In addition, high patient cost-sharing (ie, out-of-pocket costs) is known to negatively impact adherence to treatment and is thought to contribute to financial toxicity.1,4,6  In this context, providing financial incentives to patients could add value to a cancer treatment by increasing adherence.1,4

Conversely, patients and providers have very different perspectives about how value is created in cancer care.7 From a provider perspective, the definition of value should encompass clinical, physical, emotional, and psychosocial outcomes of a treatment, Dr Zafar told Cancer Therapy Advisor. He added that a “high-value treatment” is one that extends survival and has limited toxicities — and theoretically, it should also prevent future tumor growth or halt cancer progression. Thus, it is very challenging to integrate all aspects and perspectives of value into one definition.7

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A patient-focused, value-based approach that encourages reporting of patient outcomes, among other measures of quality, requires staff training and education.3 Evaluation of patient-reported outcomes (PROs) is an important component of measuring quality, and many studies have pointed to the role of PROs in improving care quality and extending overall survival.1

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Although the OCM is a small pilot evaluating 200 practices, several providers are already seeking to integrate PROs and other patient-centered parameters into their clinical workflows. Similarly, making PROs publicly available for patients will further drive the utilization of high-value services.1

In conclusion, a patient-focused, value-based approach using a mix of modest financial and nonfinancial incentives for beneficiaries will provide more support for providers to more actively engage patients in their own care. A wide range of quality measures have the potential to be meaningful for all involved parties in the cancer care continuum.

Disclosures: The author of the JAMA study reported receiving research funding from AstraZeneca. For a full list of disclosures, please refer to the original study.


  1. Zafar SY, Polite BN, McLellan M. Engaging patients in value-based care: a missed opportunity [published online August 2, 2018]. JAMA Oncol. doi: 10.1001/jamaoncol.2018.2826
  2. Valuck T, Blaisdell D, Dugan D, et al. National Pharmaceutical Council and Discern Health. Improving oncology quality measurement in accountable care. Published in April 2017. Accessed on September 21, 2018.
  3. Wade, JC. Unwanted variation in cancer care: it is time to innovate and change. J Oncol Pract. 2017;13(1):6-8.
  4. Thomson S, Schang L, Chernew ME. Value based cost sharing in the United States and elsewhere can increase patients’ use of high-value goods and services. Health Aff (Millwood). 2013;32(4):704-712.
  5. Loewenstein G, Volpp KG, Asch DA. Incentives in health. Different prescriptions for physicians and patients. JAMA. 2012;307(13):1375-1376.
  6. Baicker K, Goldman D. Patient cost-sharing and healthcare spending growth. J Econ Perspect. 2011;25(2):47-68.
  7. Ramsey S, Schickedanz A. How should we define value in cancer care? Oncologist. 2010;15(suppl1):1-4.