Developing the Oncology Service Line: What Providers Should Know

Demand for oncology services is on the rise, and that has hospitals around the country looking at either adding a new or bolstering an existing oncology service line, says Timea Zsiray, oncology marketing manager for GE Healthcare (Waukesha, Wisconsin). “The Journal of Clinical Oncology projected that by 2030 there will be a 45% increase in cancer diagnosis in the United States alone, and it’s also a big focus area around the world,” she says.¹ “There’s an increasing demand for oncology services, but they represent significant clinical challenges, and whether a facility will be successful with that service line or not depends on a lot of factors.” Zsiray says that the issue is especially complex when it comes to oncology patients, who require services beyond primary treatment as part of a comprehensive approach to their care. “Today, most programs are aiming to be comprehensive in terms of the continuum of care,” she says. “Survivorship programs, screening, and diagnosis are all services that are often brought under the oncology program’s umbrella. With these services added, facilities are able to capture more revenue—but they are also able to provide better patient care.” Processes and Pathways Cancer care is, by its nature, long-term, and for that reason Zsiray recommends that facilities offering oncology as a service line pay close attention to processes that could be improved or made more efficient. “Process improvement can focus on reducing the time from diagnosis to treatment, for instance, and provide, in this very stressful situation, a comforting and less disruptive care experience for the patient,” she notes. “We all have to think about how we can provide a more patient-centric approach to cancer care delivery.” Zsiray also recommends that facilities adopt guidelines and clinical pathways, which standardize care while maximizing value. “It’s very important that the value of a new drug, treatment technique, or imaging technique is demonstrated and well understood,” she says. “It has to be efficacious—if it can’t bring value, it will ultimately not be adopted into the guidelines. Both from the provider side as well as from an industry perspective, we need to ensure that the tools we bring to market enable clinicians to provide both high-quality care and value.” As an example, Zsiray cites the revision of CMS guidelines for cancer care to include PET/CT following validation of the modality’s value by multiple studies, including a particularly glowing report in the Journal of Clinical Oncology.² “Leveraging that technology changes a patient’s treatment course around 38% of the time, and when you think about how expensive these treatments are, that’s incredibly important,” she says. “You want to be sure that the patient is on the right treatment course to achieve the best outcomes—but you also need to demonstrate value. What happened with PET/CT was a huge win for the health care industry overall for that reason.” Unique Considerations There are other considerations that are unique to oncology as a service line, Zsiray notes. One such factor, rarely mentioned, is the emotional burden placed on clinicians as they work with patients who may not survive. “This kind of care can be as emotional for the clinician as it is for the patient,” she says. Cancer care is also very multidisciplinary, Zsiray observes, requiring coordination between radiation oncology, medical oncology, surgery, and so on. “Weekly tumor board meetings are a typical way to facilitate the collaboration amongst the various disciplines. These meetings are also often attended by the genetic counselor, pathologists, radiologists, nurses, and nurse navigators,” she says. “There are all these disciplines and functions coming together to take a holistic approach to the patient’s care.” Additionally, Zsiray notes, cancer patients tend to have multiple comorbidities that complicate their cancer disease and treatment course. “Cardiology plays a big role, for instance, because the drugs may have an effect on the patient’s heart,” she says. “Cancer care is complex in the context of the disease, and clinically, it’s even broader than that.” At the administrative level, facilities should consider how they will enable and encourage that connection between the members of the multidisciplinary care team, Zsiray says. “You need the right infrastructure, the right personnel, and the right technology,” she says. “And on the operational side, you need the right processes, the right quality assurance, the right workflow.” Demonstrating Quality and Value The advent of health care reform has placed additional impetus on providers to demonstrate quality and value for their patients, and oncology is no exception to that rule, Zsiray says. “As an industry, we need to think about patient safety and quality of life, and we need to focus on demonstrating value and treatment efficacy,” she says. “I don’t think that will ever change, because of the unique nature of oncology. In order to provide better patient care, we need to understand what all these new innovations bring in terms of clinical outcomes.” Providers can contribute to this growing need by being transparent with their data, especially insights that can be gained from their tumor registries, Zsiray observes. “Any data are absolutely vital in terms of demonstrating the efficacy of new treatment options, new technologies, and new drugs,” she says. “Maximizing the utility of tumor registries, and embracing transparency of data, plays an important role in the success of the programs.” Facilities are increasingly embracing programs aimed at improving patients’ quality of life, including patient navigator programs and multidisciplinary one-day clinics. The latter, Zsiray says, “is where the different disciplines on the care team come together to meet with the patient all at once. It’s an example of how cancer care can become more patient-focused.” She concludes, “In oncology, the common theme should always be how do we make this easier for the patient.”Cat Vasko is editor of HealthCXO.