Opinion
Video
Aligning Care: Team-Based Approaches and Patient Values
Panelists discuss how multidisciplinary care for refractory metastatic colorectal cancer involves collaborative decision-making through tumor boards, specialized oral oncology pharmacists for financial assistance and patient support, transitions of care teams, and independent pharmacist-patient conversations that often reveal concerns patients won't share with prescribers, while emphasizing that balancing survival extension with quality of life requires understanding individual patient desires and life goals, incorporating patient values into treatment decisions by assessing their tolerance for side effects and supportive care burden, and recognizing that what's clinically meaningful to providers may differ significantly from what matters most to each individual patient.
Effective multidisciplinary care for patients with refractory metastatic colorectal cancer requires comprehensive team collaboration involving oncologists, advanced practice providers, pharmacists, and specialized support staff. The pharmacy team plays a crucial role through collaborative decision-making on dosing, scheduling, and supportive care medications, often participating in tumor board meetings to optimize patient management. Specialized pharmacy services include dedicated oral oncology pharmacists who focus exclusively on oral anticancer drugs, handling financial toxicity issues through patient assistance and copay programs, and providing ongoing virtual support for side effect management. Transitions of care pharmacy teams ensure seamless medication management for patients moving between inpatient and outpatient settings, while independent pharmacist-patient conversations often reveal concerns patients may not share with prescribers.
Balancing survival extension with quality of life represents one of the most challenging aspects of late-line therapy decision-making, particularly for compromised patients experiencing treatment-related toxicities or age-related fitness concerns. This balance becomes critical during shared decision-making discussions, especially when patients are struggling with previous treatment effects like neuropathy or diarrhea. Clinicians must move beyond median survival statistics to provide personalized context that patients can understand, acknowledging that standard clinical metrics may not align with individual patient priorities. The decision-making process often involves considering clinical trials as alternative options, requiring extensive discussions about multiple treatment pathways and their respective benefits and burdens.
Systematic incorporation of patient values and preferences into treatment decisions requires understanding individual patient goals, desires, and specific life events they hope to achieve. What constitutes clinically meaningful benefit varies significantly between providers and patients, making personalized assessment essential. Pharmacists contribute to this process by explicitly discussing acceptable side effect profiles and evaluating whether available treatments can meet patient expectations over the next 3-6 months. This includes assessing willingness to accept additional supportive care medications and increased pill burden to maintain quality of life on treatment. The fundamental principle underlying all decisions is focusing on the individual patient's needs and capabilities, with realistic expectation-setting that avoids overwhelming patients while ensuring they understand their treatment options and limitations.
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