Defining Value for the Treatment of Brain Metastases in Metastatic HER2-Positive Breast Cancer - Episode 15

Patient-Centered Care for Treatment of Brain Mets

The role of patient-centered value-based care models in the treatment of brain metastases in HER2+ mBC and the importance of patient support services.

Bhavesh Shah, RPh, BCOP: Patient-centered value-based models are up and coming in oncology. For this patient population, we need to look at a lot of different things in terms of how a patient fits into this specific category. We talked about asymptomatic and symptomatic patients, what treatments the patients have received, what you would use in the first-line setting, and what you would use in the second-line setting. It’s all going to make a difference in the total cost of care. If we look at a patient, if they received the most optimal therapy as a first-line treatment, then you’re preventing or delaying that second-line therapy time to progression, and you’re creating a lower total cost of care, especially in the beginning. You’re also providing better quality of life for the patient. Especially in the initial phases of the disease, it’s important to have the appropriate therapy. If you don’t have that, what happens is that you’re going to have early progression. It’s going to lead to hospitalization and ICU [intensive care unit] stays, and that’s going to increase your total cost of care. Optimal therapy is probably the key driver in this.

Patient-support services are key because we know, especially with COVID-19 [coronavirus disease 2019], that there are a lot of patients who may have jobs for which they’re furloughed, and they may be losing their insurance. They may have had a grace period of 90 days of temporary insurance that has now expired. There are, of course, going to be a lot of access issues. We already know that, in oncology, about 25% of patients decline their therapy because of the cost sharing that they have. Being involved in this up front, we’re making sure patients have the appropriate insurance, and we’re looking at what the cost sharing is. Especially with oral agents, we know that there’s going to be cost sharing and Medicare patients, so we’re making sure patients have access to all the support programs.

It’s not just about the financials. We need to have clinical-support programs so that if you want patients to stay on drugs, there needs to be appropriate adherence that they need. That means that toxicity management needs to be done appropriately. Dosing needs to be appropriate because we know that neratinib is going to have a high incidence of diarrhea if you don’t have that dose escalation to the FDA-approved dosing. The optimization needs to be on the patient’s supportive care for financial and clinical support.