapy may also improve both the length and quality of life.

GI Cancer: The Promise of Targeted Therapies

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Targeted therapy offers a new hope for cancer patients and opens the door for the development of new treatment strategies for patients who carry certain genetic mutations in their tumors.

One condition treated effectively with targeted therapies is gastrointestinal stromal tumors (GIST), the most common type of sarcoma which occurs when abnormal cells grow in the gastrointestinal track. With July recognized as Sarcoma Awareness Month and July 13th as GIST Awareness Day, it’s the ideal time to draw attention to the growing body of evidence suggesting that GIST tumors—which don’t respond well to chemotherapy or radiation—can be treated effectively with targeted therapies such as tyrosine kinase inhibitors (TKIs).

All cells in the body are regulated by DNA that controls cell growth. Cancer cells typically have DNA mutations—changes in the normal DNA—that can cause rapid and unregulated growth of the cancer cells, leading tumors to grow and spread to various organs.

Specific mutations have been identified as main drivers for growth in GIST tumors. Targeted therapies combat these mutations by blocking the molecules that allow tumors to grow. TKIs can treat the tumors effectively or shrink them enough that surgery becomes an option. This approach precisely targets mutations that are predominantly present in cancer cells and offers a new way to control cancer cells without significantly affecting normal cells.

Our physicians at the Zangmeister Cancer Center strive to provide patients who have certain genetic mutations with access to clinical trials that include new targeted therapies. This is done by gathering information on the patient’s personal and family history of cancer. We then biopsy the tumor and send the tissue sample to a lab for genetic analysis. The results are then carefully reviewed to determine if targeted therapy—some of which are FDA approved while others are part of clinical trials—may be effective. This is an alternative to the more conventional “one-size-fits-all” approach to treatment and helps sidestep the cost and side effects associated with treatments that may not work on certain mutations.

This approach continues to evolve, and most likely will help increase the number of targetable mutations and available targeted therapies available to patients over the next years. This is an exciting time to be treating cancer, implementing new therapies that will lead to even more new tools for success.

Breast Cancer in Men: Recognizing Symptoms, Reducing Risk

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Breast cancer is most often associated with women, which is understandable as more than 276,000 women are expected to be diagnosed in 2020. Yet, breast cancer occurs in 1 of every 83 men and carries a 5% mortality rate.

Consequently, men need to be vigilant and educated about the symptoms and signs of breast cancer and should feel comfortable discussing them with their physician.

Symptoms of Male Breast Cancer

The clinical features of breast cancer in men are no different than they are in women. Symptoms include a lump or thickening in or near the breast or underneath an arm. A dimpling or puckering of the skin—known as peau d’orange—can also be a symptom, particularly of inflammatory breast cancer, and the nipple of the breast may be inverted. Another thing to look for is nipple secretion, which can be especially concerning if the drainage is blood.

No one is immune to cancer, but there are some factors that can heighten the risk of breast cancer in men, including exposure to radiation and a history of breast cancer in their family. An increase in a man’s estrogen level can also heighten the chances of breast cancer, so conditions such as Klinefelter’s syndrome and cirrhosis are risk factors. Transgender men using estrogen injections are also at an increased risk.

Self-Examination and Treatment

Like women, men should do routine self-examinations and check for thickening or lumps in the breasts. The best screening is a simple palpating of the tissue and checking in a mirror for any changes in the look of the breast’s skin or nipple. This should be done once a month, especially for men with a family history of cancer.

If any irregularities are noticed, reach out to a physician immediately. In the event of a tumor, the procedure for men is the same as women – a biopsy followed by a diagnosis, and then the decision whether to do surgery with or without chemotherapy or radiation therapy.

One of the biggest differences regarding breast cancer treatment in men and women is endocrine therapy. Aromatase inhibitors, which stop estrogen production in postmenopausal women, are used to treat women whereas men are typically treated with tamoxifen, which blocks the effects of estrogen in breast tissue. The reason for the difference is the insufficient amount of data supporting use of aromatase inhibitors to treat male breast cancer.

Erasing the Stigma

Cancer takes an emotional and mental toll on anyone it strikes. But because breast cancer is so strongly associated with women, men often face additional psychological challenges.

Some may feel their manhood is in question once they hear the diagnosis or they may become embarrassed by it. While stigmas are real and can be debilitating, the reality is that male and female breasts are made of the same tissue.

Consequently, psychological care is a big component of treating breast cancer in men, especially for patients with estrogen-receptor-positive cancer—the most common form of breast cancer wherein estrogen receptors on the surface of the cell bind to estrogen and enable the cancer to grow. In men, this means they are creating more estrogen than progesterone, which can make them feel like less of a man. Therefore, taking extra time to address stigma is an extremely important element of care.

Scarring is another concern. Reconstructive plastic surgery isn’t offered for men who undergo surgery to treat breast cancer, so it is important to remind male patients that the scar does not make them less of a person. In fact, the scar should be looked at as a symbol of the surgery that may have saved their life.

Resources for Men

In tandem with the multitude of female-driven support systems in place for women, such as the saturation of pink every October to mark Breast Cancer Awareness Month, there are also good resources for men battling breast cancer.

The Male Breast Cancer Coalition and the Young Survival Coalition are helpful resources offering information about male breast cancer, as well as hotlines and support groups.

It is important to remember that cancer can happen to anyone – and while breast cancer in men is rare, it is real and can be deadly. As providers and oncologists, it is important that we recognize the physical and mental components of working with male breast cancer patients and provide the support systems that deliver optimal care outcomes.

Oncology Care First: The Wave of the Future

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With COVID-19 on the forefront of everyone’s mind, it is difficult to remember that the decade started out with an uplifting headline in cancer care: the largest single year drop in cancer mortality.  We also saw emergence of the next generation oncology model, Oncology Care First (OCF), which comes on the heels of a successful first-of-its-kind model, the Oncology Care Model (OCM).

As you shuffle through the countless articles, studies, and theories, there are many factors that play into the reduction in cancer deaths, many associated with science, demographics, society, and a change in the delivery of healthcare. Regardless of why, the news is a welcome development at a time when the nation is in the midst of a pandemic that continues governing our lives.

I am fortunate to be a frontline witness to one of the best stories in cancer care to hit our inboxes, thanks to my role within American Oncology Network (AON), one of the fastest growing oncology networks in the nation. I am charged with protecting community oncology by securing funding through revenue cycle processes. However—and more importantly—my role challenges me to think about how cancer care is constantly changing in our drive for better outcomes, enhanced delivery methods, lower costs, and a focus on value, which in turn requires that we challenge the “norm” of reimbursement methodologies.

A Quest for Innovation

Since its inception in 2018, AON has helped lead the charge to create new methodologies through key payer partnerships such as with the Center for Medicare & Medicaid Innovation (CMS Innovation Center) and its Oncology Care Model (OCM). This commitment to change has helped drive AON’s growth. For example, its involvement with OCM was an important factor behind the decision by Genesis Cancer Center—which has been part of OCM since the initiative began in 2016—to partner with our network.

Born out of a group of seasoned oncology professionals seeking to create a first-of-its-kind oncology focused value-based model, AON ensures that its practices have a seat at the table to participate in models with the potential to transform cancer care. This includes the OCM, which permitted oncology providers to improve health outcomes for cancer patients through specific reimbursement methodologies that reward value over volume. And, as its network proliferates, the AON philosophy provides its oncology partners with the flexibility to change with emerging methodologies such as Oncology Care First (OCF), introduced by CMS Innovation Center in late 2019.

As AON develops an oncology network that, while geographically diverse, is interconnected through a rapidly growing dichotomy of oncologists and a cancer team focused on building an infrastructure to support declining cancer rates, partnerships and advanced reimbursement methodologies like the OCF are key. Payment models are complex, and the most critical part of these models permits the autonomous delivery of cancer treatments and support services—something AON continuously promotes among our local care teams.

Benefitting Physicians, Patients and Outcomes?

So now the question is whether there is a correlation between the adoption of a first-of-its-kind oncology focused payment reform model and the historic decline in cancer mortality rates. Within this next payment model, it is proposed that physicians who participate in OCF will still have the freedom to manage patient care and run their practices as they see fit. However, with OCF, they have better access to a pool of data from OCM that can guide clinical and administrative decisions and connect any dots between the model and outcome trends.

With this next generation of reimbursement, AON’s focus is on infrastructure development to support the balance between the various elements that consumers expect: value, outcomes, accuracy and timeliness. All of which is more important than ever. The network’s model is positioned to support this shift in attention as we can deliver the administrative expertise, infrastructure, and economies of scale necessary to optimize the transition to value-based care initiatives like OCF.

Wave of the Future?

OCF has great potential to be a win for independent practices, their physicians and, most importantly, their patients. This is particularly true for those that partner with networks like AON. Doing so not only streamlines participation in initiatives like OCF with access to administrative expertise and the technology required for data collection requirements, but it also helps optimize involvement by offering turnkey access to newly covered benefits like extended care services in areas such as nutrition, anxiety and depression.

Most importantly, it is a partnership that puts them on solid footing for the future by reducing costs and improving quality of care—without sacrificing their clinical autonomy.