Consider a man—we'll call him Mr. Jones—newly diagnosed with advanced lung cancer. In his first month, he starts chemotherapy. Within days, his nausea is overwhelming. He calls his clinic and gets the lunch hour voicemail: "If this is an emergency, call 911." He tries his anti-nausea medications but can't keep them down. So he drives himself to the emergency department. From there, Mr. Jones is admitted to the hospital, where he remains for 3 days so his doctors can stabilize the effects of his nausea and dehydration—a debilitating conclusion to a life-altering month.
We have seen this happen all too often. We can do better.
Acute hospitalizations are the single largest driver of differences in how doctors care for patients with cancer and account for nearly half of spending on cancer care. Many hospitalizations—like Mr. Jones'—are preventable. And once discharged, a patient is often admitted again: more than one in four patients having cancer treatment are readmitted with 30 days.
The Center for Medicare and Medicaid Services (CMS) recently proposed a new measure that seeks to reduce hospitalizations for cancer patients getting chemotherapy. In short, if a patient receiving chemotherapy is hospitalized for one of 10 conditions (including nausea and fever) within 30 days of treatment, the hospital's Medicare reimbursement could suffer. However, no one knows the best approaches to prevent unnecessary hospitalizations.
We published a study today that takes an exhaustive look at ways to reduce unnecessary hospitalizations for patients with cancer. We examined guidelines, demonstration projects, and dozens of studies. Based on our review, we propose five strategies that represent state-of-the-art cancer care.
While these may seem simple and straightforward, health care systems have only recently begun to appreciate how important even small changes can be. Imagine Mr. Jones' care if he had access to text message tools that would have allowed him to report symptoms sooner—and allowed his care team to know he was at higher risk of needing emergency care. With this proactive approach, he could have had access to stronger medications to manage his nausea sooner, dictated by an evidence-based care pathway. And if he still needed emergency care? He could have gone to his oncologist's office if the schedule had spots reserved for such visits—or even an urgent care center with particular expertise in treating cancer patients—rather than the general emergency department.
In short, the cancer care system could have anticipated Mr. Jones' needs more effectively. This isn't just about reducing unnecessary hospitalizations—it's about listening to our patients, trying to foresee their needs, and making what is inevitably a difficult period a little more tolerable.