How can we leverage diverse perspectives to improve value assessment in cancer care?
AUTHORS: Dr. Marianna de Camargo Cancela, Section Chief, National Institute of Cancer – Brazilian Ministry of Health | Dr. Salvador Acevedo-Gómez, Medical Researcher, Tómatelo a Pecho A.C. | Prof. David Taylor, Professor, School of Pharmacy, University College London
The content from this commentary is based on a panel discussion at the HTAi 2022 Annual Meeting, sponsored by MSD’s Global Oncology Policy Grants Program.
Cancer kills more people across the globe each year than any other disease, accounting for nearly 10 million deaths in 2020. The COVID-19 pandemic has uncovered how fragile our healthcare system can be, as expenses for workforce, medicines, and medical supplies continues to increase. Recent innovations in cancer care have changed how cancer is diagnosed, treated, and monitored. With increased innovation, it is crucial to incorporate diverse perspectives and information in assessing their value.
While tools and frameworks have been developed, there are strong, diverse stakeholder perspectives regarding assessing value of cancer care. We should embrace diverse perspectives and local contexts to define value in cancer care and to address the challenges that countries face in healthcare decision-making. We’ve outlined below three components for ensuring diverse perspectives are incorporated into value assessment, and ultimately, health decision-making for cancer care.
Leveraging Data to Improve Cancer Care
Collecting, analyzing, and interpreting new and existing data can help illustrate the complexities and drive value-based cancer care. To improve cancer care moving forward, we must leverage advancements in data collection and analysis for evidence-based decision-making. We can build a comprehensive value assessment that informs actionable change through ensuring that perspectives from diverse domains are brought to the table, from national data sources to localized experiences.
Around the world, countries are collecting data and informing decision-making in different ways. In Mexico for example, Dr. Salvador Acevedo-Gómez and colleagues’ research outlines the Women’s Cancer Observatory as a powerful tool for national advocacy and decision-making. Through this observatory, monitoring and evaluation of 34 indicators (including regulatory, financial, coverage, and service provision) highlights regional variation in availability and quality of cancer care. What’s makes this approach actionable is that it can then be used by regions across the country to collaborate with one another. For example, regions that have better patient health outcomes for breast cancer can work with regions that need support and could benefit from shared best practices. In addition, this observatory can be extrapolated to handle other countries’ data, allowing to make continental or even global comparisons. This is just one example of how data can be used to improve problem solving and information sharing on a national and regional level to improve cancer care, informing healthcare decision-making and prioritization.
Addressing Inequities in Cancer Care
Within and across countries, equitable access to cancer care is necessary to ensure that no one gets left behind. We need to continue better understanding the role of social determinants of health and how to identify and treat all types of patients to improve their health outcomes. One tool in understanding inequities in countries is implementing national cancer registries. Supporting and implementing population-based cancer registries (PBCR) is paramount in understanding inequities in and within countries. While there are more than 700 cancer registries worldwide, only one in three countries can report high quality data incidence at present.
Cancer registries not only allow countries to understand and implement cancer prevention and control interventions, but they allow data to be cut in various ways to understand inequities that exist. In Brazil, Dr. Marianna de Camargo Cancela’s research using public cancer registry data highlights the inequities that exist when comparing different regions across the country, but less known about inequities within cities and regions, where people with the highest incomes and access to care live next to people with lower incomes, less access to care, and low health literacy. We can prioritize health equity moving forward by focusing on including diverse voices, data collection methods, and innovative treatments to improve lives of all patients, not just ones the healthcare system reaches currently.
Elevating the Patient Voice & Societal Perspective in Healthcare Decision-Making
In addition to data collection from systems in place such as observatories and cancer registries, the patient voice and societal preferences should be incorporated into value assessment. While there is not one standalone strategy in defining and measuring value in cancer care, localized solutions come from elevating patient advocate experiences and preferences to better health outcomes.
In the United Kingdom, David Taylor’s research on understanding patient preferences towards cancer research and treatment highlights the demand for early diagnosis and access to treatments for individuals of all ages. Findings from his research include that three in four (75%) of the UK population stated they want to be regularly tested for cancer when blood tests are available; 90% believe older adults ages 70 and older have the same right to effective cancer treatment as anyone else. Exploring patient and societal preferences like these can inform healthcare decision making and ultimately lead to higher levels of adherence, greater satisfaction, and improved health outcomes.
With continued momentum and innovations in reaching patients for cancer care, it is crucial to work collaboratively to define value in cancer treatment and better the quality of care that patients around the world receive. As policymakers continue to make decisions that impact cancer patients and their care, it will be increasingly important to enhance the value of cancer through effective policy and practice to improve patient outcomes and the burden of cancer. Research from Mexico, Brazil and the United Kingdom is part of a growing body of work that can inform value assessment that incorporates many diverse perspectives in cancer care.