Premier, AstraZeneca and Healthcare Providers Collaborate to Optimize Care for Cancer Patients

Approximately 2 million new cancer cases are expected to be diagnosed in the U.S. this year. (1) It is also estimated that there will be 611,720 deaths from cancer – more than 1,600 deaths per day. (1) (Table 1)

Table 1. New cases and deaths in the U.S. (ACS 2024) (1)

While advances in diagnostics and therapeutics have helped to rapidly evolve evidence-based cancer care, clinical decision-making for cancer care has become increasingly complex for providers.

Premier Applied Sciences (PAS) conducted research with AstraZeneca and with health professionals in oncology, radiology, nursing, care coordination and pharmacy to look at current trends and care gaps for managing patients with five main cancer types: non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), ovarian cancer, breast cancer and chronic lymphocytic leukemia (CLL). 

The project’s aim was to gather insights from subject matter experts on:

• Facilitators and barriers to guideline-concordant care.
• Methods to better identify individuals with cancer using natural language processing (NLP).
• Resources to promote guideline-driven monitoring and management of cancer.
• A custom intervention platform (CIP) dashboard to help providers track and monitor changes in care.

Premier’s collaboration with AstraZeneca highlights our dedication to exploring and adopting innovative methods to enhance optimization and adherence to guideline-recommended care for patients with cancer.

To understand the barriers and challenges in treating and managing patients with these cancers, we worked with providers and other professionals at two health systems (including oncologists, genetic counselors, prior authorization team members, nurse navigators, pathologists and pharmacists) to gather quantitative and qualitative data for guideline-concordant care, using the National Comprehensive Cancer Network (NCCN) guidelines as a reference.

Methods

Quantitative Data

The team developed queries to collect quantitative data and run anonymized, aggregated reports of de-identified data for meaningful measure calculation and care gap identification. Data were obtained from unstructured clinical documents (clinical notes and reports) using NLP and supplemented with structured data. NLP uses computer science, artificial intelligence (AI) and computational linguistics to process and analyze unstructured text data.2 In electronic health records (EHR), NLP can be used to aggregate, analyze and summarize information from patient notes, discharge summaries and other open-text fields.

Quality measures were designed and calculated to help investigate guideline care. The results were shared in aggregate with providers and at the patient level in Premier’s proprietary CIP dashboard. The CIP is an interactive, web-based tool that enabled Premier and IDN sites to capture and measure documentation of patient care and compare to guidelines.

For this project, metrics included patient demographics, patient risk factors, treatment initiation or changes, and imaging or follow-ups scheduled. Analyzing the resulting data helped to shed light on treatment barriers and facilitators including variations in diagnostic work-up, highly complex patient cases, patient tolerance of or response to treatment regimens, and report availability from third-party labs.

Qualitative Data

Qualitative data are information and concepts that are not represented by numbers.3 It can be gathered from interviews, open-text survey questions, workflows, notes and other materials or observations. Qualitative data reveals the “why” behind the “what” and can provide deeper insight into what is seen in quantitative data.

For this project, the team used several methods to obtain qualitative data – a real-world evidence council (RWEC) meeting, provider baseline surveys and interviews and peer-to-peer (P2P) calls.

In the RWEC meeting, we talked to nine advisors with significant clinical oncology experience. The group comprised six oncologists, two pharmacy directors and a nurse practitioner. During the meeting, we sought to better understand the patient journey, the role of guidelines and pathways, the challenges in and barriers to treatment and management, and best practices for molecular testing in these patients.

The provider baseline survey and interviews helped measure knowledge, attitudes and beliefs regarding care management of patients with cancer across the care continuum as well as identified gaps in current practice and processes.

Premier also conducted P2P calls related to each cancer type. Attendees included providers, nurse navigators and other subject matter experts. In these calls, attendees discussed practice-level gaps, barriers and challenges, and potential solutions and workflows to address. They also reviewed, discussed and tested tools designed to address the gaps, reviewed CIP measures and patient data, and presented case studies on CIP patients who had non-guideline concordant care.

Insights gained from the qualitative research revealed that each patient’s journey with cancer presents unique characteristics and challenges that need a tailored approach for interventions. Common challenges include biomarker testing, barriers to drug access due to insurance authorizations and reimbursement issues, and care coordination.

Next Steps

Gathering and analyzing data helps to identify trends, barriers and challenges in patient care, but it is only the first step to create change in practice. With the qualitative and quantitative findings, the team built potential solutions for each cancer type to address gaps for providers and health systems. From the gaps that were identified, we organized a primary and secondary driver diagram that outlines key components to address the care management of each cancer type.

The key drivers frame how health systems can begin to gather leaders, operational staff and service line leaders. Together, these experts can help develop and implement a customized plan to engage the patient population based on NCCN guidelines and the real-world practice that we gathered from SMEs, providers, surveys and CIP data.

In the next posts in this series, we will explore the areas of opportunity in assessment and care coordination – in presentation, additional work-up and biomarker testing – and in treatment. We’ll also present the resources we developed and tested with providers to address these areas and to help them better manage these patient populations.

Want to learn more? Contact Misty Anderson for additional information on this project and Diane Loughlin if you are interested in getting involved with future research studies.

Authors:

Misty Anderson, MBAHM, BSN, RN, LSSMBB, oversees the Improvement Science team of Premier Applied Sciences (PAS). She is responsible for building standards that support evidence-based review, qualitative analysis, research and quality methods, content management and training for new and existing customers within PAS.

Cate Polacek, MLIS, CMPP, ELS, is a Senior Medical Writer on the Applied Research team within PAS. She provides writing, editing, academic research and publication services across PAS. She writes journal articles, patient and provider education, white papers, study protocols, literature reviews and qualitative analyses for all major therapeutic areas.

Nicholas Travis, MSN, BSN, RN, FNP-C, is a Manager of Content Generation on the PAS Improvement Science team. He develops tools, resources and other clinical content to support various projects. He creates frameworks, care pathways, webinar presentations, clinical support tools, patient and provider facing materials, and other clinical content for projects.

Erika Klump, MS, is the Technical Product Director on the Data, Technology and Innovation team of PAS. She works with research teams, health care systems, engineers and informaticists to ensure PAS projects have the structured or unstructured data and technology needed for project objectives.

Erica Robichaud, PT, DPT, MHA, is the Project Owner and Director on the Improvement Science team. She is responsible for overseeing the project, ensuring the quality and timeliness of deliverables and maintaining customer services. Her collaboration with the team, sites, providers and subject matter experts is key to the successful execution and completion of the project.

Andrew Long is an Analytics Developer on the Data, Technology, and Innovation team of PAS. He works to develop data pipelines integrating structured and unstructured data. He informs and implements data validation and optimization strategy for leveraging NLP solutions and supports various other PAS data solutions.

Nancy Rios is a Research Analyst on the Data, Technology, and Innovation team. She collaborates closely with cross-functional teams including research, health care systems and technology experts. Her responsibilities extend to developing and implementing data validation procedures, leveraging natural language processing solutions for data optimization and informing data quality enhancement strategies.

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