Oct 12th 2022

Q&A: eviCore’s Chief Medical Officer of Oncology on the Need for Evidence-Based Cancer Care

We sat down with Dr. Stephen Hamilton, eviCore’s Associate Chief Medical Officer for Oncology Programs, to talk about his team’s efforts to make sure patients get cancer care that’s aligned with the latest medical science. Prior to joining eviCore, Dr. Hamilton was a practicing hematologist/oncologist for over 20 years in a community-based multidisciplinary oncology practice he co-founded in 1997 in a suburb of Oklahoma City. During this time, he also served as a hospice medical director, and as chief of staff for his local community hospital. 

Why is eviCore’s Oncology Solution Important?

A cancer diagnosis is one of the most difficult things a person can face. To give oncology patients the best opportunity for successful diagnosis and treatment, we need to make sure they’re getting care rooted in the latest available medical evidence. Unfortunately, though, research shows that as many as half of cancer treatments (47%) don’t follow the latest scientific recommendations, which means vulnerable patients aren't getting the care best suited to fight their disease. 

It’s also important for oncology patients to get the right testing – things like imaging, lab testing and surgical testing like biopsies – to help inform the treatment approach and to monitor them during and after treatment.

What our team does is evaluate requests for certain cancer care services like diagnostic testing and treatments like chemotherapy and radiation against evidence-based medical guidelines and provide clinical decision support to providers to make sure patients get the best cancer treatment plan to meet their specific needs.

What Happens When Patients Get Cancer Treatment That’s Not Aligned With The Current Medical Science?

The short answer is that when cancer care isn’t aligned with the current medical science, it can be ineffective; it may cause more health problems for the patient; and it’s costlier for everybody. 

For example, for patients with early-stage breast cancer, research has shown over and over again that a shorter course of radiation (22 days) works just as well as a longer course (35 days). Having the shorter course saves patients from additional radiation exposure, pain, inconvenience, and higher costs. The American Society for Radiation Oncology endorsed the shorter course of treatment, which is called hypofractionation, way back in 2011. This seems like something that should be done for every patient in this situation, right? Yet, the truth is that only half of eligible patients receive hypofractionation. We’re working to change that for the patients we work with.

Another example comes from the world of genomic testing. There’s a form of genomic testing called molecular profiling that can confirm the presence of specific cancer tumor gene mutations that are best treated with more targeted therapies. Sadly, up to 30% of advanced non-small cell lung cancer patients don’t get the most effective treatment because they didn’t get molecular profiling.  Again, this is a place where we’re helping guide physicians toward this testing so their patients can get the best type of treatment for their cancer.

Hovering over all of this is the fact that the cost of cancer care is high and rising, which impacts patients through higher deductibles and copays, increased cost shifting, and growing premiums. According to the CDC, a quarter of cancer survivors reported material financial hardship (e.g., problems paying medical bills), and more than one-third reported psychological financial hardship (e.g., worry about medical bills). Among minority racial and ethnic groups, the percentage of survivors who reported experiencing material or psychological financial hardship was even higher.  We should be doing everything we can to help cancer patients get cutting-edge care that’s more affordable. 

Doesn’t The Doctor Know What Care is Needed For Their Patient? 

There are a couple of issues that we’re trying to help address. First, medical knowledge is exploding so fast that it’s impossible for providers to keep up with all the new information. For example, in 2018 alone, the National Comprehensive Cancer Network made over 150 updates to their published cancer guidelines and compendia.  The number of evidence-based medical journals and resources alone is increasing to a point where, one oncologist wrote, it would take more than 627 hours a month – about 21 hours a day – of reading to keep pace. That creates knowledge gaps for every physician, which we’re helping fill by using our evidence-based clinical guidelines to help ensure cancer care that’s in line with current science and medical best practices.

At the same time, most cancer patients are treated by a community oncologist rather than an oncologist with more deep and focused expertise. eviCore can connect community oncologists with cancer subspecialty experts to review a patient’s treatment and ensure it’s appropriate for their diagnosis. In a recent pilot program, 40% of patients benefited from recommendations for alternative tests and therapy choices provided to their community oncologist by an expert.

How Are Your Evidence-Based Guidelines Developed?

Our guidelines are from the National Comprehensive Cancer Network, a not-for-profit alliance of 32 leading U.S. cancer centers, as well as medical societies like the American Society of Radiation Oncology. The guidelines also incorporate recently published, peer-reviewed medical studies. They’re compiled by physicians who are appropriately specialized and reviewed by external experts. Guidelines are updated at least twice a year and are available to anyone visiting eviCore’s website.

Over time, eviCore actually helps increase providers’ adherence to evidence-based guidelines. For example, after just one year partnering with eviCore, providers’ average adherence to National Comprehensive Cancer Network guidelines for medical oncology drug management went from 75% to 88% across four health plans.

Does eviCore Do Anything To Support Access To Clinical Trials?

Yes! Another advantage we provide for patients is that we help make their doctor aware of available clinical trials. When their doctor reaches out to us to make a request about the patient’s care, we automatically display to them the available clinical trials the patient may be eligible for. We can also review drug treatment clinical trial requests. While health plans can sometimes take 2-3 weeks for this process, eviCore usually takes less than one day, and for clinical trials that have been previously approved for other patients, auto-approval can be granted immediately when the provider accepts eviCore’s prepopulated standard of care and experimental drug list.

How Are You Making Sure Patients Get Evidence-Based Cancer Care Quickly?

Our portal leads oncologists to treatment plans that are immediately approved in as little as four minutes. If a treating oncologist wants to request a customized treatment plan for their patient, we’ll work with them to ensure the plan adheres to National Comprehensive Cancer Network guidance, which we know improves patient outcomes. 

During cancer treatments, we’ll also pre-approve services like imaging or lab tests that the patient will need in the future, so their doctor doesn’t have to provide any additional information and the patient can get faster, easier access to care.

You can learn more about eviCore’s Comprehensive Medical Oncology solution on our website.

____________________________________________________________________________

Sources:

J Oncol Pract. 2015 Jul;11(4):338-43. doi: 10.1200/JOP.2014.002717. Epub 2015 Jun 9

2022 ASCO Poster presented by eviCore

Ekwueme DU, Zhao J, Rim SH, et al. Annual Out-of-Pocket Expenditures and Financial Hardship Among Cancer Survivors Aged 18–64 Years — United States, 2011–2016. MMWR Morb Mortal Wkly Rep 2019;68:494–499. DOI: http://dx.doi.org/10.15585/mmwr.mm6822a2external icon.

Rausa, M., Spangler, D., Hamilton, S., Gratias, E. Use of Clinical Decision Support and Peer Review to Increase NCCN Guideline Adherence. Journal of Clinical Pathways. Jan/Feb 2020. https://www.hmpgloballearningnetwork.com/site/jcp/article/use-clinical-decision-support-and-peer-review-increase-nccn-guideline-adherence 

Rausa, M., Spangler, D., Hamilton, S., Gratias, E. Use of Clinical Decision Support and Peer Review to Increase NCCN Guideline Adherence. Journal of Clinical Pathways. Jan/Feb 2020. https://www.hmpgloballearningnetwork.com/site/jcp/article/use-clinical-decision-support-and-peer-review-increase-nccn-guideline-adherence