Telephone-based support programs are capable of reducing cancer-related medical costs by 10% to 30%, according to results of the first nurse-led study of the cost impact of telephonic case management in oncology (Wu C, et al. J Oncol Pract. 2014;10:178-186). This cancer support program was offered to self-insured employers with 3000 or more employees. Patients with cancer could choose to participate in the program or not.
The goals of the program were to help patients understand their treatment goals, whether palliative or curative, and to facilitate informed decision-making about treatment; to reduce emergency department visits and hospitalizations; and to enhance the effective management of symptoms, complications, and adverse effects.
Nurses assisted patients with navigating the healthcare system and provided referrals to specialists as needed. Nurses took an active role in managing costs by reviewing medications and comparing them with evidence-based standards.
The investigators compared outcomes in 3991 patients with cancer who chose to participate in the program and 4842 patients who did not participate.
Study Results The average cancer-related medical costs were 9.8% lower over 6 months of follow-up in patients with cancer who participated in the program than in those who did not participate (P <.01), with 57.8% of the savings attributable to lower inpatient costs, 32.2% attributable to reduced chemotherapy use, and 5.4% attributable to fewer nonchemotherapy-infused drugs.
The mean cancer-related medical costs over 6 months per patient per month (PPPM) were lower in survivors who received active treatment and participated in the program ($10,363) compared with those who did not ($11,491). Similarly, the mean medical costs PPPM were lower among patients who participated in the program but did not receive active treatment ($1306) compared with those who did not participate in the program ($1448; P = .002).
The mean cancer-related medical costs were 28.2% lower for decedents in the last month of life if they had participated in the program ($14,684) than for those who did not participate in the program ($20,713; P <.01), with 81.3% of the cost-savings attributable to reduced inpatient costs, 9.8% attributable to reduced radiation therapy, and 5% attributable to less surgery.
Patients who participated in this telephonic support program spent more days in hospice in the last month of life than those who did not participate (16.4 days vs 12.8 days, respectively; P = .04).
Betty Ferrell, RN, PhD, MA, Director and Professor, Division of Nursing Research and Education, City of Hope, Duarte, CA, who was not involved with the study, said that this study is “significant” and adds to the growing body of evidence that telephone-based cancer support can reduce costs and can increase the use of palliative care. “One of the significant things about this paper is that it was in a large group of people,” Dr Ferrell said.
She said that in a true cost-benefit analysis, the researchers would have tallied up the costs of running the telephone-based support, but she had no doubt that the program was cost-effective. “The investigators didn’t provide the length of the phone calls and the minutes of nursing time, which you would need to figure out how much time the nurses spent on average with each patient to put a price tag on the program, but I think even though they didn’t go into the cost of the program, [telephone-based care] is not very costly,” Dr Ferrell said.
According to Dr Ferrell, oncology care has to keep moving toward providing cancer support programs at the beginning of cancer treatments to keep patients out of the emergency department and reduce hospitalizations. “We have abundant data that says that if people don’t have good effective management, they will be rehospitalized,” she said. “We can’t be reactionary anymore, or we will go broke.”
