Addressing Cancer Care Challenges for Patients, and Ensuring Equity: Coral Omene, MD, PhD

Coral Omene, MD, PhD

Image credit: Rutgers Cancer Institute

There are a variety of challenges patients with cancer face when trying to access care, including distance from treatment centers and hurdles imposed by insurance companies that delay care, explained Coral Omene, MD, PhD, associate professor at Rutgers Cancer Institute and RWJBarnabas Health. When delivering true value-based cancer care, a better understanding of the quality-of-life metrics that matter to the individual patient is important, she added.

Insurance Hurdles

Delivering quality care means following evidence-based guidelines, but providers are often faced with hurdles and have to jump through several hoops, such as prior authorization, in order to start patients on the best treatment. The appeals process to get a regimen that is on guidelines approved for coverage can be “very taxing,” Omene said. Both patients and providers find the process frustrating, and it can create a lot of anxiety for both parties.

The appeals process can vary in duration, ranging from several days to 2 weeks, and it can be detrimental to patient care. Sometimes, providers will abandon the original treatment plan and pivot to another that is not the best option for that patient.

“If someone has an aggressive disease that you need to start treatment right away, they don't have a week, a week-and-a-half to get this [treatment approved],” she said.

Personalizing Care, True Value, and Addressing Disparities

Often, “value” in cancer care is tied to data points like overall survival or progression-free survival, but Omene emphasized that it should really be based on an idea of quality that is specific to the individual patient. Metrics on value should incorporate quality-of-life value.

Real-world data and analytics are crucial for understanding value and tracking the impact of interventions in cancer care. Analyzing this data can inform treatment decisions, allowing for tailored care based on outcomes. However, not all practices, especially smaller ones or those in rural areas, are equipped to collect and analyze such extensive data, potentially leading to disparities in care.

To ensure the definition of value reflects the diverse needs of all patient populations, including historically marginalized ones, it is essential to collect data that includes social determinants of health. These determinants, such as transportation, housing security, and access to care, are critical for understanding and addressing the needs of minority and underserved communities.

“Gathering this information helps one to target these patients appropriately [and] intervene with resources that are needed to be able to carry out the care in this value-based way,” Omene said.

However, value-based care models can have unintended consequences that exacerbate existing inequities. The administrative burden of data collection and reporting can strain already limited resources in underserved communities, potentially diverting them from direct patient care. This could lead to self-selection, where patients who can afford more or have easier access to care are prioritized.

“Then, people who cannot [pay more] may have to be traveling longer distances to get care where they can, and…if transportation is already a problem, it goes on, and it's like a vicious cycle,” Omene said. “You can see how it can sort of permeate in ways that are unintended but can easily happen depending on the setting.”

Technology in Cancer Care

One way to improve access to care for remote or underserved communities is by better utilizing technology. While telemedicine has become increasingly prevalent since the pandemic, there are still more ways it can work, such as expanding access to clinical trials for patients who may not easily be able to travel to large cancer centers.

Using technology, health care professionals can discuss clinical trials with patients and even obtain virtual consent, eliminating the need for an additional in-person trip for signing documents.

“[We should] think about how we can leverage some of these avenues that we use in recent years to better get high-tech care to these patients,” Omene said.