Suggestions for how to address practical challenges and shortcomings in the current management of adults with ALL
| Proposed action . | Issues addressed . | Potential benefits . |
|---|---|---|
| Confirm feasibility of later phases of treatment plan when frontline therapy is initially selected | Complexity of contemporary treatment approaches Frequent transitions of care between referral and local medical centers | Better adherence to intended (and presumably optimal) treatment plan Mitigate challenges related to patient housing and transportation Preserve comfort level of community providers and medical systems |
| Transition high-cost IV medications to outpatient administration when appropriate | Possible discrepancies between inpatient and outpatient reimbursement for medication administration | Improved financial compensation for medical system Simplify inpatient pharmacy workflows by reducing utilization of rarely used medications |
| Consider likely sites of care when designing prospective studies of novel agents and/or combinations | Complexity of contemporary treatment approaches Frequent transitions of care between referral and local medical centers Possible discrepancies between inpatient and outpatient reimbursement Overall costs of care | Preserve comfort level of community providers and medical systems Improved financial compensation for medical system Reduce financial toxicity |
| Commit to performing randomized controlled trials to validate superiority of treatment approaches | Limited evidence to support optimal treatment sequencing Frequent transitions of care between referral and local medical centers Complexity of contemporary treatment approaches Overall costs of care | Increase confidence in effectiveness of treatment plans Preserve comfort level of community providers and medical systems Reduce financial toxicity (if more costly approaches do not improve outcomes) |
| Invest in clinical trials studying approaches that remain feasible in lower-resource settings | Complexity of contemporary treatment approaches Frequent transitions of care between referral and local medical centers Overall costs of care | Increase confidence in effectiveness of treatment plans Preserve comfort level of community providers and medical systems Mitigate challenges related to patient housing and transportation Reduce financial toxicity (if more costly approaches do not improve outcomes) |
| Proposed action . | Issues addressed . | Potential benefits . |
|---|---|---|
| Confirm feasibility of later phases of treatment plan when frontline therapy is initially selected | Complexity of contemporary treatment approaches Frequent transitions of care between referral and local medical centers | Better adherence to intended (and presumably optimal) treatment plan Mitigate challenges related to patient housing and transportation Preserve comfort level of community providers and medical systems |
| Transition high-cost IV medications to outpatient administration when appropriate | Possible discrepancies between inpatient and outpatient reimbursement for medication administration | Improved financial compensation for medical system Simplify inpatient pharmacy workflows by reducing utilization of rarely used medications |
| Consider likely sites of care when designing prospective studies of novel agents and/or combinations | Complexity of contemporary treatment approaches Frequent transitions of care between referral and local medical centers Possible discrepancies between inpatient and outpatient reimbursement Overall costs of care | Preserve comfort level of community providers and medical systems Improved financial compensation for medical system Reduce financial toxicity |
| Commit to performing randomized controlled trials to validate superiority of treatment approaches | Limited evidence to support optimal treatment sequencing Frequent transitions of care between referral and local medical centers Complexity of contemporary treatment approaches Overall costs of care | Increase confidence in effectiveness of treatment plans Preserve comfort level of community providers and medical systems Reduce financial toxicity (if more costly approaches do not improve outcomes) |
| Invest in clinical trials studying approaches that remain feasible in lower-resource settings | Complexity of contemporary treatment approaches Frequent transitions of care between referral and local medical centers Overall costs of care | Increase confidence in effectiveness of treatment plans Preserve comfort level of community providers and medical systems Mitigate challenges related to patient housing and transportation Reduce financial toxicity (if more costly approaches do not improve outcomes) |