Self-Management Support in Cancer Care

We have entered an unprecedented era of treatment advancements, novel therapies, and improved survivorship for patients with cancer. Despite these rapid and ongoing advances, the cancer care system lags in comparison to other chronic health conditions around a key component of successful care—self-management support (SMS).¹

Literature identifies several reasons for cancer SMS trailing other conditions, which includes the complexity of cancer and the historically paternalistic treatment paradigm for cancer care. For the latter, this structure centers treatment as an acute occurrence in which providers maintain primary responsibility for disease management through directives to the patient.^1,2 Furthermore, many cancer clinicians often do not have the time or additional coaching skills required to effectively train patients in successful self-management.²

For oncology pharmacists, these factors present an opportunity to aid health care professionals (HCPs) in advancing SMS as a critical component of quality cancer care. Specifically, oncology pharmacists are well placed to assist in promoting positive self-management support for patients with chronic illness and cancer.

Self-Management and Chronic Illness

Self-management for patients with chronic illness has been defined as the process through which individuals can actively cope with their chronic disease in the context of their daily lives.³ Clinical research has shown that self-management can be an effective tool to improve patient outcomes for a range of chronic conditions, such as asthma, diabetes, and arthritis.⁴

Self-management interventions can help engage patients to actively participate in their daily care. These interventions go beyond simply providing information or education, as they additionally help patients learn to employ psychosocial skills and actively engage in their own care.⁵ Patients engaged in SMS experience better health outcomes including quality of life (QOL) measures, such as mood and feelings of wellbeing.⁶

SMS has also been shown to reduce emergency room visits and overall costs for patients with chronic health conditions.⁷ As the US health care system pivots to a value-based model of care, self-management support for patients with chronic illness has become a strategic priority. A wide body of research demonstrates the efficacy of self-management in meeting a triple aim for health care reform: better health, better health care, and better value.⁸

Self-Management and Cancer

In 2005, the Institute of Medicine laid out 6 phases in the cancer care continuum. The phases include prevention, early detection, diagnosis, treatment, survivorship, and end-of-life-care.⁴

However, self-management in the continuum of cancer care has been found to be lagging when compared to SMS for other chronic conditions.¹

This lag has changed in recent years as cancer is increasingly treated as a chronic health condition in which patients, their families, and caregivers participate in the development and execution of personalized cancer care.

Additionally, a growing body of research is demonstrating the efficacy of SMS across the cancer care continuum. One literature review identified a range of positive outcomes attributed to SMS interventions including higher levels of self-care, self-help, and psychosocial adjustment; significant reduction in fatigue, pain, and nausea; decrease in pain intensity scores; fewer hospitalizations; and increased survivorship.²

Promoting Self-Management for Patients With Cancer

Patients with cancer value working with a pharmacist.⁴ Recent polling from Gallup shows Americans’ trust in the pharmacy profession is the highest it has been in a decade.⁹ Working in conjunction with HCPs, the oncology pharmacist has a unique opportunity to leverage that trust to engage patients and deploy SMS interventions that can impact health outcomes and QOL.

Patients value seeing the humanistic qualities of their health care providers and want to be engaged in shared decision making around their own care.¹⁰ For this engagement to occur, the importance of the patient-provider relationship cannot be understated. Research shows that strong patient-provider relationships can impact patient ability to cope, adherence, QOL, and positive beliefs regarding impact of therapy.¹¹

Pharmacists typically participate in the cancer continuum of care during a critical juncture—treatment. Often the first opportunity the pharmacy team has to deploy SMS interventions is around medication access. Under pharmacist supervision, referral and intake specialists provide the resources and support to help patients navigate a fragmented, often confusing health care environment. Specifically, this can include addressing the financial challenges associated with cancer treatment.

“Open communication and patience are key. Patients are understandably overwhelmed when it comes to coordinating access to their cancer treatment,” said Amanda Hasenei, a referral specialist at BioMatrix Specialty Pharmacy. “We acknowledge their emotion and develop goals around their concerns. We use our expertise to help break down barriers to care while actively involving the patient and caregiver wherever possible, so they are better prepared to anticipate and resolve future issues.”

Additionally, oncology-focused pharmacists can deploy medication therapy management (MTM) to help patients navigate the course of their cancer treatment. Embedding SMS interventions as part of the MTM process can help lead to positive health outcomes around key aspects of treatment, including adverse events, treatment adherence, and QOL.

“Successful SMS is about communication, education, empowerment, and ongoing follow-up throughout the patient journey,” said Royce Burruss, MBA, RPh, FASCP, corporate director of clinical services for BioMatrix Specialty Pharmacy. “Providing the right resources and support can help patients effectively manage adverse events, tolerate therapy, and avoid unscheduled higher levels of care.”

There has never been a greater need to promote positive self-management skills for patients with cancer. A shortage of oncology medical professionals, new treatments, longer survivorship, polypharmacy, and site-of-care shifting to the outpatient setting underscores the importance of helping patients develop strong self-management capabilities.

“Effective SMS means fostering collaboration between patient and other health stakeholders including the oncologist,” said Kionna Oleru, PharmD, pharmacy manager at BioMatrix Specialty Pharmacy. “Empowering and assisting patients to overcome the fragmentation that occurs in our health care system helps to alleviate some of the challenges associated with cancer treatment.”

Currently, there are numerous SMS resources, frameworks, and implementation strategies outlined for chronic health conditions in current academic literature. Specialty pharmacies serving patients with cancer should identify opportunities to incorporate SMS throughout the patient journey as a key component of quality, value-based care.

REFERENCES

1. Howell, D., Mayer, D., Fielding, R., Eicher, M., Verdonck-de Leeuw., Johansen C., Soto-Perez-de-Celis, E., Foster, C., Chan, R., Alfano C., Hudson, SV., Jefford, M., Lam, W., Loerzel, V., Pravettoni, G., Rammant, E., Schapira, L., Stein, K. Koczwara, B., Global Partners for Self-Management in Cancer. (2021). Management of cancer and health after the clinic visit: A call to action for self-management in cancer care. Journal of the National Cancer Institute. 2021, 113(5). doi: 10.1093/jnci/djaa083
2. McCorkle, R., Ercolano, E., Lazenby M., Schulman-Green D., Schilling, L., Lorig, K., Wagner, E. (2011). Self-management: Enabling and empowering patients living with cancer as a chronic illness. CA: A Cancer Journal for Clinicians. 61(1) 50-62. https://doi.org/10.3322/caac.20093
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9. Lindhorst, J. (2020). What does excellence in oncology pharmacy look like?. Pharmacy Times. https://www.pharmacytimes.com/view/what-does-excellence-in-oncology-pharmacy-look-like
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