The Argument For Better Patient-Centered Care in Oncology

Amy Berman, RN, BS

After 4 years of living with inflammatory breast cancer, Amy Berman, RN, BS, senior program officer at the John A. Hartford Foundation, said she felt fine during her speech at The American Journal of Managed Care’s Patient-Centered Oncology Care meeting in Baltimore, Maryland.

Although she has Stage IV breast cancer for a type of the disease where the survival rate to 5 years is under 20%, she works full time and continues to have a busy social life.

“And the reason why I am doing well, in part, is because the care is matching my goals and my values,” Ms Berman explained.

While some patients may choose aggressive, costly treatment to the end, she went a different route and decided against a mastectomy and aggressive treatments. Instead, her priority was quality of life. And evidence suggests that her decision will actually make her live longer, she said.

“I’m the walking Triple Aim,” Ms Berman said. “I have better health, I have better care, and I have significantly lower costs.”

In fact, she estimates that she has probably saved approximately $1 million over the past 4 years. The important thing is that her care team has supported her decision and understood what she wanted to get out of her life, Ms Berman explained.

Unfortunately, these are not decisions that most people ever discuss with their providers. Of the 2 oncologists she saw, one was in line with her plan for quality of life, while the other wanted to start the aggressive treatments that she felt would “drive me into the ground.”

Ms Berman called her choice of care the “Niagara Falls trajectory,” wherein she would experience a lot of good days and would get dropped off the cliff at the end. The path of aggressive treatments would do the opposite: drop her off the cliff at the beginning and float her out to the same endpoint.

She decided to forgo the aggressive treatments because she wanted to maximize the good days while minimizing the bad ones. And she has. Over the last 4 years, Ms Berman has jet skied out to Liberty Island and ridden camels in the Jordanian desert.

“The only thing we know in life is where we start and where we end,” she said. “This is the same for everybody. But I had values that said this is the trajectory I am trying to aim for.”