Optimizing timing and sequencing of biomarker testing for patients with metastatic colorectal cancer through implementing the 4R Oncology Model

This project’s overall goal is to optimize treatment planning and support patients with metastatic colorectal cancer, incorporating biomarker testing before the decision and initiation of first line systemic therapy and/or clinical trial. The project will also incorporate biomarker testing, as appropriate, in re-evaluation for ongoing therapy and future lines of therapy. The project will utilize the 4R Oncology Model for a shared-care sequence between patient and provider throughout the process of care including: diagnostic testing, treatment decision-making, treatments, supportive care, re-evaluation, additional lines of therapy, and end-of-life care. The 4R (Right Information and Right Treatment to the Right Patient at the Right Time) Oncology Model is an innovative approach to personalized cancer care planning, team-based care delivery and patient / caregiver self-management. 4R uses project management principles to create a personalized, comprehensive, patient-specific “care project plan” called a 4R Care Sequence. The 4R Care Sequence plan outlines the order and timing of workup / testing, decision-making, treatment, symptom and side effect management, supportive services, re-evaluation, and treatment adjustment for additional lines of therapy, chronic disease / comorbidity management, nutrition services, while incorporating the patient’s goals and preferences. The 4R Care Sequence plan is used by patient / caregiver and multi-disciplinary care team as a comprehensive care pathway, with the purpose to optimize care delivery, outcomes of treatment and patient’s quality of life, while minimizing treatment side effects and comorbidities. Objective 1: Implement 4R Care Sequence plans to support metastatic colorectal cancer patients workup/testing, treatment decisions and care. The main outcome is for appropriate biomarker testing results to be available for treatment decision making and prior to initiation of systemic therapy. This project will (1) design guideline-based 4R Care Sequence plans for patients with metastatic colorectal cancer and (2) implement them at Northwestern as a quality improvement project. Objective 2: Share tools created, including the metastatic colorectal care sequences, through webinar(s) and other dissemination activities with ACCC. The outcome of this objective is to make care sequences available to ACCC membership.