Low-touch, team-based care for co-morbidity management in cancer patients: the ONE TEAM randomized controlled trial

Abstract

Background As treatments for cancer have improved, more people are surviving cancer. However, compared to people without a history of cancer, cancer survivors are more likely to die of cardiovascular disease (CVD). Increased risk for CVD-related mortality among cancer survivors is partially due to lack of medication adherence and problems that exist in care coordination between cancer specialists, primary care physicians, and cardiologists. Methods/Design The Onco-primary care networking to support TEAM-based care (ONE TEAM) study is an 18-month cluster-randomized controlled trial with clustering at the primary care clinic level. ONE TEAM compares the provision of the iGuide intervention to patients and primary care providers versus an education-only control. For phase 1, at the patient level, the intervention includes video vignettes and a live webinar; provider-level interventions include electronic health records-based communication and case-based webinars. Participants will be enrolled from across North Carolina one of their first visits with a cancer specialist (e.g., surgeon, radiation or medical oncologist). We use a sequential multiple assignment randomized trial (SMART) design. Outcomes (measured at the patient level) will include Healthcare Effectiveness Data and Information Set (HEDIS) quality measures of management of three CVD comorbidities using laboratory testing (glycated hemoglobin [A1c], lipid profile) and blood pressure measurements; (2) medication adherence assessed pharmacy refill data using Proportion of Days Covered (PDC); and (3) patient-provider communication (Patient-Centered Communication in Cancer Care, PCC-Ca-36). Primary care clinics in the intervention arm will be considered non-responders if 90% or more of their participating patients do not meet the modified HEDIS quality metrics at the 6-month measurement, assessed once the first enrollee from each practice reaches the 12-month mark. Non-responders will be re-randomized to either continue to receive the iGuide 1 intervention, or to receive the iGuide 2 intervention, which includes tailored videos for participants and specialist consults with primary care providers. Discussion As the population of cancer survivors grows, ONE TEAM will contribute to closing the CVD outcomes gap among cancer survivors by optimizing and integrating cancer care and primary care teams. ONE TEAM is designed so that it will be possible for others to emulate and implement at scale. Trial registration This study (NCT04258813) was registered in clinicaltrals.gov on February 6, 2020.

Use of Cancer Survivorship Care Guidelines by Primary Care Providers in the United States

“…34,35 Other team-based approaches that integrate PCPs into the oncology care team using scalable, less resource intensive methods may be another promising approach. 36 Health information technology might help support PCPs in providing survivorship care. [37][38][39][40] Welldesigned clinical decision support tools integrated into electronic health records (EHR) could provide a summary to PCPs of the patient's cancer diagnosis, and alert PCPs on recommendations for survivorship care based on current guidelines.…”

Cardiometabolic Comorbidities in Cancer Survivors

“…It is our goal to engage PCPs in the management of pre-existing cardiometabolic comorbidities for their patients during cancer therapy. 154 Enhancing PCP engagement early in the trajectory will provide the oncology team more time to focus on their area of expertise—achieving a durable cure for the patient. It will also familiarize the PCP with the patient’s cancer journey and hopefully improve the subsequent transition to survivorship health care.…”

A new phase of the Cancer Moonshot to end cancer as we know it

“…For patients transitioning to primary care, managing non-cancer-related comorbidities is critical. The ONE TEAM study is looking at delivery of survivorship care through coordinating care with primary care physicians and encouraging patients’ adherence to non-cancer medications 15 . Another group is testing a telehealth self-management intervention that provides coaching for patients on follow-up care after treatments for lung and colorectal cancer, which can improve knowledge and confidence, communication with cancer care and primary care doctors, and quality of life.…”