Not so many years ago, doctors had no choice but to use a one-size-fits-most approach to treat cancer. Surgery, chemotherapy, and radiation were among the available tools, but clinicians lacked the ability to precisely determine the best treatment for each individual patient.
That’s no longer the case. Newer tests and therapies have given doctors tools to optimize treatments, which can protect patients from being undertreated or over-treated, said Dr. Bhuvana Sagar, the senior medical principal leading clinical innovation at Evernorth, the health services division of The Cigna Group, and a practicing oncologist in Houston.
Patients and their doctors increasingly recognize that in certain clinical scenarios, less intense targeted therapies offer improved health outcomes. These therapies also take less of a toll on physical and mental well-being. With that in mind, more and more patients are considering potential side effects and the impact to their quality of life as they evaluate which options are best for them.
Overtreatment in Breast Cancer Can Lead to Lower Satisfaction, Especially Among Younger Patients
Historically, many patients diagnosed with breast cancer had disfiguring mastectomies, Dr. Sagar said, but researchers learned over time that these extensive surgeries did not increase the cure rate.
In the 2000s, surgeons refined their techniques and developed breast conservation approaches such as lumpectomies. Yet unilateral and bilateral mastectomies, especially among young women, have increased since 2015, she said.
More surgery does not always lead to better outcomes, she said, noting that in the long run, young women who opted for breast-conserving surgery have higher satisfaction and quality of life scores.
In the past, women with early stage breast cancer were treated with chemotherapy to prevent the cancer from recurring. Today, with better molecular testing, we can predict the risk of cancer recurrence and whether someone would benefit from the addition of chemotherapy.
This has been a game changer in the management of breast cancer, Dr. Sagar said, noting that chemotherapy can have a severe impact on patients and their families. In order for patients to benefit from the most-up-to-date treatments, however, their doctors must order the right tests. These tests allow patients who won’t benefit from the treatment to avoid suffering short- or long-term mental and physical side effects from chemotherapy drugs.
Targeted Therapies Help Lung Cancer Patients Live Longer
Today’s genetic testing and other diagnostic tools allow oncologists to precisely tailor treatments to each individual. Some cancers have driver gene mutations that actually drive lung cancer, and specific treatments can target those driver mutations, giving patients better outcomes.
With targeted therapies, for example, patients with advanced stage lung cancer can live longer. “About 15 years ago, when advanced stage lung cancer was treated with chemotherapy, the median survival was somewhere between six to nine months — maybe 12 months,” Dr. Sagar said. “Nowadays, with new oral drugs in selected clinical scenarios, survival has improved dramatically — anywhere from 36 months to 60 months, which was unheard of in the past.”
Despite plentiful evidence that genetic testing maximizes outcomes and minimizes unnecessary side effects, however, Evernorth saw that patients were not being tested consistently before their physicians prescribed chemotherapy.
To close this gap in care, Evernorth utilizes prior authorization to ensure that patients with advanced lung cancer undergo specific testing before chemotherapy can be approved. For example, eviCore healthcare, Evernorth’s medical benefits management arm, developed prior authorization protocols that guide lung cancer patients to the appropriate genetic testing. Usage of this program has increased guideline-recommended genomic testing in patients with advanced non-small cell lung cancer from approximately 62% to 97%.
“We’re partnering with oncologists to make sure patients who may benefit from these targeted drugs are properly screened — and, if appropriate, receive that targeted treatment to deliver the best outcomes,” said Dr. Stephen Hamilton, eviCore’s associate chief medical officer for oncology. “We have seen that up to 30% of patients with advanced non-small cell lung cancer were not receiving the most effective cancer treatment because of a lack of genetic testing,”
Helping Patients Get the Benefit of the Latest Cancer Guidelines
The oncology field is considered one of the most complex areas of medical care, with innovations in diagnosis and treatment options — yet not all patients are benefiting from these continuing advances. To help address these gaps in care, Evernorth created a clinical consult program that pairs community oncologists with subspecialists in complex cancers from leading cancer centers. The program improves patients’ access to the best possible treatments while receiving their care close to home.
“Peer-to-peer consultation programs give community oncologists information they may not be aware of, helping patients gain access to treatment recommendations based on the latest evidence-based guidelines,” Dr. Hamilton said. “We are continually looking for ways to ensure our patients get the right cancer care, at the right time in their journey for the best possible outcomes.”
Evernorth Guided Cancer Care helps members get the right care early enough in their cancer journey to have a positive impact on both health outcomes and costs. Our comprehensive approach combines two unique solutions: Concierge Cancer Support and Cancer Consult Service. Concierge Cancer Support is designed to quickly identify where we can add the most value for each member and provides members a single point of contact – a Care Advocate. Care Advocates provide personalized care plans for each member, serving as a resource to guide and support members through their entire care journey from diagnosis, to treatment, to survivorship. Additionally, we help ensure that members with the most complex cancer cases receive an accurate diagnosis and optimal treatment plan options through our Cancer Consult Service.
The eviCore onConnect suite integrates medical and radiation oncology, radiology, genomic laboratory utilization management, and claims payment integrity with our comprehensive oncology solution. Members receive direct support from experienced oncology nurses and community oncologist support from National Cancer Institute physicians to empower the best outcomes for patients and payers.