Streamlining Breast Cancer Therapy Access for Better Patient Outcomes: Rebecca Chacko, MD

Rebecca Chacko, a breast medical oncologist at Henry Ford, shed light on key challenges in breast cancer care in an interview with The American Journal of Managed Care^®. Chacko served as a panelist at the Detroit Institute for Value-Based Medicine (IVBM) on the session titled "Evolving Breast Cancer Care: Addressing Unmet Needs Across the Patient Journey, emphasizing the significant hurdles in getting patients timely access to breast cancer therapies.

Chacko specifically addressed how chemotherapy regimens, particularly multidrug ones, often face delays due to payer preferences for individual medications. This can lead to frustrating holdups in patient care. She advocated for real-time feedback from insurers to streamline authorizations and reduce these critical treatment delays. Overall, Chacko championed open communication to ensure patients fully understand their treatment plans and remain actively engaged in their care.

This transcript was lightly edited; captions were auto-generated.

Transcript

What are some of the primary hurdles you encounter when trying to secure coverage and timely access for patients to the newest, often high-cost, breast cancer therapies?

I think a lot of our chemotherapy regimens are multidrugs, and it involves a lot of different evaluations from the payer side. Sometimes it can just be one drug that the payer has a preference for that holds up the entire regimen coverage, and so that can translate into a delay in care for the patient. Sometimes we won't get that feedback until weeks after we've submitted authorization, and although those things are understandable, it can be frustrating for the patient who is waiting to start their treatment and get the green light to go ahead.

In terms of advocacy, I think being able to get that real-time feedback and knowing if there is something that is preferred over another with each individual payer, I think that can reduce the back and forth between us and the insurance, and finally, get the patient in the chair for their treatment.

"Addressing Unmet Needs Across the Patient Journey" is a key theme of the panel you are on. Beyond the therapeutic advancements, what are some of the most significant nonpharmacological unmet needs that can be identified among patients with breast cancer?

I think with our patients becoming even younger, we really have to face family planning head-on and be able to tackle those issues. We have to at least be able to have honest conversations with our patients, allowing them to know what their options are for fertility preservation, and then also getting them to the right team in order to facilitate expediting those processes. We need to make sure that their long-term goals are still preserved, even though they might be facing chemotherapy in between. Our patients are becoming younger and younger, and we are diagnosing and treating patients in really important years. These are the years that they probably had looked forward to growing their family, and a lot of exciting dreams and hopes that have to be on pause. I think we really do have to take that into account when we are treating our patients, and knowing that that really does have an impact on how they view their treatment and their outcomes.

How can patients be more engaged in shared decision-making when discussing complex treatment options, particularly when balancing potential benefits, significant toxicities, and personal preferences regarding quality of life?

I think the initial consultation between the oncologist and the patient and family members is really important, because that really is what sets the pace and the tone for what treatment is hopefully going to look like. Then understanding the goals of treatment, whether it's curative or palliative, and then integrating that into how patients are tolerating treatment is really important, and something that needs to be an open conversation in every visit with the physician and the patient.

I think the patient really does need to develop a sense of comfort and knowing that the physician is ultimately on their side, that they can be open and honest, but then also understand the goal of treatment and what their physician and their team is trying to get them toward. It is important for the patients to remain open, to know that their doctor and their team is on the same side as them, and it's just a matter of open communication and understanding and asking questions.

If they don't totally understand what is happening or why something is happening, ask those questions, because a lot of the time, if you have more insight into why something is happening, it helps you understand it better and stick to a plan, rather than if you really don't know why or what you're doing, it won’t really help you reach that goal.