“We have to stop focusing primarily on survival or even short-term quality of life,” Dr. de Souza told ENTtoday. “Rather, the focus also needs to be on functional outcomes, recovery, sustainability of that recovery, and the lasting impact that a given treatment can have on a patient’s daily activities. To date, I’m not sure our profession has been doing a great job of giving all of these variables the weight they deserve.”
Explore this issue:November 2015
The good news is that there are several strategies for rebalancing the value equation back to the patient, Dr. de Souza stressed in a recent paper (Am Soc Clin Oncol Educ Book. 2014:e304-9). One strategy he advocates, although it still needs further study, is de-escalation of potentially toxic
chemotherapies in patients with head and neck cancers who are positive for human papillomavirus (HPV). Studies have shown that such patients have a type of oropharyngeal cancer that responds better to chemotherapy than HPV-negative oropharyngeal cancer does. Thus, he noted, efforts to de-intensify treatments for HPV-positive patients are underway, with the goal of minimizing treatment-related toxicities (J Clin Oncol. 2013;31[suppl;abstr 6005]).
“If we can reduce toxicity and improve functional outcomes while providing a similar survival benefit [using de-escalation], that’s going to result in lower overall costs to the healthcare system,” Dr. de Souza said. “But it’s not going to happen unless clinicians start taking that longer, patient-focused view when choosing a given treatment regimen.”
Dr. de Souza noted that otolaryngologists are not the only ones advocating a more patient-focused approach to creating more value in cancer care. He pointed to a recent initiative by the American Society of Clinical Oncology (ASCO) to publish their own value framework in cancer care (See “An Update on the ASCO Value Framework,” p. 8), “and it is noteworthy for its focus on all of these other patient-oriented domains that are so important.”
Dr. Roman agreed that the work of ASCO, coupled with the bundling effort of MD Anderson, is an encouraging trend for the profession.
“Make no mistake—as time goes on, there will be increasing pressure on head and neck surgeons to measure the quality and value of the care we provide,” he said. “The earlier we get in the game, the more ownership we will have over how that care is measured, instead of someone else telling us how that should play out.”
David Bronstein is a freelance medical journalist based in New Jersey.