Jun 3, 2024
Rural cancer care lifeline: Improving outcomes by connecting community oncologists to world-class guidance

Keeping up with advancements in medical care and treatments – let alone current guidance and best practices – is a daunting and growing task for any health care provider.

Less than 10 years ago, for example, the National Comprehensive Cancer Network (NCCN) – an alliance of over 30 leading cancer centers with expert panels for more than 50 types of cancer plus their subtypes – provided 20 to 30 pages of guidelines for breast cancer treatments. Today, each of the NCCN’s cancer treatment guidelines average over 200 pages. That adds up to more than 10,000 pages of information, which is updated almost daily.

Where is the care?

Identifying recommended cancer care is especially challenging for providers who practice in rural communities and have limited access to current cancer guidelines, changes to those guidelines, and any additions. 

While 14% of Americans live in rural areas, the American Society for Clinical Oncologists estimates just 3% of medical oncologists work in those communities.  Compared with suburban and urban areas, rural communities also have fewer gastroenterologists, general surgeons, and radiation oncologists – professions that are integral to colorectal cancer screening and treatment.

Prior authorization data (unpublished) from Evernorth, the health services division of The Cigna Group, shows that rural residents are less likely to be screened for cancer than others. The data also shows that while people living in rural areas are less likely to be diagnosed with cancer, they have higher death rates from cancers that can be prevented or diagnosed earlier through screenings. Additionally, rural Americans are more likely to be diagnosed with later-stage cancers, have poorer cancer outcomes, and have lower survival rates. Shortages of rural health providers and a lack of cancer services may explain some of those disparities.

In 2020, Evernorth’s prior authorization data led to the launch of what is now the Oncology Consult Service. This service includes a collaborative initiative between rural oncologists and oncologists at cancer centers recognized by the National Cancer Institute (NCI). 

A deeper look at data leads to better care

“We noticed that every six months or so, we’d see certain data and diagnoses had a revision come in because treatment wasn’t working,” says Dan Greden, product management senior advisor for Cigna Healthcare product solutions, who helped coordinate and implement the pilot. “It meant more expert help was needed to help these rural providers and patients benefit from a second opinion from oncologists who had access to the most up-to-date data and protocols.”

This was scaled up in 2022 to serve more health plans and uses proprietary technology that lets Cigna Healthcare identify patients recently diagnosed with a complex cancer who are most likely to benefit from a consultative review. Cancer subspecialty experts from NCI-designated cancer centers review patients’ diagnoses and treatment plans – usually in about a week’s time – and recommend the best tests, therapies, or clinical trial opportunities for each patient. Data from the pilot shows that these subspecialty oncologists recommended alternate tests and therapy choices in 40% of the cases they reviewed.

Connecting world-class care to communities

Community oncologists care for most cancer patients, treating all types of cancer and keeping patient care close to home. While they have access to the NCCN guidelines, the review process is manual and inefficient. The volume and complexity of these guidelines make it unrealistic for community oncologists, who are not affiliated with academic medical centers, to know every nuance for each patient they see.

The benefits of the Oncology Consult Service have been positive and continue to grow – not just for Cigna Healthcare patients, but also for rural oncologists. Patients in the pilot received the recommended tests and therapies while staying close to home and their families, in the hands of their trusted community oncologists.

Dr. Stephen Hamilton, associate chief medical officer, Oncology Solutions for Evernorth Health Services, has connected with many rural oncologists who participated in the peer review service. “Their appreciation has come through loud and clear,” he said. “A physician in a rural area of Texas described it as ‘a godsend for a community oncologist like me, here in the middle of nowhere.’ As a physician in Arizona recently shared, ‘At the end of the day, we all want to do the best for our patients.’”

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