Access to Care

Conquering the Cancer Care Continuum – Series Three: Second Issue —March 9, 2015
Lillie D. Shockney, RN, BS, MAS, ONN-CG
Editor-in-Chief, JONS; Program Director, AONN+; University Distinguished Service Professor of Breast Cancer, Administrative Director, The Johns Hopkins Breast Center; Director, John Hopkins Cancer Survivorship Programs; Professor of Surgery and Oncology, JHU School of Medicine; Co-Creator, Work Stride-Managing Cancer at Work

This second issue of Conquering the Cancer Care Continuum™ focuses on the serious nature of the problems associated with access to care. Whether it be access to cancer screening, diagnosis, treatment, or follow-up care, it is an issue that remains unresolved. Some models aimed at early detection, such as the Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program, have been successful in reaching some individuals. Difficulty still remains, however, in screening certain populations and arranging for them to receive treatment.

This publication contains articles written from the perspectives of a clinical oncology pharmacist and an oncology nurse practitioner. Both of these healthcare professionals provide their insight into the underlying causes of disparities in access to care, as well as the additional challenges associated with ensuring that a patient is receiving quality care. 

We know that healthcare disparities in the United States continue to exist. Historically, these gaps were associated with low socioeconomic status and/or low educational levels. The lack of health insurance has been an issue as well, resulting in delayed diagnoses and higher mortality rates once an individual is diagnosed with cancer. Today, the circumstances that impact access to care have broadened. Although lack of insurance was identified by the Agency for Healthcare Research and Quality as the most significant contributing factor to gaps in access to care, we also must consider the escalating costs in cancer care. With medications and drug development being more expensive now than in the past, insurance companies are being forced to pass along more healthcare expenses to the patient, which are, in turn, associated with high copayments, higher deductibles, and even capitation for some episodes of cancer care. This means that having health insurance no longer completely solves the problem of access to care. 

So, how do we wrap our arms around the rising costs of cancer care? One way is to utilize oncology nurses in a more expansive way. As the shortage of oncology specialists grows, along with a prexisting shortage of primary care physicians, we need to turn to nurses to fill in some of the gaps, as well as serve as bridges for continuity of care. Oncology pharmacists are serving in advocacy roles, thus helping patients obtain free or discounted drugs directly from the pharmaceutical companies. This service is needed not only by the indigent, but by working families as well. Although the development of new drugs is exciting, the costs associated with these agents are higher than we have ever witnessed before. Patients and their families do not and will not have the financial means to absorb the costs of cancer care that now rest on their shoulders. 

Add to this equation the fact that the American Society of Clinical Oncologists is encouraging oncologists to expand their discussion with cancer patients about treatment options by not limiting the conversation to the risks and benefits of each potential therapeutic option, but providing patients with information on treatment costs as well. And when it comes to offering treatment to patients with advanced metastatic cancer, a priority among such individuals is not to leave their families with any financial debt associated with their cancer care after they are gone. 

And what will happen to the patient who gets screened and, as a result, is diagnosed with cancer? We can no longer assume that this individual will proceed with the treatment of his or her disease. Some patients may feel that treatment is simply not possible for financial reasons, and will seek care that lacks evidence-based research and deviates greatly from standards of care. Patients may also feel that they cannot afford to take time off from work to get the treatment that they need.

To date, there is no one solution to this dilemma. We must work as a team to develop practical strategies to improve access to care, whether it be screening, prevention, early detection, diagnosis, treatment, or follow-up care. We need to become creative…to become truly innovative. We must also remember that treatment for treatment’s sake is not necessarily good quality of care. The healthcare system has rewarded physicians and hospitals for providing more and more treatment. Now is the time to step back and remember the Hippocratic Oath—“First, do no harm.” To create accessible quality cancer care in different environments, such as the workplace. To shift treatment hours to when patients are available to receive their therapy, which is often not in the middle of their workday. To promote healthier lifestyles so we can decrease cancer risk. There is a lot to be done. We need to work together to develop solutions sooner, rather than later.

Related Articles
The Value of Palliative Care Early in the Treatment Process
Lillie D. Shockney, RN, BS, MAS, ONN-CG
Best Practices in Breast Cancer – October 2018 Vol 9
Palliative care has a serious identity problem. Seventy percent of Americans describe themselves as “not at all knowledgeable” about palliative care, and most healthcare professionals believe it is synonymous with end-of-life care.1 This perception is not far from current medical practice, because specialty palliative care—administered by clinicians with expertise in palliative medicine—is predominantly offered through hospice care or inpatient consultation only after life-prolonging treatment has failed. This means that the majority of patients who could benefit from palliative care are not receiving it until they are very close to death. To ensure that patients with metastatic breast cancer receive the best cancer care throughout their disease trajectory, palliative care should be initiated alongside standard oncology care, and it should be implemented early.
Recognizing Progress and Encouraging Further Strides in Breast Cancer
Lillie D. Shockney, RN, BS, MAS, ONN-CG
Best Practices in Breast Cancer – October 2018 Vol 9
In addition to the obligatory orange and black decorations of October, it’s also the time of year to don your pink in honor of Breast Cancer Awareness Month! The progress we have made as a nation in elevating the importance of regular breast cancer screenings, funding research, and supporting breast cancer survivors has had a direct impact on our ability to increase and improve survivorship.
“Establishing a Successful Navigation Program”: A JONS Exclusive Series
Lillie D. Shockney, RN, BS, MAS, ONN-CG
October 2018 Vol 9, NO 10

How do you establish a successful navigation program? The answers are right here in this issue!

Last modified: June 6, 2018

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