CANCER BUZZ

Remote patient monitoring is a type of telehealth that allows patients to share data about their health with their care team in between clinic visits, including symptoms and vitals. Symptom tracking and monitoring technologies allow better management of treatment side effects, in turn allowing longer administration of treatments and improved clinical outcomes. While advantages to remote patient monitoring are well-known and documented in the literature, translation into clinical practice must account for patient preferences, equity considerations, financial sustainability, and patient/provider education needs.

In 2022, ACCC conducted a survey to measure patient, caregiver, and provider perceptions and adoption of messaging tools, electronic questionnaires, and connected devices used to track and monitor symptoms during cancer treatment. This podcast shares key survey findings.

Guest:

David Penberthy, MD, MBA

Associate Professor of Radiation Oncology

Penn State Health, Milton S. Hershey Medical Center

Immediate Past President

Association of Community Cancer Centers

"Through the pandemic, healthcare has been contending with workforce shortages, and so everybody is concerned about how we do more with less. Using digital tools can actually help facilitate patient engagement with the healthcare team—hopefully keeping people out of the hospital and intervening earlier so we can achieve more of what we're trying to achieve of maintaining health as opposed to just reacting to illness."

Read more here.

Resources:

Remote Patient Monitoring: The New Frontier in Telemedicine Opportunities

Changing the Tune for CAR T-Cell Therapy: A Music City Experience in Remote Patient Monitoring

Remote Patient Monitoring and Health Equity

Telehealth Success Stories: Remote Symptom Monitoring Using Patient Reported Outcomes

Chemotherapy Care Companion: An Oncology Remote Patient Monitoring Program

Remote Home Monitoring of Patients with Cancer During the COVID-19 Pandemic

This project is supported by AstraZeneca.

As myeloproliferative neoplasms (MPNs) carry a heavy symptom burden which can significantly impact a patient's quality of life, hear how multidisciplinary care and psycho-social support can help alleviate this burden for patients. In this episode, CANCER BUZZ speaks with Sarah Everette, LCSW and oncology social worker at Baptist Health Louisville in Kentucky about how these types of support and coordination can optimize care for patients with myeloproliferative neoplasms.

"If we get patients into physical therapy or occupational therapy early in their treatment, it helps with outcomes; it helps them [patients] not decondition so easily, especially for elderly populations. However, not only addressing their physical symptoms, but also their mental and emotional health [is important] too, because we know that we are not just caring for one aspect of the person but the whole person." -Sarah Everette, LCSW

Sarah Everette, LCSW

Oncology Social Worker

Baptist Health Louisville

Louisville, KY

Resources:

Myeloproliferative Neoplasms (cancersupportcommunity.org)

The Psychosocial and Financial Aspects of Treating Myelofibrosis (accc.org)

National Comprehensive Cancer Network (NCCN) Guidelines: Myeloproliferative Neoplasms

The goal of treatment for most patients with myelofibrosis is to relieve symptoms. A provider will use a formula to assign a risk category (indicating aggressiveness) for the disease. Myelofibrosis categorized as low risk may not require treatment. Instead, a provider would monitor a patient's health through regular checkup to watch for signs of disease progression. For those patients with intermediate- or high-risk, treatment most often focuses on managing symptoms. CANCER BUZZ spoke to Aaron Gerds, MD, MS, Associate Professor of Medicine in Hematology & Medical Oncology, Deputy Director for Clinical Research at the Cleveland Clinic Taussig Cancer Institute, and Medical Director at the Case Comprehensive Cancer Center's Clinical Research Office in Cleveland, OH. Hear Dr. Gerds discuss standard of care treatment options and new therapies for treating patients with myelofibrosis.

"I think the biggest thing when taking care of patients with myelofibrosis is to know what is driving the disease in the patient in front of you. What are the mutations and chromosomes driving disease as well as symptoms and presentation of disease."

"There is a big focus on quality of life for myelofibrosis, but none of these things that patients feel are solely from disease…"

Aaron Gerds, MD, MS

Associate Professor of Medicine in Hematology & Medical Oncology

Deputy Director for Clinical Research

Cleveland Clinic Taussig Cancer Institute

Medical Director, Clinical Research Office

Case Comprehensive Cancer Center

Cleveland, OH

Resources:

· Leukemia & Lymphoma Society

· MPN Research Foundation

This project is supported by AbbVie.

Each year, ACCC is active at the state and federal level, advocating on behalf of its members to ensure that the rules and regulations in place do not in any way impede the delivery of high-quality cancer care. In 2023, ACCC members identified four core areas of focus among a larger set of issues and concerns that the organization will support: 1) Protect Adequate and Stable Reimbursement for Oncology Providers; 2) Reduce Delays in Care Due to Utilization Management; 3) Preserve Provider and Patient Choice in Cancer Treatment; and 4) Improve Access to and Coverage of Supportive Oncology Services.

Guest:

Barbara Schmidtman, PhD

Vice President of Operations, Corewell Health West

Chair, Governmental Affairs Committee, Association of Community Cancer Centers

"Continued access to telehealth coverage is an important topic that we need to continue to bring up over the next several years...as we look at the shortage of medical oncologists and other specially-trained providers and…the rural communities that do not always have access to highly-specialized or sub-specialized clinicians, the use of telehealth is incredibly impactful for providing care to those rural communities."

Read more in "ACCC Announces its 2023 Advocacy Agenda" in ACCCBuzz.

Resources:

Advocacy in Action: Putting Guardrails Around Step Therapy

Compliance: Jumping Through the Hoops of Prior Authorizations and Denials to Deliver Comprehensive Cancer Care

How to Prepare for the Prior Authorization Blizzard

Study Highlights Need for Medicare Advantage Prior Authorization Reform

Pharmacy Benefit Managers: How Advocacy Led to Action [PODCAST] Ep 85

State by State: Advocacy Advances PBM Reform, Part 1

State by State: Advocacy Advances PBM Reform, Part 2

The average survival rate for patients with myelofibrosis is six years. But this varies based on potential treatments. There are no drugs that can modify the outcome for myelofibrosis, and the only treatment that leads to cure is an allogeneic hematopoietic cell transplantation (allo-HCT). However, because of the high rates of morbidity and mortality, this treatment must be carefully considered based on the patient. CANCER BUZZ spoke to Gabriela S. Hobbs. MD, Assistant Professor of Medicine, Harvard Medical School, and Clinical Director of Leukemia, Massachusetts General Hospital in Boston, MA. Listen as Dr. Hobbs discusses symptom scoring, risk stratification, and effective practices in building a strong myelofibrosis program.

"…If a patient is higher risk, they should be referred to transplant; also patients who are high risk are more likely to have low blood counts, low platelets, and low red blood cells that may also influence how these patients are treated." – Gabriela S. Hobbs. MD

This project is supported by AbbVie and GSK.

Gabriela S. Hobbs. MD

Assistant Professor of Medicine

Harvard Medical School

Clinical Director of Leukemia

Massachusetts General Hospital

Boston, MA

Resources:

Leukemia & Lymphoma Society

MPN Research Foundation

While significant advances have been made overall in the treatment of multiple myeloma, the management of transplant-ineligible patients remains challenging. Patients with multiple myeloma are not cured with conventional therapy. Treatment does, however, alleviate symptoms, improve quality of life, and prolong survival. The current standard of care for multiple myeloma patients includes an anti-CD38 monoclonal antibody in either first- or second-line treatment of myeloma. CANCER BUZZ spoke to Cindy Varga, MD, Hematologist at Atrium Health's Levine Cancer Institute in Charlotte, NC. Listen as Dr. Varga discusses the positives and negatives with subcutaneous versus intravenous drugs in treating patients with multiple myeloma.

"There are benefits to the patient (for subcutaneous administration), it is very fast, as quick as 5-minutes. So. there is convenience there and less side effects."

"Having patients be able to access these amazing drugs (both IV and subcutaneous) in their local infusion center, definitely helps with their up-front treatment plan. These patients are going into remissions, feeling better, and their quality of life is better on these drugs because they are so effective…"

- Cindy Varga, MD, Hematologist at Atrium Health's Levine Cancer Institute

Cindy Varga, MD

Hematologist

Levine Cancer Institute at Atrium Health

Charlotte, NC

Resources:

- Leukemia & Lymphoma Society

- American Cancer Society

- Multiple Myeloma Research Foundation

This project is sponsored by Johnson & Johnson ACCC is collaborating with The Leukemia & Lymphoma Society on this project.

Recognizing the need for better care coordination and prompted by the experience of a patient partner, WellSpan Health embarked on a multispecialty effort to reimagine how incidental nodules are managed through the lens of the Quadruple Aim: improving the patient and provider experience, lowering per capita cost of care, and optimizing the health of populations. The new care delivery model identifies, implements, and expedites patient lung nodule care in real time and provides consistent follow-up along the continuum of care. The result: patient outcomes are optimized by early intervention of undiagnosed lung cancer. This care delivery model for incidental lung nodule findings can serve as a springboard for other incidental findings and help detect other early carcinomas.

Guest:

Nikhilesh Korgaonkar, MD, MBA, FACS

Thoracic Surgeon

Chief Medical Officer

Wellspan Health Cancer Institute

"One thing I will say is that I cannot understate the importance of marking sure all the stakeholders are on board with a program like this. We have stakeholders in radiology, in primary care, in pulmonology, and, of course, in administration. And this program is the result of making sure everyone was on the same page with the goals and the desired outcomes of this program. And that really set this program for success."

Read more in "Reimagining Healthcare for Incidental Lung Nodules" in Volume 38, Number 2, Oncology Issues.

Resources:

· Oncology Capture of ED Patients with Incidental Radiologic Findings

· Addressing ED Incidental Imaging Findings Through Navigation

· A Small, Island Community Hospital Removes Barriers to Lung Cancer Screening and Detection

· Engaging Patients & Assisting Primary Care Physicians in Lung Cancer Screening

· The Rapid Access Chest and Lung Assessment Program

· Development & Evolution of an Incidental Lung Lesion Program

As clinicians continue to seek new ways to provide the best patient care for patients with myeloproliferative neoplasms, a group of rare hematological cancers which can be challenging to treat, hear how recent guideline and treatment updates by the National Comprehensive Cancer Network (NCCN) can optimize care for patients with myeloproliferative neoplasms. In this episode, CANCER BUZZ speaks with Andrew Kuykendall, MD, assistant member of the Department of Malignant Hematology at Moffitt Cancer Center in Tampa, Fla. about the impact of these new guidelines.

"Every single patient is very different in the symptoms they present with, the duration of the disease, and what their goals are in receiving therapy. Ultimately, that often means that we don't have a one-size-fits-all treatment strategy…Instead, we have a variety of treatment options that can provide different benefits for patients and when you have that, it merely comes down to what makes sense for the patient, what makes sense for the disease, what makes sense for the patient's family, and what you feel as a physician is the most appropriate for the patient." – Andrew Kuykendall, MD

This is the fourth video podcast in a four-episode series on myeloproliferative neoplasms in connection with the education program Advancing Care for Patients with Myeloproliferative Neoplasms (MPNs). This episode is supported by Incyte.

Guests: Andrew Kuykendall, MD,

Assistant Member, Department of Malignant Hematology

Moffitt Cancer Center

Tampa, FL

Resources:

Myeloproliferative Neoplasms (cancersupportcommunity.org)

National Comprehensive Cancer Network (NCCN) Guidelines: Myeloproliferative Neoplasms

As soaring testing costs, coverage challenges, and heavy administrative overhead continue to impact access to guideline-concordant screening and biomarker testing, hear what multidisciplinary care teams need to know about mitigating the financial burden of cancer diagnostics. In this episode, CANCER BUZZ speaks with Jan Nowak, MD, PhD and clinical chief of Molecular Pathology at Roswell Park Comprehensive Cancer Center, Alti Rahman, MHA, MBA, CSSBB and practice administrator at Oncology Consultants, and Jordan Karwedsky, financial counselor at St. Vincent Hospital Cancer Center Green Bay Oncology, on how to reduce financial hurdles and increase access to cancer diagnostics.

"Understanding how coverage decisions and policies are made will help identify gaps in those policies, which can then be addressed…understanding this process can also enable productive appeals to payment denials when they occur." – Jan Nowak, MD, PhD

"The cancer screening process is a community-based approach; it is something that doesn't just belong to the healthcare provider or health system realm–it is an approach taken to educate various communities on the importance of screening." – Alti Rahman, MHA, MBA, CSSBB

This video podcast was produced in connection with the education program Cancer Diagnostics: Transforming Complex to Clear, with support by Bristol Myers Squibb, Merck, Lilly, AstraZeneca, and Amgen.

Guests:

Clinician: Jan Nowak, MD, PhD

Clinical Chief, Molecular Pathology,

Roswell Park Comprehensive Cancer Center

Buffalo, NY

Administrator: Alti Rahman, MHA, MBA, CSSBB

Practice Administrator

Oncology Consultants

Houston, TX

Financial Counselor: Jordan Karwedsky,

Financial Counselor

St. Vincent Hospital Cancer Center, Green Bay Oncology

Green Bay, WI

Resources:

ACCC Financial Advocacy Network

ACCC Updates Financial Advocacy Services Guidelines

Financial Advocacy Playbook

Financial Advocacy Toolkit

LIVE from NOC: Advocates Weigh-In on Financial Advocacy Guidelines Update — [MINI PODCAST]

LIVE from NOC: Financial Advocacy Guidelines — [MINI PODCAST]

As cancer programs seek new ways to improve coordination of molecular testing, hear how precision medicine stewards can streamline testing processes to improve efficiency and improve the patient experience. In this episode, CANCER BUZZ speaks with Melissa Cruz-Tanner, LPN, OPN-CG, and manager of Patient Navigation Services and the newly created Molecular Processing Department at Astera Cancer Care in New Jersey about their journey from development to approval of a new molecular processor role to support precision medicine testing.

"The period of wait time [for test results] causes so much trauma to the patient—the anxiety of not knowing. With us implementing the molecular team in our practice, it allowed us to have a realistic timeline on when we could tell the patients their results would be in. It also allowed us more diversity in test selection [i.e., the ability to select specific vendors or test types based on precise timelines for processing], thus cutting the time and access to treatment and improving the overall patient experience." – Melissa Cruz-Tanner, LPN, OPN-CG

This vodcast was developed in connection with the ACCC education program Precision Medicine Stewardship and was made possible with support by AstraZeneca and Blueprint Medicines.

Guest:

Melissa Cruz-Tanner, LPN, OPN-CG

Manager of Patient Navigation and Molecular Processing

Astera Cancer Care

East Brunswick, NJ

Additional Reading/Sources

· Precision Medicine Stewardship (accc.org)

· Precision Medicine Trends: Stewardship is on the Rise

· Precision Medicine Stewards: The Next Step in Personalized Medicine

· Academy of Oncology Nurse & Patient Navigators