Post COVID-19: more than oncology. Better oncology!

Valuing value-based healthcare: the oncologist's perspective

Value in healthcare is a broad concept, too commonly intended as ‘another’ declination of cost-effectiveness. With the pandemic spread of COVID19, all the countries in the world have faced the struggle to make choices in healthcare: an unusual exercise of priority- setting for usually resource-rich settings.

The implementation of public health measures to tackle the pandemic has soon touched the cancer services. People with cancer have been promptly identified as possible more vulnerable to both COVID19 itself and exposed to more vulnerability from the (temporary?) withdrawn of health services.

While priority-setting has become the leitmotiv for decision-makers, it is unsure whether a value-driven approach has been universally implemented. However, can we estimate the value of all the established cancer interventions, to inform quality prioritization exercises?

Several studies have reported temporary withdrawn of valuable cancer services – but the lack of robust mechanisms to estimate the value of and rank the health interventions has not always resulted in valuable decisions – nor clearly disclosed. Although only few health modelling efforts for cancer were provided, this has not prevented drastic decisions in oncology, portending tangible harms.

While not deliberate, the consequences on the population health are often irreversible, portrayed across the entire cancer continuum. Some decisions have dusted off inveterate prejudices about cancer control, low knowledge of the value of the interventions and poor inclusiveness in the decision-making processes.

The need to protect vulnerable persons has generated the paradox of profound gaps in cancer control efforts: three-quarter of the countries in the world have reported disruptions in non-communicable diseases services.

The number of new diagnoses of cancer has dropped up to 90%, with pervasive discontinuities in cancer treatments, resulting in an estimated increase of the cancer mortality of 4-16% in 5 years. Definitely a predictable consequence of the pandemic itself, unsure in what proportion avoidable, perhaps evolved in the pabulum of the hard decisions of the emergency state through (mostly) short-term health planning.

Therefore, how valuable is value in healthcare?

High-value health interventions are impactful by delivering durable and sustainable population health, societal and economic benefits. Value is about contest-appropriateness, intrinsic value, explicit magnitude of benefit and robust evidence: science is the fundament of impact, the synolon of value – but the value manifests through implementation efforts.

The pragmaticism for implementation functions as a Demiurge who functionalizes the notions, fertilizing the black matter between theoretical modelling and the status quo. Without health delivery – primarily a planning+ logistic+ implementation concept, all the notions will be exposed and never utilized: an inflexible idealism in Valpinçon.

Largely invoked for effective cancer control in low- and middle-income countries, the value-driven health planning has emerged as the health priority in the pandemic era, ubiquitously. As a unison, chief oncology Societies have urged to prioritize the interventions with significant intrinsic impact on the health-related outcomes, namely quality of life and survival, enforcing the preeminent role of the supportive and palliative care, and addressing the healthcare utilization patterns.

Deciding between oral and intravenous treatments, weekly or monthly schedules, pre-surgical or post-surgical therapies, standard or modified fractionation for radiotherapy, one-time surgeries, have all been framed in a broader perspective of public health utility: one serves one patient and all people, together.

A pragmatical lesson of valuable healthcare delivery, cognizant of the health impact of the models and patterns of healthcare delivery. A post-pandemic oncology can only be viewed as a valued-driven, equitable and impactful on the population health – (re)designed to align entirely with sustainable impactful objectives.

It is about being cognizant and conscientious, integrative, and inclusive, comprehensive, and multidisciplinary. An era for syncretic multiple stakeholders.

The pandemic has showed how challenging can be to withdrawn cancer services, and why value should be the focus for all decisions. Although carefully, multiple Societies have showed that some practices in oncology can be safely omitted, without tangible effects and, vice versa, some other are just essential. Such a value-oriented exercise generated possible frameworks for decision-making to complement or inform the development of benefit packages in the pandemic era – the core for post-pandemic ‘built-better’ oncology.

When envisioning the post-pandemic perspectives, one should not imagine an apocalyptic saga, rushing to restore the pre-pandemic situation at all costs: post-pandemic era is not the time for a revolution. The choice to build better is in our hands: to enhance value in all the healthcare, boost healthcare resilience, value the care of the entire continuum of population health – tailored around single patients, built to have population impact.

The key to deliver impactfully is to delivery valuably.

Read further! Some reference links to this blog entry

UN News: Impact of COVID-19 on cancer care has been ‘profound’, warns UN health agency: Click here

WHO/EURO Statement – Catastrophic impact of COVID-19 on cancer care: Click here

The Lancet Oncology: Valuing all lives equally: cancer surgery, COVID-19, and the NHS in crisis: Click here

The Lancet Oncology: The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study: Click here

ESMO: Cancer patient management during the COVID-19 Pandemic: Click here