Why Receiving Cancer Care Near Home Makes (Dollars and) Sense: RCCA’s Iuliana Shapira, MD, Comments on Major New Study

A new study shows that the benefits of receiving cancer care close to home extend beyond the obvious quality-of-life advantages to a reduced incidence of being hospitalized and lower costs paid by patients. The study, published in the August 1, 2019 issue of the Journal of Clinical Oncology, examined how travel time affected healthcare costs and other factors for more than 23,000 Medicare patients being treated for cancer.1

The study drew on data for people in the southeastern United States who received care from a cancer center affiliated with the University of Alabama at Birmingham (UAB) Cancer Community Network between 2012 and 2015, explains Iuliana Shapira, MD, Chief Medical Officer of Regional Cancer Care Associates, or RCCA, one of the nation’s largest networks of oncology specialists. (Neither Dr. Shapira nor RCCA was involved with the research.)

“The researchers divided those patients into 3 groups – those who traveled an average of 30 minutes or less to their cancer care site, those who generally travel 31 to 60 minutes to receive care, and those who traveled for more than an hour to a cancer care site. They then looked at how travel time affected overall costs, patient out-of-pocket costs, hospitalization rates, and other factors during the initial cancer-treatment period, during the survivorship phase of care, and in the end-of-life phase,” Dr. Shapira notes.

The results, she adds, were striking. “In the initial phase of treatment, the monthly costs for which the patient was responsible were 13% higher for those who traveled more than an hour for care compared to those with 30 minutes or less of travel time. That cost differential increased to 20% in the survivorship phase of care, which typically is the longest phase, although patient costs were comparable in the end-of-life phase,” notes Dr. Shapira, who is a board-certified hematologist and medical oncologist. She adds that the costs Medicare paid went up in parallel with increasing travel time at all stages of care, and that hospitalization rates ranged from 4% to 13% higher across stages of care for those who traveled an hour or more vs. those whose cancer care site was 30 minutes or less from their home.

“Several factors need to be considered when deciding where to receive cancer care,” Dr. Shapira observes. “Having access to the latest, most-effective therapies and to clinical trials is critical as you pursue the best possible outcomes. Many years ago, that often meant having to travel to a major academic medical center in a large city. Patients traded convenience and quality of life for an opportunity to receive cutting-edge treatments that perhaps were not available in the community setting. Fortunately, that no longer is the case.”

Dr. Shapira explains, “As a community-based oncology network, RCCA offers the latest therapies and clinical trials in care centers near the patients’ home. Our medical oncologists and hematologists draw on the training they received at major institutions, make treatment decisions based on the same evidence-based guidelines employed by their colleagues at those institutions, and remain closely linked to the best that academic medicine has to offer through our academic site, the John Theurer Cancer Center at the Hackensack Meridian Health Hackensack University Medical Center. However, speaking as someone who spent most of her career as a cancer researcher and clinician at academic centers, I do believe that patients often are more comfortable with the scale of a community care center, and with the ability to forge relationships with office staff, nurses, physicians, and others who live nearby and who share much in common with the patient and his or her family.”

With 30 care centers in New Jersey, the Maryland/Washington, DC area and Connecticut, RCCA offers ready access and short travel times to patients throughout the region. “Whether you want to get back to your office quickly after a routine visit, or get home without dealing with big-city traffic jams following a chemotherapy session, proximity is an important quality-of-life consideration,” notes Dr. Shapira.

The hematologist-oncologist adds, “The study’s finding that shorter travel time is associated with lower costs and fewer hospitalizations entirely accords with our experience at RCCA. While I can’t speak to the reasons that drove those findings in the study, I know that our value-based approach to providing care yields many efficiencies that large institutions simply can’t offer due to their infrastructure and overhead. Further, our ability to see patients quickly when there is a concern allows us to readily handle issues – such as providing in-office intravenous hydration to a patient who may need that intervention following chemotherapy – that would result in an emergency department visit and perhaps even hospital admission at a major center. Add to that our close working relationships with the patient’s other physicians, and we’re able to offer care that is comprehensive and coordinated, as well as cost-efficient and convenient.”

With more than 80 cancer specialists and 800 staff members at care centers throughout Connecticut, Maryland, New Jersey and the Washington, DC area, RCCA provides care to more than 22,000 new patients and 225,000 established patients each year. It offers those patients immunotherapy, targeted treatment, cell-based therapy, and other cutting-edge treatments and diagnostic modalities, as well as access to clinical trials.

Reference
1. Rocque GB, Williams CP, Miller HD, et al. Impact of travel time on health care costs and resource use by phase of care for older patients with cancer. J Clin Oncol. 2019;37(22):1935-1945.

Hopeful news for cancer patients from Iuliana Shapira, MD, RCCA’s chief medical officer