Leadership Series

While cancer-related deaths are on the decline in America, the American Cancer Society anticipates that we are on the cusp of a record-breaking year for new diagnoses. The ACS estimates more than 2 million Americans will be diagnosed with cancer in 2024, the highest incidence in recorded history.

On its surface, this projection is not surprising. The likelihood of a cancer diagnosis increases with age, and we have an expanding aging population. An increasing number of cancer diagnoses is, therefore, a natural consequence of people living longer lives. What is concerning and remains unexplained is the rising incidence of colorectal cancer in the younger population. 

Over the past three decades, the incidence of colorectal cancer has doubled among 20- to 39-year-olds and nearly doubled in people ages 40 and 50. At the same time, the incidence of colorectal cancer in individuals older than 50 has declined, likely due to early screening that facilitates the removal of premalignant polyps. 

Breast cancer diagnoses in women 20 to 49 are also on the rise, according to research published in JAMA Network Open. Other cancers affecting the younger population that cause alarm include HPV, pancreatic and liver cancers. 

Treating Disease, Identifying the Root Cause

Because the rising incidence of cancer has now been publicized, clinicians should maintain an appropriate level of suspicion in patients presenting with concerning symptoms, including younger patients. For example, primary care providers and emergency physicians should at least consider a diagnosis of colorectal cancer in patients with the following symptoms:

• Changing bowel habits

• Rectal bleeding

• Unexplained weight loss

In addition to considering and evaluating patients with one or more of these symptoms for hemorrhoids or other non-malignant bowel conditions, providers should consider colonoscopy to rule out colorectal cancer.

Younger patients diagnosed with colorectal cancer and other cancers are at increased risk of mortality without treatment, as their cancers can be particularly aggressive. We in the medical community should work harder to evaluate younger patients for potential cancers, enabling us to provide lifesaving treatment in a more timely manner.

Additionally, the academic and scientific community must determine why there is an increased incidence of cancer in this population and what we can do to reverse this disturbing trend. Investigators at Baylor St. Luke’s Medical Center (BSLMC) are actively engaged in clinical and translational cancer research to identify whether environmental factors may be inducing microbiomic or epigenetic changes in the bowel that cause cancer. 

Create a Patient-Centric Culture

The medical community continues to focus on equity of care and identify obstacles to access, which include lack of education, geography and socioeconomic factors. With a rising patient load, these barriers are unlikely to resolve on their own. To help their patients overcome these obstacles, clinicians must go the extra mile to transform their concern for patients’ well-being into actionable measures. Two such examples are:

• Plugging patients into primary care. Many patients who harbor undiagnosed cancer bounce between emergency rooms, undergoing redundant evaluation without anyone taking responsibility for their care. When engaging patients who are at risk of being “lost to follow-up,” clinicians should connect these patients with primary care physicians or specialists to ensure continuity of care.

• Spending more time with patients. Insurance reimbursement, unfortunately, incentivizes clinicians to order more tests, administer more treatments and move patients through the system as quickly as possible. By spending more time educating patients and addressing all of their needs—physical, emotional, financial and logistical—rather than maximizing revenue generation, patients will surely receive better comprehensive care.

Implementing a patient-centered approach while preserving physician well-being must be fostered by health care leaders, who should set realistic expectations of clinicians and empower them to prioritize patient care over profit. BSLMC is committed to creating an environment in which outpatient care is optimized, and inpatient care is reserved for acutely ill patients, thus simultaneously improving patient care and reducing medical costs.

Optimizing Efficiency and Quality 

Reviewing the full range of therapeutic options and discussing clinical trials soon after diagnosis enhances the cancer journey and improves both the quality and efficiency of care. As the incidence of cancer continues to rise and as therapeutic options become increasingly more complicated and numerous, clinicians must have the knowledge, experience and multidisciplinary team to review a case thoroughly, develop a tailored treatment plan based on the individual and his/her cancer’s molecular profile, relay the plan to the patient and execute the plan based on the patient’s preference. Since this nuanced approach takes time, cancer programs should enact the following measures (among others) to increase efficiency without compromising quality:

1. Hire patient navigators. Navigators expedite the intake process, increase the efficiency of scheduling diagnostic and therapeutic procedures and boost patient satisfaction. Their services are invaluable to the multidisciplinary team and its complicated patients.
2. Make the first patient visit as valuable as possible. In order to devise and implement a treatment plan as soon as possible and to save patients from the inconvenience and cost of unnecessary clinic visits, medical records must be available to the consulting physician before the first appointment. That way, the physician has time to learn as much as possible about the case beforehand, obtain additional records if need be, and enter the visit with initial impressions and recommendations. By the end of that first visit, there should be a clear path forward to further evaluation and/or treatment.
    

We’ve come a long way in our effort to improve outcomes for many cancers, but we still have a long way to go. As we care for a growing number of patients in 2024 and beyond, we will continue honing our unique, personalized model of cancer care to yield the best cancer outcomes for our patients while investigating the root causes of rising cancer rates.