A call to bridge the cancer care – chronic illness management gap

Providing cancer care for someone who also has a chronic illness, such as diabetes or high blood pressure, requires a systematic, co-management approach to produce better cancer and overall health outcomes, said UNC Lineberger Comprehensive Cancer Center’s Samuel Cykert, MD.

Cancer patients with a chronic illness often experience poorer outcomes. This is especially true for Black patients. Contributing to this disparity, studies show, is the increased likelihood that people with chronic illnesses may not be offered standard cancer treatments like surgery, chemotherapy or radiation. If they do start standard treatment, they might not complete it due to complications from their chronic conditions.

In an article published in the ASCO Daily News, Cykert said the lack of direct communication between primary care physicians and oncologists is a significant barrier preventing more collaborative and comprehensive care for patients being treated for cancer and chronic illness.

“It is almost traditional for cancer care and chronic disease management to be siloed and for communication between oncology and primary care to be limited to templated medical notes,” said Cykert, professor of medicine at UNC School of Medicine and co-chair of the Lineberger Equity Council. “There is very little real-time communication to delineate care responsibilities as care progresses and virtually no feedback loops to assure that concerns are addressed between the realms. This problem is exacerbated when cancer care is at an academic center and other care is in a separate system or community.”

Cykert proposed a three-phase approach to improving care management and outcomes:

During diagnosis

Chronic disease management and cancer care must be integrated. One approach is to have automated reminders for chronic care management triggered whenever a complex test, imaging or a medical procedure is ordered. This can help keep the management of chronic conditions a priority.

During treatment

Care teams must clearly define who is responsible for managing chronic illnesses. It is important to closely monitor chronic conditions and promptly address any negative impacts of cancer treatments. Cykert suggests using nurse navigators to facilitate communication between cancer and chronic care teams, ensuring effective care management of a patient’s health issues.

After treatment

Managing chronic illnesses should be a key focus of the post-cancer treatment care plan. Patients should undergo a comprehensive assessment to evaluate the risk for cardiovascular events and determine the need for appropriate treatment. Patients should be advised and encouraged to eat a healthy diet, quit smoking and begin a caregiver-approved exercise program.

“Cancer treatment, especially through advances in precision medicine, often converts an expectation of poor survival into years of high-quality life,” Cykert said. “Why allow this tremendous science and cost to be wasted by undertreating chronic disease and cardiovascular risk, particularly in patients who are more vulnerable?”