The "Real World" of Patient Care

Arnold Potosky, PhD, discusses the social and environmental factors that effect patient care.

July 16, 2010

Arnold Potosky, PhD, director of Health Services at Lombardi believes that there are two worlds when it comes to reducing the burden of cancer: the world of laboratories and clinical trials, and the “real world”, where patients receive care.

“All too often cancer patients do not receive the best possible care, due to the barriers that exist in the health care delivery system,” says Potosky. As the director of Health Services Research, his research focuses on what happens in this real world of cancer care delivery, specifically, the patterns of care, and patient outcomes such as survival and quality of life. This information can be used to advise patients faced with decisions about their care, with the ultimate goal of improving decision making and the quality of care.

“Personalized medicine is a rapidly emerging concept in cancer care and health care more generally,” says Potosky. This type of medicine is commonly held to include tailoring cancer therapies based mainly on a person’s genetic make-up and tumor characteristics, but he stresses that personalization should also account for other personal and environmental risk factors as well as cultural values and preferences. He stresses that many factors can contribute to disease outcomes, including psychological, social, economic, and cultural factors.

“The quality of care delivered in the community is the result of more than just a patient’s biology,” he says. Potosky is hopeful that doctors and policy makers are increasingly aware that this combination of factors has a critical effect on patients’ survival and well-being, and that health care reform and more research studies will incorporate this broader view of medicine.

Potosky studies the effectiveness and side effects of prescribing hormonal therapy for prostate cancer. The long term benefits of this therapy remain unclear, but serious risks include bone fractures, heart problems, and diabetes. Potosky hopes to clearly communicate these risks and benefits to the patients and their doctors, so each man can make a personal choice.

In his other research, Potosky conducts surveys about patient well-being and experiences after cancer treatment. Standardized ways of asking patients to report their experiences with symptoms and other aspects of their quality of life are known as “patient reported outcome measures.” However personal factors such as socioeconomic status, cultural background, age and race may influence how patients respond to these questions. So it can be difficult to measure the impact of cancer treatments across different subgroups.

“We want the questions we ask patients about their experiences to be reliable and accurate for all groups of people. That way we can use them more widely and with confidence in both research and clinical practice to measure the effectiveness of health care,” explains Potosky. He and other investigators at Lombardi are working with an NIH funded group of research institutions to test questions that are used to measure the experiences of patients for their accuracy. Ultimately, Potosky hopes to optimize the medical care each individual receives.

Potosky was recruited to Lombardi in 2008 after a 21-year career at the National Cancer Institute (NCI). As an undergraduate at the University of Virginia, Potosky opted out of pre-med—against his parents’ wishes—choosing to major in History and Foreign Affairs. While pursuing a master’s degree in Health Finance and Management at the Johns Hopkins School of Public Health, Potosky discovered his love of epidemiology, the study of populations, and soon earned his PhD in Health Services Research (HSR). “I liked the systematic approach involved in epidemiology, and wanted to apply it to studying the epidemiology of cancer care in the general population, which is what HSR is mostly about”.

As the focus on more personalized medicine becomes a more integral part of health care, he believes, “we need to figure out how to help people understand the increasing number of choices they will have as we learn more and more about biology and its interactions with treatments and patients other characteristics. By systematically researching cancer care delivered in community practice settings, we can learn much more about the contributions of biological, behavioral, and delivery system factors on cancer outcomes. This is vital information needed to guide and inform clinical practice and health care policies, with the ultimate objectives of improving care delivery, preventing cancer, reducing cancer deaths, lowering costs, and enhancing patients’ well-being and quality of life.”

Author: Claire Cushman and Nkem T. Wellington