Making the Case for Reimbursement of Supervised Exercise Therapy in Cancer Care[Podcast Series]
[:55] Dr. Bantham introduces her guest, Dr. Kathryn Schmitz
Dr. Kathryn Schmitz is Interim Director of the UPMC Hillman Cancer Center.
She is Past President of the American College of Sports Medicine, and an American Cancer Society Clinical Research Professor.
[1:16] Evidence for exercise as a standard of care in cancer treatment
“And what this trial shows is the first randomized, controlled trial evidence of a 28% improvement in disease free survival, which means not having a recurrence. And this was specific to colon cancer. And a whopping 37% improvement in overall mortality by the time we get out to about eight years.”
[6:58] Improving access to exercise oncology programs
“In order to change the legislature's mind, what we needed was good stories. And I think we have, you know, we could kill them with evidence at this point. We could bury legislators in evidence in exercise oncology at this point. So, the evidence base is extremely strong, and yet, right? And yet, it's not happening. And it is happening, but it's, it's sporadic. The likelihood that the average cancer patient in the United States has access to a high quality exercise oncology program is based on whether or not there happens to be a champion at the local hospital they're going to or the cancer center that they're a part of. There are 58 comprehensive cancer centers in the United States. Less than 10 of them have an adequate exercise oncology program. It's not paid for. It's not mandated.”
[13:25] Making the case for reimbursement for exercise oncology programs
“We have one randomized control trial showing, in one group of cancer patients, that there is a disease free survival benefit and a mortality benefit, and we know that there's a lot of nice to have outcomes, right? Nice, nice to have is quality of life, things that are not going to be something that the payer pays for. So there's our challenge, that's the truth, that's the truth of our situation. That's why it's going to be difficult. And I think the challenge provides us one of the first opportunities to be able to really lay all of that bare. And then the question becomes, how do we motivate hospitals, healthcare systems and payers to pay for something when there is no profit in it for them?”
[18:52] CMS coverage of supervised exercise training for people with cancer
“And so the question is, is there a way to leverage those interests in a direction of trying to move CMS, Centers for Medicare and Medicaid Services, towards coverage of supervised exercise training for people who have had a diagnosis of cancer? And what I can tell you is that I think the answer is yes, and I think there is interest, and I think that there are a number of questions that need to be answered. And, you know, there is a team of people interested in trying to help CMS to answer those questions.”
[24:20] Moving Through Cancer areas of focus
“And we came up with five sort of topic areas that we needed to focus on. One of them was stakeholder awareness and engagement. And stakeholder meaning writ large, meaning we need the patients to understand. I mean, I think if patients were to rise up tomorrow and demand these services, it would happen quicker. So there's stakeholder awareness from the patient, there's also the providers, and then the workforce as well, because most exercise trainers are not aware that there is specialty training that is necessary for them to be working with cancer patients.”
[30:46] Prognosis for 2029
“So I think, I think we will have it in a patchwork by 2029. Will we have it for every patient, everywhere? That’s that remains to be seen.”
