The Future of Cancer Care: Are We Ready for Personalized Value?

1049

Journal of the National Comprehensive Cancer Network

The Last Word

The Future of Cancer Care: Are We Ready For

Personalized Value?

Jonas A. de Souza, MD; Colleen Kelly, BA; and Chadi Nabhan, MD

Tremendous advances have been achieved in the understanding of cancer biology, with

cancer researchers extolling the potential of precision medicine in tailoring treatment

to specific tumor markers. However, instead of feeling empowered, patients often have

difficulty comparing and selecting among various treatment options.1 Compounding

this perplexity is the rising cost of cancer therapies coupled with continued concerns

about side effects and their impact on quality of life (QOL). Although incremental

improvements in overall survival remain the most important consideration when

selecting a particular treatment, additional critical considerations are needed for

proper therapeutic choosing. This delicate balance has recently been translated into

so-called “value” in cancer care. Although frameworks to better understand and

practice “value in cancer care” have been developed,2 these tools have not actively

involved patients. To create an effective model of value in oncology care, the views

and needs of all stakeholders must be aligned with those of the patients. To that end,

we propose a patient-centered value framework as a mechanism of optimizing cancer

care moving forward (Figure 1).

Jonas A. de Souza, MD

Jonas A. de Souza, MD, is Assistant

Professor of Medicine in the

Department of Medicine, Section

of Hematology and Oncology, The

University of Chicago Medicine,

Chicago, Illinois.

The Personalized Value Model

Porter3 proposed aligning stakeholders’ incentives with the concept of value for the patient

as an approach for improving the health care system as a whole. In that context, value

was defined as “health outcomes achieved per dollar spent.” These outcomes incorporated

measures of survival and QOL. Also, they consisted of a more complex set of functional...