Prioritizing Patient-Centered Care in a World of Increasingly Advanced Technologies and Disconnected Care

Abstract

With more treatment options in oncology lead to better outcomes and more favorable side effect profiles, patients are living longer — with higher quality of life — than ever, with a growing survivor population. As the needs of patients and providers evolve, and technology advances, cancer care is subject to change. This review explores the myriad of changes in the current oncology landscape with a focus on the patient perspective and patient-centered care.

Introduction

The field of oncology is rapidly expanding. There are more treatment options, many of which demonstrate better outcomes and more favorable side effect profiles for individuals diagnosed with cancer.^1–5 Oncology care teams are larger, consisting of multidisciplinary care teams including diagnostic, therapeutic, and supportive services.⁶ Care delivery itself is more convenient, with telehealth appointments,^7–12 increased outpatient services, and chemotherapy at home.^13–16 Patients are living longer — with higher quality of life — than ever, with a growing survivor population.^17,18

But along with these promising changes, there are new tensions. Despite greater demand for oncologists, the number of independent oncology practices are declining while healthcare systems, hospitals and larger conglomerate practices proliferate and predominate.^19–22 Artificial intelligence-based technology is advancing all aspects of cancer care but has understandably generated concerns around ethics, privacy, and confidentiality.^23–25 As treatments advance and costs go up, the risk of financial toxicity increases—leading to access, and affordability barriers for patients and families.^26–30

As the needs of patients and providers evolve, and technology advances, cancer care is subject to change. These changes should be fully explored for providers to be equipped as necessary and for patients to seek full benefit. Special attention should be devoted to vulnerable populations who may suffer care disparities and heightened barriers. Hence, this review explores the myriad of changes in the current oncology landscape with a focus on the patient perspective.

Treatment

Treatment advances via targeted agents, immunotherapy, and ablative technologies have allowed cancer treatment to be customized to patient anatomy and tumor characteristics for truly personalized medicine. These advances provide precise and tailored treatment, but also escalate costs and the need for sub-specialized care, advanced technologies, and testing. Here we discuss the most widely used recent advances from a patient-centered lens.

Advanced Radiation Technologies

Leading advancements in radiation, current and next generation technologies including FLASH radiotherapy and MRI-guided linear accelerators, provide opportunities to improve the therapeutic ratio as evident by preclinical work and early clinical trials.^4,5,31 However, facility investments, overhead costs, and machine upgrades to support these novel therapies are out of reach for most treatment centers. Even access to particle therapies, e.g., carbon ion and protons (with a more robust, longer-standing body of research to support their use) are geographically limited and have been restricted by high costs^2,3,32. Like any other technology, new treatment models are at the mercy of the free market, which inherently determines their sustainability and is constantly changing in response to key variables and players including private equity and company bankruptcy.^33–35 Additionally, patient awareness and knowledge may limit their ability advocate for themselves to seek second opinions or prioritize travel to centers with advanced technology capacities. While patients may learn of advanced technologies in varying degree of detail via providers, support groups, and personal research, the access is not uniform; their adoption can differ based on insurance type, socioeconomic status, age, and race.³⁶

Immunotherapy

The fundamental principles of immunotherapy were first explored in the 19^th century by Dr. William Coley, who unethically infected patients with cancer with bacteria but successfully achieved remission.³⁷ Decades later, cytokines were posited as key players in antitumor immune responses, leading to the use of high-dose IL-2 for some patients with renal cell carcinoma.³⁷ More recently, checkpoint inhibitors have come into focus—particularly CTLA-4 and PD-1. Both of these T-cell receptors naturally suppress the immune system, when blocked, the immune system is upregulated and attacks tumor cells.³⁷ To optimize immune responses, and yield even higher remission rates for patients, researchers have begun exploring combination immunotherapy.^1,37 Adding Nivolumab (a PD-1 inhibitor) and Ipilimumab (a CTLA-4 inhibitor) yielded a higher progression-free survival (11.5 vs. 2.9 months) for metastatic melanoma patients over Ipilimumab.³⁸

But immunotherapy is a double-edged sword; the upregulation of a patient’s immune system can also induce an inflammatory response against normal tissue.³⁷ Pneumonitis, thyroiditis, and colitis are common immune-related adverse events³⁷ and combination therapy doubled adverse events from therapy on the Ipi/Nivo trial.³⁸ Similarly, patients treated with radiation-immunotherapy are also more likely to develop radiation pneumonitis leading to a research paradigm to improve outcomes and to more effectively integrate this tool into the oncology arsenal.^39–41 Lastly, costs of ongoing therapy from immunotherapy can create significant access barriers for patients.

Care Delivery

The modes of cancer care are adapting to patients’ need with increased accessibility, convenience, and a better focus on symptom management. Patients now have multidisciplinary care teams, allowing for specially trained healthcare professionals to address varying aspects of their care. Cancer care has also expanded past acute treatment of cancer and now involves care of cancer survivors, enabling addressment of survivors’ emotional and physical needs.

Multidisciplinary Teams

Multidisciplinary teams (MDTs) have been considered a key component of high-quality cancer care since the late 20^th century. Implementation of a multidisciplinary team optimizes medical opinion, reduces bias, and, when executed correctly, can generate a collaborative environment to thoroughly address patients’ quality of life, symptom burden, and health-related social needs.^6,42 More importantly, MDTs have been shown to improve patient outcomes.⁴²

MDT composition varies greatly depending on cancer subtype. As an example, perhaps the most extensive are teams for patients with head and neck cancers given their complex treatment plans, high psychological, social, and physical symptom burdens, and long-term functional deficits as a result of acute and long-term side effects from radiation and/or surgery. Individuals with head and neck cancers often suffer from dysphagia, pain, and fatigue leading to reduced quality of life and malnutrition.⁴³ As a result, their care teams are large to include speech and language pathologists, dietitians, physiotherapists, dentists, prosthodontists, nurses, advanced practice providers, social workers, surgeons, anesthesiologists, pathologists, radiation oncologists, medical physicists, medical dosimetrists, radiation therapists, medical oncologists, pain medicine, and palliative care.⁴² With such large teams, however, there is always growing concern for disconnected care in which patient needs are not communicated effectively or provider responsibly is unclear. One solution may be comprehensive questionnaires that assess patients’ holistic needs, ranging from emotional to spiritual concerns. For example, a study among men surviving prostate cancer revealed that a comprehensive online holistic needs assessment can better clarify patients’ priorities, as opposed to what was assumed or inferred (sometimes wrongly) by providers.⁴⁴

In addition to diverse care teams, protecting the ongoing well-being of team members also benefits patients. Research shows burnout alone is associated with lower patient satisfaction, worse health outcomes and may even increase healthcare costs.⁴⁵ Unfortunately, many cancer-related healthcare professionals suffer high burnout likely from the complexities of care delivery, emotional burdens of cancer care, and high job demands. One study found that areas of job frustration were the highest predictor of burnout, particularly time constraints, lack of administrational support, lack of institutional support of self-care, and poor/inconsistent staffing.⁴⁶ In order for these teams to provide the highest quality cancer care to patients, institutions must support each and all roles. While physician burnout is well-studied, the emotional wellbeing of other team members like radiation therapy technologists (RTTs),^47,48 or medical physicists, is less so.⁴⁹ Research and support should be comprehensive and encompass all MDT members, including their unique stressors, for teamwork to be sustainable.

Telehealth

Since the onset of the COVID-19 pandemic in 2020, telehealth (TH) has been a necessary and widespread component of care delivery. Benefits of virtual appointments are plentiful, including the reduction in travel and related costs, reduced infection risk, less disruption to patient personal and work responsibilities, increased access to specialty care, and speaking to providers from the comfort of home.⁷ However, TH is not without drawbacks—virtual visits may limit provider/patient rapport and preclude standard physical exams.⁷ Cancer survivors have shared fears about providers missing something during video appointments⁸ and providers may have concerns for sustainable reimbursement of TH visits.⁹

Telehealth has also highlighted extant equity and access issues. Patients with internet/data limitations or lacking an internet device altogether were less able to participate in telehealth visits; these gaps are more prevalent in rural and minority populations.^10,50 Elderly patients and patients without prior use of TH were less likely to find telehealth acceptable, which suggests need for more robust and readily available TH education.¹¹ TH access also depends on electric grid and wi-fi network availability and stability, which, even when present, can worsen during natural disasters.¹²

Given the varying benefits and drawbacks of TH, as well as differing patient preferences, in the post-pandemic world, providers often offer telehealth as a limited option or supplement to in-person appointments. Institutional investment in resources for telehealth education and navigation has been variable. Investing in community spaces that already offer free computer use, like public libraries, to fund private areas suitable for telehealth could help bridge the equity gap.⁹ Research may also focus on improving the shortcomings of telehealth, particularly the limited physical examinations, where artificial intelligence or even trained lay health-workers may prove beneficial.

Practice Consolidation

There is a rise in oncology practice consolidation for both medical and radiation oncologists likely due to changing market forces. Despite increases in the number of practicing oncologists in recent years, the numbers of small practices have been declining while the number of large oncology practices has increased.^19,20 One study found that more than half of independent medical oncology practices in 2007 had integrated into a hospital or health system within ten years.²¹

Unfortunately, practice consolidation is associated with higher healthcare costs.²¹ Furthermore, these moves may decrease the amount of closely available providers for patients, which would worsen travel distances and other challenges already experienced by individuals living in more rural areas.⁵¹ This is particularly challenging for patients requiring radiation. More research is needed to investigate the impact of widespread practice consolidation for both providers and patients and how anti-trust enforcement and federal policy may preserve independent clinics.²²

Chemotherapy at Home

Ambulatory chemotherapy (also called chemotherapy at home) is the delivery of chemotherapy within a private residence. Although oral chemotherapy and hormone therapy pills have been used at home for years, home infusion chemotherapy has previously been limited to specific situations with elastomeric pumps without buttons or programming. New at-home chemotherapy paradigms are being developed in response to a shift towards patient-centered care, which also require some degree of sustainability and fiscal responsibility, which is so far encouraging with lower healthcare costs and improved patient access.

To ensure optimal safety, shared-decision making should focus on key elements: patient stability, appropriateness of home infusion, reliable communication in case of emergency, ability to self-care and manage side effects, and proximity to hospital/healthcare setting in case of emergency.⁵² Though a newer form of care delivery, home chemotherapy research is so far hopeful. One study of a small cohort of patients with colon cancer found home chemotherapy was safely administered and the majority of patients felt secure.¹⁴ Another study compared clinic infused IV trastuzumab to subcutaneous trastuzumab administered at home and found the subcutaneous formulation to be non-inferior, preferred by patients, and less expensive.⁵³

While not without safety stops or temperament, home chemotherapy has potential to transform cancer care delivery. Similar to telehealth, acute home-based care offers lower costs, comfort, and convenience, which would certainly be beneficial for patients with logistical challenges (traveling far distances or mobility restrictions), financial considerations (job restraints), or health concerns (high immunocompromised states). Overcoming logistical and financial barriers to broader implementation is a key goal for future patient-centered care.^15,16

Survivorship (from Diagnosis to Death)

According to the National Cancer Institute, an individual is considered a cancer survivor “from the time of diagnosis through the balance of life.”⁵⁴ With increasing cancer prevalence, given the growing aging population, the cancer survivor population is growing⁴³ and estimated to exceed 18 Billion as of 2022.⁵⁵ Many cancer survivors have unique physical and psychosocial needs, which are made worse by fragmented healthcare.¹⁷ Multiple care issues contributing to survivorship challenges including communication (e.g., lack of cost transparency), care delivery (e.g., transitions to primary care physicians managing survivorship care), and lack of information (e.g., guidance on healthy living or reoccurrence risk).¹⁷ Research on optimizing survivorship outcomes is in its nascent phase.⁵⁶

For current patients or survivors in remission, fear of recurrence is common, with a recent meta-analysis revealing almost 3 in 5 patients/survivors experience this fear. Younger people in particular scored higher, suggesting these populations are more likely to have emotional concerns in grappling with a sometimes uncertain future.⁵⁷ Provider teams should address these fears and provide support whenever necessary, including providing and explaining survivorship care plans which may reduce fears.

With advances in treatment for incurable disease, some patients are survivors but live with metastatic disease, often requiring treatment for the remaining portion of their lives. Quality of life in advanced cancer survivors is often neglected as a research focus.⁵⁸ Research studies that do exist have revealed different challenges, including anxiety regarding scans, fear of disease progression or dying, concern about impact on loved ones, and uncertainty about treatment options or outcome.³⁴ Patients with metastatic disease may have disparate needs from interventions;¹⁸ for example, one study found that those living with metastatic disease had higher baseline resilience scores and thus didn’t benefit as much from a stress management intervention. While much of the research to date documents the negative aspects to living with metastatic disease, specific communities like the “Metavivors^™” (metastatic breast cancer community)⁵⁹ and “EGFR Resisters” (patients with epidermal growth factor receptor mutated lung cancer)⁶⁰ groups have galvanized a grassroots, patient-driven mission to prioritize, support, and fund research that focuses on their unique needs.

Cancer therapies are improving outcomes for patients, including patients with metastatic disease. Oncology care teams should be equipped to support patients in all types of survivorship by addressing their emotional and social health as well as their physical health. Research should include strategies to support ongoing anxiety, distress, uncertainty, and/or loss felt by patients living with cancer as a chronic disease.⁶¹

Financial Considerations

Cancer treatments are becoming more expensive, creating significant financial, practical and emotional challenges for patients and their families. Robust solutions are necessary to provide relief, and efforts should scale from the individual provider/care teams to institutional changes.

Financial Toxicity and Navigation

Cancer costs are projected to increase to $246 billion by 2030.⁶² This trend reflects advancing cancer therapies and increasing complexities of care and implicates high risk of financial burden for patients with cancer.⁶³ Financial toxicity refers to the financial, psychological, and sometimes physical distress that patients feel from both direct and indirect cancer treatment costs.²⁶ Financial toxicity has three domains: material (e.g. out of pocket costs), behavioral (e.g. skipping appointments or pills), and psychological (e.g. distress from debt).²⁷ It has been linked to worse clinical outcomes, up to and including higher mortality rates—likely due to quality-of-life issues and compromised cancer care adherence.^28,29,64,65

To support patients with cancer with financial concerns, institutions may invest in financial navigation, often social workers or nurses.^26,30,66 Financial navigators assess patients’ financial risk factors and connect patients with appropriate resources including payment plans, co-payment assistance programs, or optimized health insurance plans.^26,67 Financial toxicity screening should happen early and consistently to allow resources to be tailored to each patients’ individual needs and disease trajectory.⁶⁷

Institutional commitment to reducing affordability barriers can span from the simplistic (offering parking and meal vouches) to more involved: investments in financial navigator staffing,^68,69 optimized appointment consolidation, and incentivizing providers practicing high value care like prescribing bioequivalent generic drugs, consistently using hypofractionated radiation (when appropriate), and offering telehealth when an option.²⁷ Promoting a culture of patient-centered cancer care can also have financial implications. For example, if goals-of-care conversations are initiated at appropriate times, acute hospitalizations towards end of life may potentially be avoided; these hospitalizations may be traumatic and certainly contribute to profound cancer costs.^70–73

Patient Empowerment

Patients have more agency in their cancer care than before given increased access to their medical information and widespread efforts to reject paternalistic medical practices. Instead, providers and care teams are turning towards shared decision making with patients and families, holistic care that cares for the whole person, not just their symptoms, and research that include patients’ own accounts.

Shared Decision-Making

Shared decision-making is when patients and providers “make decisions together with the best available evidence.”⁷⁴ Shared decision-making in oncology is essential given the complexity of treatment paths and sometimes divergent treatment options. If applied well, shared decision-making may improve quality of life, treatment satisfaction, and overall patient education.⁷⁵ Understanding the tradeoffs of symptom burden, financial toxicity, and time toxicity of modern treatment requires effective communication.⁷⁶ To better inform patients in this process, decision aids have been developed including videos, interactive applications, and paper forms; these aids can help clarify patients’ and caregivers’ goals and concerns with treatment.^77,78

Unfortunately, given disparate communication needs and variable time available for clinic interactions, shared decision-making is not always applied equitably.⁷⁹ Research has revealed differences in provider communication, including being less likely to offer referrals to palliative care or to clinical trials for marginalized groups like racial and/or ethnic minorities.^80,81 In one study of patients at end of life, providers even exhibited fewer positive nonverbal cues (such as facing patients when speaking, standing near the patient in exam rooms, or spending adequate time with patients and their families) with Black patients.⁸² Effective communication and building effective trust are crucial in shared decision-making, which empowers patients to be active and engaged agents in their health journeys.

Patient-Reported Outcomes

Patient-reported outcomes (PROs) are patients’ direct assessment of their health status without outside interpretation, often in the form of validated questionnaires.⁸³ Despite increasing efforts to incorporate PROs, they remain under-adopted as primary or secondary outcomes of clinical research studies.⁸⁴ Difficulties implementing widespread use of PROs may include patient barriers like time restraints, inability to recount symptoms, illness hindering capacity to respond, or irrelevance of questions.⁸³ Meanwhile, researcher and provider barriers may include difficulty appropriately interpreting PROs or implementing surveys into their workflows.⁸³

Despite challenges, patient-centered data reporting is important. Studies have demonstrated improved patient-provider communication, heightened patient satisfaction and quality of life, and even increased survival.⁸⁵ Over time, PROs can assist in treatment selection by providing both providers and patients a truer sense of treatment side effects. PROs may also offer a more holistic understanding of the patient experience that is otherwise absent from clinical interaction or documented in trials.⁸⁴

Narrative Medicine

Narrative medicine is an evolving paradigm in modern medicine which has increasingly recognized value to both clinicians and patients. As a clinical practice, narrative medicine involves recognizing, absorbing, interpreting, and applying patients’ illness stories. When applied to patient care, these skills can facilitate empathy, reflection, professionalism, and trust.⁸⁶ Since its inception, narrative medicine has become widely acknowledged, researched, and practiced.^87–89

In the realm of oncology, narrative medicine has unique power to document and explore the lived experiences of patients with cancer. Narrative medicine adds humanism and storytelling that can lead to better connection between providers, patients, and caregiving communities.⁹⁰ Narrative medicine centers the stories of patients in the healthcare setting, allowing for meaningful physician-patient connections and improved patient care.^91,92

With advancing cancer technologies, restricted clinic appointment times, and bureaucratic processes, the emotional needs of patients with cancer may be unmet; however, humanism in medicine or viewing patients as people with rich life experiences, can improve patient perspectives and patient-centered care.⁹³ An emphasis on humanization in medicine has shown to improve patient satisfaction, reduce medical errors, reduce hospital stays, and even optimize healthcare costs.⁹³

Vulnerable and At-risk Populations

A key part of patient-centered care is an awareness (and dedication to the elimination) of the inequities of oncology. Multiple policy statements over time have aimed at focusing attention on gaps in care for vulnerable populations and the need to address specific disparities in cancer prevention, screening, diagnosis, treatment, and survivorship.^94,95 This includes calls to address the social determinants of health (SDoH), and the role of structural racism in healthcare, and the unique needs of sexual and gender diverse patients.^96,97 A focus on access barriers in rural communities has also been highlighted given the large gaps in specialty care available.⁹⁸ As the population of cancer survivors ages in a “silver tsunami”,⁹⁹ the optimal care of the geriatric patient population remains under-addressed as well as patients living with disabilities.¹⁰⁰ An important step in bridging the equity gap is fostering an oncology workforce that reflects the diversity of the patient population. Fostering such an environment requires both recruitment and perhaps more importantly, retention of this diverse workforce.

Technology Advancements

Cancer care is changing in response to advancing technologies, particularly in the realms of artificial intelligence, medical record access, and social media. These changes are allowing for a more connected provider-patient world, as well as more efficient and accurate cancer detection and treatment for patients.

Social Media

Social media is transforming the landscape between health experts and the public; now, many patients can follow their oncologists or cancer centers on online platforms, learn of active clinical trials, and even promote their own patient advocacy work. Providers have opportunities to network virtually, increase their own research traction, and gain exposure to diverse opinion.¹⁰¹ However, social media has also generated concern. There are limited safeguards, if any, for protecting privacy/confidentiality, flagging misinformation or conflict of interests, or reporting online harassment.^101,102 Further, providers may be censored by institutions or reprimanded after the fact if there are breaches of professionalism,^101,103 the thresholds of which may be ambiguous.

A significant benefit of social media is the distillation and circulation of public health information.¹⁰¹ For example, dermatologists can promote skin cancer prevention campaigns, such as wearing sunscreen and avoiding indoor tanning beds.¹⁰⁴ But online information is unfiltered, allowing the spread of false information as well. For example, the Human Papilloma Virus (HPV) vaccine, which is protective against HPV-related cervical, head-and-neck and anal cancers, was one of the top categories for misinformation on media platforms.¹⁰⁵ One analysis found that posts with harmful cancer misinformation was more likely to be shared than those that contained factual information¹⁰⁶. In addition to misinformation, there can be information gaps. One study found disproportionately fewer social media posts about lung and colon cancer compared to breast and prostate,¹⁰⁷ despite lung and colon cancer being the top causes of cancer death in the United States.

Social media users can also vary. Studies have found gender and ethnic differences across platforms,¹⁰⁷ though the reasons are unclear. Understanding target audience may help promote cancer-related social media interventions such as targeted campaigns to improve rates of cancer screening.¹⁰⁷

Accessing Electronic Medical Records

Signed into law in December 2016, the 21^st Century Cures Act addressed patient access to the electronic medical record (EMR).¹⁰⁸ While prior legislation had guaranteed patient access to their health record, the Cures Act in 2016 emphasized a more streamlined approach in which information was available to patients immediately upon being posted to their chart. Although most patients support the immediate release of medical information,¹⁰⁹ it can have consequences, such as a patient learning of their cancer diagnosis or seeing imaging results or lab work concerning for disease progression prior to speaking to their provider.¹¹⁰

Given high intensity and frequency use of EMR communication by patients, oncologists may not be able to communicate with patients in an acceptable response time to address new concerns. Providers may be restricted due to clinic duties or the sheer volume of EMR notifications, as studies have shown higher volume and patient participation in oncology fields when compared to primary care and other specialties.¹¹¹ Effective triage of EMR patient messages may be necessary to reduce provider burden and efficiently address patient issues.¹¹²

Straddling the line of allowing cancer patients convenient access to their health information and protecting patients from distressing clinical updates, without the in-person benefits of compassionate delivery and contextual information, will be difficult. Further investigation and ultimately, sustainable solutions are necessary to address the needs of patients while providing high value, accessible oncology care.

Artificial Intelligence

Artificial intelligence (AI) is quickly advancing the field of oncology by furthering cancer detection screening, tumor classification, prognostication, and identifying tumor biomarkers. However, AI carries privacy, legal and ethical concerns.²³ In general, the breadth and depth applications of AI in oncology have mirrored incidence rates—that is, the more commonly diagnosed cancers (breast, prostate, lung) currently have more real estate.²⁴ Though ultimately, the fields of deep and machine learning will likely grow to better represent all cancer types including more rare tumors where novel solutions may actually be the most useful.

For cancer imaging, AI has the potential to not only help radiologists detect and classify lesions, but uniquely characterize them, by identifying new features or patterns, and monitor them over time, to assess whether masses remain stable or progress.²⁵ In pathology, AI has been found to accurately in determine malignant potential; for instance, AI was more than 90% accurate in identifying malignant histology among breast biopsy H&E slides.¹¹³ Additionally, AI has been able to correctly identify benign or malignant polyps in real-time, which could save patients from unnecessary resection or missed malignancy.^23,25

Building upon preexisting research that uses large datasets collected in the EMR, AI can analyze large amounts of patient health data to better inform medical decision-making. This can include informing risk stratification, which could guide cancer screening recommendations; anticipating treatment complications and emergencies, which could prevent avoidable hospitalizations; and predicting survival and disease reoccurrence, which could help providers effectively escalate or de-escalate care.²⁵ The impacts on cancer care are profound and, if validated, the ease in which this information is produced may ultimately save researchers time, effort, and cost.

In addition to more effective diagnostics, treatment, and surveillance, AI also enables and informs patient-facing tools to facilitate easier health navigation.^114–118 Apps serve different and often multiple functions, including symptom tracking (e.g., My STORI^™ for brain cancer patients¹¹⁴), messaging with provider teams,¹¹⁵ connections to advocacy groups,¹¹⁶ access to health information (e.g., ACS CARES^™ for cancer patients and caregivers),¹¹⁷ and guidance on healthy lifestyles.¹¹⁸ Importantly research has also shown that patients have multiple concerns related to the safety of AI, threats to patient choice, potential increases in healthcare costs, data-source bias, and data security.¹¹⁹ Any large scale implementation of AI informed technology in healthcare needs to be thoroughly vetted from a patient-centered efficacy and ethical standpoint.

Conclusion

Cancer care is adapting to the age of technology. Patients can learn and share health information more easily, and receive the newest cancer therapies, which are more effective and precise. Providers can engage with patients virtually, from telehealth visits to online health apps, and engage globally on social media platforms to promote research or anti-cancer campaigns. Meanwhile, artificial intelligence-based technology is rapidly changing the way cancer can be detected, monitored, and treated.

But new strides in technology also come at an expense: markedly high treatment costs that can have deleterious effects on patients and potentially widen equity gaps. Disparities in treatment access, quality, and outcomes vary across multiple demographics and require solutions at every level to reach health equity.

As cancer care changes, so do the needs of patients with cancer and their families—especially as the numbers of patients and survivors continue to grow. Multi-disciplinary teams should optimize the skillset of each team member to ultimately address physical, emotional, and logistical needs of each patient. Care teams should prioritize shared decision-making, mitigate risks of financial toxicity, identify technology barriers, and approach care from a humanistic perspective, as each patient is a person with unique life experiences that shape their cancer journey.

Practicing truly patient-centered care is the new horizon for oncology. As care becomes more complex, ensuring equitable access and prioritizing the patient experience is the next frontier in improving outcomes.

Table 1:

Cancer Topics and Summary Points.

Cancer Care Topics	Summary
Treatment
Advanced Radiation Technologies	Radiation technology is more precise with less collateral toxicity, but cost and accessibility are still barriers for patients.
Immunotherapy	Immunotherapy has yielded higher survival rates than cytotoxic chemotherapy alone, but has immune-related side effects, ranging from mild to severe. Access is also a barrier for many given cumulative treatment costs.
Care Delivery
Multidisciplinary Teams	Teams of multiple healthcare professionals, ranging from nurse practitioners to case managers, allow for care that can address the multitude of patient needs, including symptom management, treatment toxicities, and health system navigation. Disconnected care is a risk of large teams however.
Telehealth	Telehealth has offered patients safer and more convenient care but has sacrificed standard physical exams and potentially rapport, while also revealing disparities in technology quality, ownership, and usage.
Practice Consolidation	Small independent oncology practices are declining while larger practices, healthcare systems and hospitals are on the rise, changing the scope of and access to care for providers and patients, respectively.
Chemotherapy at Home	Studies have found chemotherapy at home non-inferior, with patients reporting satisfaction with home treatments. Patient safety, education, and drug properties warrant further research.
Survivorship	Cancer survivors are a growing population with special needs, which can be met by care teams as well as other survivors.
Financial Considerations
Financial Toxicity and Navigation	Substantial costs of cancer care negatively impact patients and caregivers, rendering financial toxicity screening, financial navigation, and cost consciousness high priority.
Patient Empowerment
Shared Decision-Making	In order for patients to be empowered and engaged in their cancer treatment, care teams should strive for shared decision-making, which may require decision aids for patients and anti-bias training for providers.
Patient-Reported Outcomes	Patient-reported outcomes shape research to be more patient-focused, but in practice, the application of patient-reported outcomes has faced hurdles.
Narrative Medicine	The practice of listening to patients’ stories to inform holistic care via narrative medicine can benefit cancer patients and their families.
Vulnerable and At-risk Populations	Vulnerable populations (racial, ethnic, gender/sexuality minorities, people with disabilities, and geriatric groups) face unique challenges with healthcare, which should be addressed by care teams.
Technology Advancements
Social Media	Many patients and providers are using social media for health and research purposes, but safety stops are few, allowing misinformation and conflicts of interests to slip through the cracks.
Accessing Electronic Medical Records	Patients can easily access electronic medical records, but information can be distressing and does not guarantee immediate interaction with providers or care teams.
Artificial Intelligence	Artificial intelligence is improving cancer detection, treatment and surveillance but raises questions about ethics and privacy.