Dec 18th 2020

Guiding Cancer Care: Positive Patient Stories

Coping with a cancer diagnosis is not easy for any patient. It’s usually a time of gnawing uncertainty, with consideration of numerous treatment options as well as other emotionally taxing clinical and personal issues. While no one's cancer journey is exactly the same as another's, all patients benefit from caring and expert guidance provided by a team of people invested in improving their care.


Following are some real-life examples of benefits provided by eviCore guiding cancer care.


Juan’s Story


Juan* recently completed chemotherapy and radiation treatment for lung cancer. For his next phase of therapy, Juan’s oncologist provided eviCore a request for the use of an immunotherapy drug. To ensure effectiveness, this treatment requires an imaging procedure to confirm that there is no evidence of disease progression. Upon review of Juan’s case, eviCore’s board-certified medical oncologist found that the imaging procedure had not been performed, and initiated a peer-to-peer consultation with Juan’s oncologist. During the call, the requesting provider indicated that he wanted to start immunotherapy now and wait a couple of months for the CT-scan. The National Comprehensive Cancer Network (NCCN) Guidelines were discussed and Juan’s oncologist agreed to obtain the necessary CT-scan prior to initiating treatment.


A Real Chance for a Positive Outcome


The eviCore medical director assisted Juan's provider by issuing approval for the CT-scan. Unfortunately, the scan revealed a suspicious liver metastasis, and biopsy confirmed metastatic cancer. This meant that immunotherapy was not the optimal treatment choice. The peer-to-peer consultation helped Juan avoid an ineffective treatment, unnecessary cost, and negative side effects. Instead, eviCore's medical director worked with Juan's oncologist to ensure that Juan received the most appropriate evidence-based treatment given his clinical situation and the one that gave him the best chance for a positive outcome.


Some patients benefit greatly from the application of an alternative diagnostic test, which can indicate a substantially different treatment option after an authorization review.


Grace’s Story


Grace* complained of throat pain and difficulty breathing. After seeing her primary doctor and receiving appropriate testing, Grace was diagnosed with head and neck cancer. Her doctor referred her to a radiation oncologist, who submitted a request to eviCore for curative radiation therapy. However, upon review of the clinical information, eviCore’s board-certified radiation oncologist learned that the patient's cancer had spread to multiple parts of her body. Due to the spread of the cancer, eviCore’s oncologist recommended to Grace’s doctor that Grace be treated with chemotherapy instead of radiation. After a collaborative discussion, Grace’s doctor agreed.


Collaboration Fosters the Most Appropriate and Effective Care


As a result, Grace received timely and appropriate treatment while avoiding an unnecessary and lengthy course of radiation therapy and side effects that can include dry mouth, pain, difficulty eating, and weight loss.


When patients receive the tests and treatment options backed by the latest scientific evidence, they can avoid inappropriate, expensive, and potentially unsafe procedures and treatments.


A primary mission of eviCore is to protect patient well-being by making sure their care aligns with the most current evidence-based medical guidelines for cancer care.


*To maintain the patient’s privacy, names and other potentially identifying details have been changed.