The Role of a Functional Clinical Staff in Guiding High-Cost Drug and Novel Technology Decision Making: Experience From a Latin American Oncology Clinic
Author(s)
Juan G. Montoya, MD, Maria F. Mercado, MSc, MD, David Mejía-Zapata, MBA, MSc, PhD, MD.
Fundación Colombiana de Cancerología Clínica Vida, Medellín, Colombia.
Fundación Colombiana de Cancerología Clínica Vida, Medellín, Colombia.
OBJECTIVES: In 2018, FCCCV implemented the Functional Clinical Staff (FCS), a multidisciplinary team that comprehensively evaluates the functional status of cancer patients with progressive disease. This team's purpose is to define the optimal therapeutic approach and determine the clinical appropriateness of high-cost drugs/novel technologies, such as immunotherapy. This research aims to describe the FCS's experience and its impact on decision-making regarding high-cost drugs/novel technologies.
METHODS: This was a retrospective analysis of cases evaluated by the FCS between December 2018 and December 2024. All cancer patients whose oncologists/hemato-oncologists prescribed high-cost drugs/novel technologies due to their clinical characteristics and disease progression were included. The FCS comprises specialists in oncological rehabilitation, clinical oncology, hemato-oncology, palliative care, psychology, nutrition, general support medicine, and pharmaceutical chemistry. The FCS's decision can result in two outcomes: with indication or without indication for the high-cost drug/novel technology proposed by the treating oncologist/hemato-oncologist.
RESULTS: A total of 2148 cases were analyzed. Mean age 60.7 ±13.6 years. Most frequent cancers were breast (30.9%), lung (21.8%) and melanoma (8.1%). Pembrolizumab (15.9%) was the top high-cost drug/novel technology prescribed by specialists. High psychosocial risk was present in 47.9% (825/1721) of patients, and 54.7% (938/1712) had high malnutrition risk. The FCS initiated immediate symptomatic control for 68.4% (1172/1713), referred 7.7% (134/1720) to the emergency department, and 26.3% (432/1638) to palliative care. ECOG performance status distribution was: ECOG 0 (n=371,17.2%), ECOG 1 (n=1041, 48.4%), ECOG 2 (n=362, 16.8%), ECOG 3 (n=290, 13.5%), ECOG 4 (n=84, 3.9%). Overall, 34.2% of patients had an ECOG ≥2. After multidisciplinary evaluation, three out of ten patients had no indication for high-cost drugs/novel technologies.
CONCLUSIONS: The FCS serves as a differentiator in FCCCV's care model by playing a crucial role in individualized decision-making regarding the appropriateness of high-cost drugs/novel technologies, based on patients' functional, psychological, nutritional, and symptomatic status.
METHODS: This was a retrospective analysis of cases evaluated by the FCS between December 2018 and December 2024. All cancer patients whose oncologists/hemato-oncologists prescribed high-cost drugs/novel technologies due to their clinical characteristics and disease progression were included. The FCS comprises specialists in oncological rehabilitation, clinical oncology, hemato-oncology, palliative care, psychology, nutrition, general support medicine, and pharmaceutical chemistry. The FCS's decision can result in two outcomes: with indication or without indication for the high-cost drug/novel technology proposed by the treating oncologist/hemato-oncologist.
RESULTS: A total of 2148 cases were analyzed. Mean age 60.7 ±13.6 years. Most frequent cancers were breast (30.9%), lung (21.8%) and melanoma (8.1%). Pembrolizumab (15.9%) was the top high-cost drug/novel technology prescribed by specialists. High psychosocial risk was present in 47.9% (825/1721) of patients, and 54.7% (938/1712) had high malnutrition risk. The FCS initiated immediate symptomatic control for 68.4% (1172/1713), referred 7.7% (134/1720) to the emergency department, and 26.3% (432/1638) to palliative care. ECOG performance status distribution was: ECOG 0 (n=371,17.2%), ECOG 1 (n=1041, 48.4%), ECOG 2 (n=362, 16.8%), ECOG 3 (n=290, 13.5%), ECOG 4 (n=84, 3.9%). Overall, 34.2% of patients had an ECOG ≥2. After multidisciplinary evaluation, three out of ten patients had no indication for high-cost drugs/novel technologies.
CONCLUSIONS: The FCS serves as a differentiator in FCCCV's care model by playing a crucial role in individualized decision-making regarding the appropriateness of high-cost drugs/novel technologies, based on patients' functional, psychological, nutritional, and symptomatic status.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HSD110
Topic
Health Service Delivery & Process of Care
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology