The cancer care system lags behind other chronic health issues in this key area.
We have entered an unprecedented era of therapeutic advances, new therapies and improved survival for cancer patients. Despite these rapid and continuous advances, the cancer care system lags behind other chronic health issues around a key element of successful care: self-management support (SMS).1
The literature identifies several reasons why SMS cancer follows other conditions, including the complexity of cancer and the historically paternalistic treatment paradigm for cancer care. For the latter, this structure centers treatment as an acute event in which providers retain primary responsibility for disease management through patient guidance.1.2 Additionally, many cancer clinicians often do not have the time or the additional coaching skills to effectively train patients in successful self-management.2
For oncology pharmacists, these factors provide an opportunity to help healthcare professionals (HCPs) advance SMS as an essential part of quality cancer care. Specifically, oncology pharmacists are uniquely positioned to help promote positive support for self-management in patients with chronic disease and cancer.
Self-management and chronic disease
Self-management of patients with chronic disease has been defined as the process by which individuals can actively cope with their chronic disease in the context of their daily life.3 Clinical research has shown that self-management can be an effective tool in improving patient outcomes for a range of chronic conditions, such as asthma, diabetes, and arthritis.4
Self-management interventions can help patients participate actively in their daily care. These interventions go beyond simply providing information or education, as they also help patients learn to use their psychosocial skills and actively engage in their own care.5 Patients engaged in texting experience better health outcomes, including quality of life (QOL) measures such as mood and sense of well-being.6
Texting has also been shown to reduce emergency room visits and overall costs for patients with chronic illnesses.seven As the US healthcare system moves towards a value-based model of care, supporting the self-management of chronically ill patients has become a strategic priority. A large body of research demonstrates the effectiveness of self-management in achieving a three-fold goal of health care reform: better health, better health care, and better value.8
Self-management and cancer
In 2005, the Institute of Medicine defined 6 phases of the cancer care continuum. The phases include prevention, early detection, diagnosis, treatment, survival and end-of-life care.4
However, self-management across the cancer care continuum has been found to lag behind SMS for other chronic conditions.1
This mismatch has changed in recent years as cancer is increasingly treated as a chronic health problem in which patients, their families and caregivers are involved in the development and delivery of personalized cancer care.
In addition, a growing body of research demonstrates the effectiveness of SMS in the cancer care continuum. A review of the literature identified a range of positive outcomes attributed to SMS interventions, including higher levels of self-care, self-help, and psychosocial adjustment; significant reduction in fatigue, pain and nausea; decrease in pain intensity scores; fewer hospitalizations; and increased survival.2
Promote self-management of cancer patients
Cancer patients enjoy working with a pharmacist.4 A recent Gallup poll shows Americans’ confidence in the pharmacy profession is the highest it has been in a decade.9 In collaboration with healthcare professionals, the oncology pharmacist has a unique opportunity to leverage this trust to engage patients and deploy SMS interventions that can impact health outcomes and quality of life.
Patients appreciate seeing the humanistic qualities of their healthcare providers and want to participate in shared decision-making about their own care.ten For this engagement to happen, the importance of the patient-provider relationship cannot be underestimated. Research shows that strong patient-provider relationships can impact a patient’s ability to cope, adherence, quality of life, and positive beliefs about the impact of therapy.11
Pharmacists are typically part of the cancer care continuum at a critical juncture – treatment. Often the first opportunity the pharmacy team has to deploy SMS interventions is access to medicines. Under the supervision of the pharmacist, referral and admission specialists provide the resources and support necessary to help patients navigate a fragmented and often confusing healthcare environment. Specifically, it may be about addressing the financial challenges associated with cancer treatment.
âOpen communication and patience are essential. Patients are naturally overwhelmed when it comes to coordinating access to their cancer treatment, âsaid Amanda Hasenei, Reference Specialist at BioMatrix Specialty Pharmacy. âWe recognize their emotion and develop goals around their concerns. We use our expertise to help remove barriers to care while actively involving the patient and caregiver where possible, so that they are better prepared to anticipate and resolve future problems. “
Additionally, oncology pharmacists can deploy drug therapy management (MTM) to help patients navigate the course of their cancer treatment. Integrating SMS interventions as part of the MTM process can contribute to positive health outcomes around key aspects of treatment, including adverse events, treatment adherence, and quality of life.
âA successful SMS is all about communication, education, empowerment and continuous monitoring throughout the patient journey,â said Royce Burruss, MBA, RPh, FASCP, general manager of clinical services for BioMatrix Specialty Pharmacy. âProviding the right resources and support can help patients effectively manage adverse events, tolerate treatment, and avoid unanticipated higher levels of care. “
It has never been more necessary to promote positive self-management skills for cancer patients. A shortage of healthcare professionals in oncology, new treatments, longer survival, polypharmacy and a shift from the site of care to the outpatient setting underscore the importance of helping patients develop strong self-management skills.
âEffective SMS means fostering collaboration between the patient and other healthcare stakeholders, including the oncologist,â said Kionna Oleru, PharmD, Pharmacy Manager at BioMatrix Specialty Pharmacy. âEmpowering and helping patients overcome the fragmentation that occurs in our health care system helps alleviate some of the challenges associated with cancer treatment. “
Currently, there are many SMS implementation resources, frameworks and strategies described for chronic health conditions in the current academic literature. Specialty pharmacies serving cancer patients should identify opportunities to integrate SMS throughout the patient journey as a key component of quality and value-based care.
- Howell, D., Mayer, D., Fielding, R., Eicher, M., Verdonck-de Leeuw., Johansen C., Soto-Perez-de-Celis, E., Foster, C., Chan, R. , Alfano C., Hudson, SV., Jefford, M., Lam, W., Loerzel, V., Pravettoni, G., Rammant, E., Schapira, L., Stein, K. Koczwara, B., Global Partners for cancer self-management. (2021). Cancer management and health after the clinic visit: a call to action for self-management in cancer care. Journal of the National Cancer Institute. 2021, 113 (5). doi: 10.1093 / jnci / djaa083
- McCorkle, R., Ercolano, E., Lazenby M., Schulman-Green D., Schilling, L., Lorig, K., Wagner, E. (2011). Self-management: Enabling and empowering patients living with cancer as a chronic disease. CA: A Cancer Journal for Clinicians. 61 (1) 50-62. https://doi.org/10.3322/caac.20093
- O’Connell, S., McCarth, Vera JC., Savage, E. (2018). Frameworks for chronic disease self-management support: a comparative literature review across countries. BMC Health Services Research. 18 (583). https://doi.org/10.1186/s12913-018-3387-0
- Agency for Research and Quality in Health. (ND) Why is self-management support important? https://www.ahrq.gov/ncepcr/tools/self-mgmt/why.html
- Agency for Research and Quality in Health. (ND). Practice Facilitation Manual. https://www.ahrq.gov/ncepcr/tools/pf-handbook/mod21.html
- Barlow, J., Wright C., Sheasby, J., Turner, A., Hainsworth J. (2002). Self-management approaches for people with chronic diseases: a review. Education and counseling for patients. 48 (2002) 177-187.
- Ahn, S., Basu, R., Smith, ML., Jiang, L., Lorig, K., Whitelaw N., Ory MG. (2013). The impact of chronic disease self-management programs: Saving on health care through community intervention. BMC Public Health. 2013 13 (1141). doi: 10.1186 / 1471-2458-13-1141
- Ory, MG., Ahn, S., Jiang, L., Smith, ML., Ritter PL., Whitelaw N., Lorig, K. (2013). Success of a National Chronic Disease Self-Management Program Study: Achieving the Three-fold Goal of Health Care Reform. Medical care. 51 (11) 992-998. DOI: 10.1097 / MLR.0b013e3182a95dd1
- Lindhorst, J. (2020). What does excellence in oncology pharmacy look like? Pharmacy time. https://www.pharmacytimes.com/view/what-does-excellence-in-oncology-pharmacy-look-like
- Saad, L., (2020). American ethical reviews are on the rise for medical workers and teachers. Gallup. https://news.gallup.com/poll/328136/ethics-ratings-rise-medical-workers-teachers.aspx
- Hirpa, M., Woreta, T., Addis, H., Kebede, S. (2020). What matters to patients? A timely question for value-based care. Plos One. https://doi.org/10.1371/journal.pone.0227845