Human behavior may be the most significant variable in the future of cancer care in two senses: a). The “front-end” or “topographical changes” affecting the identification of need and potential treatment modalities; and b). The care “system” delivery/payment models for care. It will not be about the technology or some great pharmaceutical breakthrough, at least not in the next 3-5 years. Innovation in cancer care will really be about changes in human behavior.
These “topographical” or general marketplace shifts are likely to be driven by two groups: patients/supporting family members; and payors (public and private). Millennials, as they age and assume a greater share in the maintenance of aging parents, bring some realities, specifically
growing up in a digitally connected world where the internet has all the answers.
As a cautionary example, care-givers of my mother, after she suffered a life-threatening stroke, were besieged by my younger brother bringing reams of “data” from various websites concerning treatment protocols, options, clinical trials, etc. Ultimately the hospital legal counsel had to mediate which group—my brother or my mom’s physicians—were going to make critical treatment decisions.
As our society struggles with the costs and treatment options inherent in greater cancer incidence (in part due to the natural result of increased longevity and success in curing other sources of disease and morbidity), such disputes will become more common.
At the same time, payors face higher and higher costs associated with such critical care situations. One response will be ever-greater scrutiny of treatment regimens, especially more aggressive surgical interventions and expensive drug treatments that only marginally extend life. The problem is while “society” may be willing to make trade-offs, all bets are off in caring for one’s own parents.
The social media eruptions over changing recommendations on mammograms are just a foretaste of the potential disruptions should payor-initiated protocols begin to shift patients from the oncologist to hospice care irrespective of family requests. Another past example of what we may be seeing more of in the future was the case of Dr. Michael DeBakey, the famous cardiologist, who suffered a life-ending heart attack from a dissecting aortic aneurysm in early 2006. Even though he had signed a DNR order, after his family pressured the hospital and attending physicians, Dr. DeBakey was aggressively treated and ultimately survived for another two years…at a cost of over $1million.
On the physician and provider side, the volume of data collected about their treatment outcomes will be increasingly accessed by families and payors to direct patient flows. The application of “protocol-driven” predictive analytics, especially in the areas of long-term survival, complications and “quality-of-life” estimates, will be leveraged to drive volumes and payments.
Imagine a world where there are few, high-quality cancer centers that are increasingly difficult to gain admission to due to growing demand (the “Ivy League”), and the remainder of the provider networks that compete based on lowest price and local access. As all studies show, those cancer centers with the highest volumes will have the best outcomes and lowest per unit costs, further pressuring private and public payors–in their drive to lower costs while improving quality–to disproportionately reward the wealthiest providers.
In summary, while much of the medical literature eloquently expounds on the promise of technological breakthroughs in cancer care from pharmaceutical treatments to personalized medicine, the real battlegrounds over the foreseeable future will be around changing expectations and our all-too human behavioral responses in facing this deadly disease.
Jim Austin is Senior Lecturer at the Brown University Executive Master in Healthcare Leadership Program and a former Vice President for Strategy at Baxter Healthcare.