Dr. Schnipper said such comments “weren’t a total surprise,” given the fact that the developers knew that the method used to craft the value framework has some limitations, including how the NHB scoring components were weighted. But the tool’s unwieldy format is perhaps its most serious drawback, he noted.
Explore this issue:November 2015
“What we published is very cumbersome and certainly not practical, in its current form, to talk to the patient about something so complicated,” he said. “But like many things in the digital age, complicated algorithms can be reduced via software to relatively simple technological measures. So we are likely going to issue an RFP [request for proposal] asking software developers to convert our complicated system into something that is quite user-friendly for both patients and providers.”
Those refinements notwithstanding, what has the publication of the ASCO value framework succeeded in doing with regard to the debate over value in cancer care?
“Our hope is that it has pointed to a better way of discussing treatment options with our patients,” he said, citing patients with aggressive, advanced cancer as an example. “They may know they are going to die from their disease and that there may be some new targeted—and often very expensive—treatment that may delay that by a few months,” Dr. Schnipper said. “But to them, relief from symptoms—quality of life, if you will—may be far more important than overall survival. Well, without some type of tool that triggers a conversation about what that patient truly values, what’s the chance that a cancer regimen that fully factors in their needs is going to be suggested?”
“We need to be able to develop a tool that can be used at the interface between the physician and the patient, to help ensure those conversations are taking place in a streamlined, reproducible, and humane fashion.”—DB