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Closing The Gaps in Patient-Centricity in Cancer Care

Highlights from the Medscape Education full panel discussion during this year's #ESMO22.

Patient-centricity means that no decision is made without the patient, but how can clinicians achieve that given today's challenges of cancer care?

During ESMO 2022 in Paris, France, Medscape welcomed leading key opinion leaders in cancer care and patient advocates to the Eiffel Tower for an honest discussion about patient-centricity and patient-centered cancer care. Dr John Whyte, WebMD CMO; Professor Nadia Harbeck, director of the Breast Center at the University of Munich; Dame Professor Lesley Fallowfield, director of Sussex Health Outcomes Research and Education in Cancer at the University of Sussex in the UK; and patient advocate Steve Clark, campaign ambassador of Cancer Research UK, a volunteer patient voice at Bowel Cancer UK, and the founder of Strive for Five gathered with conference attendees to discuss how, at a time when clinicians are busier than ever and cancer care is more complex than ever, the care team can stay patient centred.

The Patient Perspective

Steve Clark began the discussion with his viewpoint as both a patient advocate and a person living with cancer. He highlighted a key point -- that keeping the patient first in cancer care is of the utmost importance. For a long time, treating cancer has been all about the disease itself, with many discussions centering on the cancer rather than the needs and feelings of the patient. Now, however, the focus of the conversation needs to change to bring in the patient and advance the terminology, tone, and language that clinicians use. Patients are living longer now, he explained as one example, and for that reason, language needs to move away from their cancer being incurable and instead focus on it being treatable.

Patient-Clinician Understanding

All the new treatments being developed can present a challenge for patients. They allow patients to live longer and have a better quality of life in some cases, but they can be complex and difficult for patients to understand. The language used can sometimes be ambiguous, leading to confusion or misunderstanding about the effects of the treatment or a patient's prognosis. Many patients believe that medicine is an exact science, but the reality is that it is not, and the challenge lies in how to translate complex, changing science into something that is easy for patients to understand.

One reason it's difficult to translate medicine into something the patient understands is that clinician training is different than the realities of care. Time with patients is a big limitation, as are financial incentives. In real-life practice, procedures like ultrasounds are incentivized better than conversations with patients, which can lead to less time spent on them.

The Role of the Entire Care Team

Caring for patients living with cancer is a team effort. From physicians to nurses to pharmacists and patient advocates, each member has a role in ensuring the focus of care is on the patient. There is, and will continue to be, a large role for nurses if we allow them to work on the same level and come at patient care from a different angle. Advocacy groups can also play a large role and can help care for the patient beyond the disease by providing support and access to information. For patients, finding information about their disease is important, but they often stumble upon inaccurate or harmful misinformation in their search. Advocacy resources can help ensure that what they find is accurate and current, which can lead to better and more informed conversations with their care team.

The Current State of Care

Advances in treatment mean that patients are living longer than ever, and that long-term care is more common. As the landscape changes, it's important that the perception of the various types of care also changes.

Palliative care is one aspect where a change in perspective is needed. Many patients believe that discussion of palliative care means they are nearing the end of their life, when the reality is they should be involved in palliative care from the beginning regardless of their prognosis. In fact, Dame Professor Lesley Falllowfield states that palliative care can produce overall survival benefits that can beat some cancer drugs. With such huge benefit to patients, having an honest conversation and making sure that patients understand what palliative care entails is critical.

Similarly, it's important for clinicians and patients to have a conversation around prognosis and outcomes when clinicians are considering enrolling the patient in an early phase clinical trial, to ensure that patients fully understand their current state and possible outcomes.

The Impact of the Pandemic

As in other aspects of health care, the pandemic has changed how patients and clinicians interact in cancer care. In some ways this change has made communication more modern, as clinicians and patients can communicate through video or email, but virtual interaction has its limitations. With the world opening up again, privacy and data concerns have limited some communications as many systems move away from email once more. Backlogs of care have also limited the amount of time that clinicians can spend with patients, particularly the careful conversations that are so critical to cancer care. In some systems, a lack of consistency in scheduling which clinician a patient sees can also cause gaps in communication.

While telemedicine seems to be here to stay post-pandemic, it is not a perfect solution. Many clinicians report that their patients do not have the digital literacy or necessary technology to have conversations via telemedicine. Those who do still face limitations. It is more difficult to establish eye contact with a patient when dealing with a camera, and body language, such as touching the arm of an emotional patient, is limited or impossible when conversing through a computer.

Still, there is a future in digital with the development of new wearable monitors that may expand care, so long as that care is patient centered.

The Need for Education

The answer to many of the challenges faced by clinicians lies in education, but how can we educate them when their time is so limited?

Although clinicians receive education on communication during their medical training, new advances and insights on how to be an effective communicator are continually being identified. Effective communication is a skill that needs continuous honing. Therefore, education is essential not only to reinforce communication skills, but also to educate clinicians on new approaches and strategies for communication so that patients feel more supported and positive about their treatment journey.

While clinicians learn how to break bad news, complex and difficult conversations need to be constantly revisited and updated in line with the advances in medicine that underpin them. It is therefore essential that clinicians adopt new techniques and approaches that make it easier for patients to understand these details. For example, Professor Nadia Harbeck commented on the rapidly evolving landscape within breast cancer research and the challenges this brings to clinicians and patients from a communication perspective. The array of new drug approvals and biomarkers that must now be considered, discussed, and measured has increased considerably, and clinicians are now faced with having to talk to patients about highly technical and complex information -- such as why their disease is not just hormone positive, but hormone positive and also HER2-low; or why they have a germline BRCA mutation, and what that means -- all packaged up in a conversation that lasts anywhere between 15 and 30 minutes.

Another conversation clinicians need to hone and learn to reframe occurs when a patient is moving into clinical trials. Rather than focusing on not knowing how to treat the patient, clinicians can instead focus on the ways a clinical trial may help the patient improve.

By engaging the entire care team, patient-centricity can be improved, and patients living with cancer can have a longer and higher quality of life throughout their treatment journey.

You can watch the entire discussion here or save it on YouTube to watch later here.



About Medscape Education:

Medscape Education (medscape.org) delivers dynamic, innovative education to optimize learner engagement and patient outcomes worldwide. Medscape Education is the leading online global destination for physicians and healthcare professionals, providing over 5 million members with the latest medical news, expert opinion, and precision education (CME and CPD) to improve clinical practice and advance health outcomes. Medscape's unrivalled membership reach and therapeutic expertise deliver education across 30+ specialties in 40+ learning formats, using the latest digital and live technology. Medscape is a subsidiary of WebMD Health Corp.

About WebMD

WebMD Health Corp., an Internet Brands Company, is the leading provider of health information services, serving patients, physicians, health care professionals, employers, and health plans through our public and private online portals, mobile platforms, and health-focused publications. The WebMD Health Network includes WebMD Health, Medscape, MedicineNet, eMedicineHealth, RxList, OnHealth, Medscape Education, and other owned WebMD sites. WebMD®, Medscape®, CME Circle®, Medpulse®, eMedicine®, MedicineNet®, theheart.org®, and RxList® are among the trademarks of WebMD Health Corp. or its subsidiaries.

21st October 2022

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