Enhancing Cancer Care

Cancer care today often provides state-of-the-science biomedical treatment, but fails to address the psychological and social (psychosocial) problems associated with the illness. This failure can compromise the effectiveness of health care and thereby adversely affect the health of cancer patients. Psychological and social problems created or exacerbated by cancer--including depression and other emotional problems; lack of information or skills needed to manage the illness; lack of transportation or other resources; and disruptions in work, school, and family life--cause additional suffering, weaken adherence to prescribed treatments, and threaten patients' return to health. Today, it is not possible to deliver high-quality cancer care without using existing approaches, tools, and resources to address patients' psychosocial health needs. All patients with cancer and their families should expect and receive cancer care that ensures the provision of appropriate psychosocial health services. Cancer Care for the Whole Patient recommends actions that oncology providers, health policy makers, educators, health insurers, health planners, researchers and research sponsors, and consumer advocates should undertake to ensure that this standard is met.

For cancer patients and their families, the effects of both cancer and its conventional treatment methods can take a heavy toll, physically and mentally. Increasingly, health professionals are being asked for advice on complementary therapies, also described as natural or holistic therapies. Enhancing Cancer Care is a practical, evidence-based guide to complementary cancer therapies, which are becoming popular alongside orthodox treatments as part of the 'integrative' approach to care. These therapies can benefit patients by relieving distressing symptoms, boosting their resistance to the cancer, and giving them a greater sense of control regarding the management of their illness.

In the United States, approximately 14 million people have had cancer and more than 1.6 million new cases are diagnosed each year. However, more than a decade after the Institute of Medicine (IOM) first studied the quality of cancer care, the barriers to achieving excellent care for all cancer patients remain daunting. Care often is not patient-centered, many patients do not receive palliative care to manage their symptoms and side effects from treatment, and decisions about care often are not based on the latest scientific evidence. The cost of cancer care also is rising faster than many sectors of medicine--having increased to $125 billion in 2010 from $72 billion in 2004--and is projected to reach $173 billion by 2020. Rising costs are making cancer care less affordable for patients and their families and are creating disparities in patients' access to high-quality cancer care. There also are growing shortages of health professionals skilled in providing cancer care, and the number of adults age 65 and older--the group most susceptible to cancer--is expected to double by 2030, contributing to a 45 percent increase in the number of people developing cancer. The current care delivery system is poorly prepared to address the care needs of this population, which are complex due to altered physiology, functional and cognitive impairment, multiple coexisting diseases, increased side effects from treatment, and greater need for social support. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis presents a conceptual framework for improving the quality of cancer care. This study proposes improvements to six interconnected components of care: (1) engaged patients; (2) an adequately staffed, trained, and coordinated workforce; (3) evidence-based care; (4) learning health care information technology (IT); (5) translation of evidence into clinical practice, quality measurement and performance improvement; and (6) accessible and affordable care. This report recommends changes across the board in these areas to improve the quality of care. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis provides information for cancer care teams, patients and their families, researchers, quality metrics developers, and payers, as well as HHS, other federal agencies, and industry to reevaluate their current roles and responsibilities in cancer care and work together to develop a higher quality care delivery system. By working toward this shared goal, the cancer care community can improve the quality of life and outcomes for people facing a cancer diagnosis.

We all want to believe that when people get cancer, they will receive medical care of the highest quality. Even as new scientific breakthroughs are announced, though, many cancer patients may be getting the wrong care, too little care, or too much care, in the form of unnecessary procedures. How close is American medicine to the ideal of quality cancer care for every person with cancer? Ensuring Quality Cancer Care provides a comprehensive picture of how cancer care is delivered in our nation, from early detection to end-of-life issues. The National Cancer Policy Board defines quality care and recommends how to monitor, measure, and extend quality care to all people with cancer. Approaches to accountability in health care are reviewed. What keeps people from getting care? The book explains how lack of medical coverage, social and economic status, patient beliefs, physician decision-making, and other factors can stand between the patient and the best possible care. The board explores how cancer care is shaped by the current focus on evidence-based medicine, the widespread adoption of managed care, where services are provided, and who provides care. Specific shortfalls in the care of breast and prostate cancer are identified. A status report on health services research is included. Ensuring Quality Cancer Care offers wide-ranging data and information in clear context. As the baby boomers approach the years when most cancer occurs, this timely volume will be of special interest to health policy makers, public and private healthcare purchasers, medical professionals, patient advocates, researchers, and people with cancer.

Cancer Care: Assuring Quality to Improve Survival surveys the policy trends in cancer care over recent years and looks at survival rates to identify the why some countries are doing better than others.

Rising health care costs are a central fiscal challenge confronting the United States. National spending on health care currently accounts for 18 percent of gross domestic product (GDP), but is anticipated to increase to 25 percent of GDP by 2037. The Bipartisan Policy Center argues that "this rapid growth in health expenditures creates an unsustainable burden on America's economy, with far-reaching consequences". These consequences include crowding out many national priorities, including investments in education, infrastructure, and research; stagnation of employee wages; and decreased international competitiveness.In spite of health care costs that far exceed those of other countries, health outcomes in the United States are not considerably better. With the goal of ensuring that patients have access to high-quality, affordable cancer care, the Institute of Medicine's (IOM's) National Cancer Policy Forum convened a public workshop, Delivering Affordable Cancer Care in the 21st Century, October 8-9, 2012, in Washington, DC. Delivering Affordable Cancer Care in the 21st Century summarizes the workshop.

Maintaining quality and improving cancer care does not occur in a vacuum. It requires a coordinated effort among many team members to whom this book is directed. Cancer care in the United States is in crisis as per a recent National Institute of Health publication. Much of this has to do with the complexity of the cancer care, its delivery systems, the aging population and the diminishing workforce. We need to be smarter and more efficient to de-escalate this crisis and improve the survival and survivorship of our cancer patients. Improved survivorship of families and caregivers will be included as well. The book will follow the continuum of cancer care model as its outline vide infra. It will provide many concrete instances of successful practices and programs which improve survivorship. Initially it will discuss the current crisis on a global and then national platform. There will be a discussion about disability adjusted life years lost, lost productivity, loss of life and its impact upon the nation and communities. The financial impact of cancer on society and government will be included in this. Population health management as regards cancer will then look at communities served, community health needs assessments and social determinants of health. How prevention and screening programs can be formulated from the above will be illustrated. Compliance with treatments as promulgated by the Commission on Cancer’s Cancer Program Practice Performance Reports (CP3R) will be reviewed. The relationship between compliance and improved survival will be highlighted. Navigation and distress management to assure patients complete planned treatments will be included in this section. Quality of survivorship will review the four domains of life- spiritual, social, psychological and physical. How these can be maximized through system improvement and program development will be illustrated. Financial issues and legal protections will also be included in this section. Survivorship care planning i.e. surveillance for recurrent cancer, prevention of related and new cancers will be an integral part of this section. Palliative, end of life care and bereavement care will complete the continuum cycle. Identifying hospitalized patients in need of palliative needs will be refreshed. How to establish an in-patient palliative care team and creating a seamless transition from in-patient to out-patient palliative care will be presented. Intended AudienceAdministrative and clinical staff involved in the delivery of cancer care including: hospital executives, physicians, nurses, radiation therapists, psychology counselors, social workers, physical therapists, occupation therapists, nutritionists, government, healthcare insurance representatives, etc.

One of the barriers to improving the quality of cancer care in the United States is the inadequacy of data systems. Out-of-date or incomplete information about the performance of doctors, hospitals, health plans, and public agencies makes it hard to gauge the quality of care. Augmenting today's data systems could start to fill the gap. This report examines the strengths and weaknesses of current systems and makes recommendations for enhancing data systems to improve the quality of cancer care. The board's recommendations fall into three key areas: Enhance key elements of the data system infrastructure (i.e., quality-of-care measures, cancer registries and databases, data collection technologies, and analytic capacity). Expand support for analyses of quality of cancer care using existing data systems. Monitor the effectiveness of data systems to promote quality improvement within health systems.