Cancer Care: Can America Step It Up?
With the number of new cancer patients in America expected to rise by nearly 45% over the next 16 years, it behooves us as a society to make sure those patients receive the best possible care – which doesn’t necessarily mean the MOST possible care. A new report from the Institute of Medicine outlines some recommendations.
A tsunami of new cancer patients is about to hit the already shaky foundations of the current U.S. health-care system.
Why? Because the largest age group diagnosed with cancer annually is adults over age 65. And with the oldest of the Boomers just starting to reach that demographic – and millions more aging into it over the next 15 years – cancer diagnoses will rise precipitously: up to 2.3 million new diagnoses annually, by 2030. (Walsh, 2013)
Meanwhile, as cancer care becomes increasingly personalized, it necessarily becomes more complex. Gone are the days when all cancer was treated with basic surgery, radiation, and chemotherapy. Now surgery has become a tricky balancing act, as surgeons try to remove as little tissue as possible while still finding every cancerous cell.
With special equipment and a laparoscopic approach, radiation can be delivered over the course of a week, instead of 6 weeks. And chemotherapy drugs (and drug combinations) have flooded the market, each aimed at a specific sub-set of a particular cancer.
This complexity, combined with increasing numbers of cancer patients and rising expenses (from $72 billion in 2004 to an estimated $125 billion by 2020), will result in a “crisis” in cancer care, according to a report issued in September by the Institute of Medicine, part of the National Academy of Science.
Patricia Ganz, a professor at UCLA’s School of Medicine and School of Public Health, chaired the committee that wrote the report, “Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis.” “As a nation we need to chart a new course for cancer care,” says Ganz. “Changes are needed across the board, from how we communicate with patients, to how we translate research into practice, to how we coordinate care and measure its quality.” (Walsh, 2013)
Ambitious goals – but how do we even approach them? The report outlines six key points. (Walsh, 2013)
Gone are the days when doctors were God and patients their willing acolytes. Instead, cancer patients are being urged to take an active role in the decision-making around their treatment; and the medical community is being asked to facilitate increased patient engagement via clearer and more thorough communication about the risks and benefits of any particular treatment.
Recent studies have shown that up to 80% of patients with advanced cancer believe their treatment can cure them, when in fact it may only prolong their life minimally. (Begley, 2013) Might these patients opt for less aggressive (read: less painful) treatment, given the understanding that to do so might quicken their death, but increase the quality of their life?
An adequately staffed, trained, and coordinated work force
It’s predicted that as the number of cancer patients increases, the number of oncologists to treat them will dwindle; according to a report from the American Society of Clinical Oncologists, “The nation will be short 2,500 to 4,080 medical oncologists by 2020.” (Begley, 2013)
Patient care should move to a team-based model, with the oncologist coordinating a team that, trained in core competencies, will deliver everything from chemotherapy drugs to palliative care. This whole-patient approach is already being tried in a number of top-quality cancer centers across the nation.
Evidence-based cancer care
Patients should be treated with therapies backed by scientific research and data. And patients should be fully informed of the benefit and downside of any treatment, in order to make the best decision. Included in this information should be specific information about how the treatment might impact quality of life. It’s the doctors role to save life; but too often saving a life means prolonging it at great cost – both financial, and to the patients’ quality of life.
A learning health care information technology system for cancer care
Cancer care needs to embrace a “learn as you go” approach – with technology at its core. With advances in research happening so rapidly, it’s difficult for any doctor or hospital to keep up; improved communication between institutions around data analysis of treatment results can only help move everyone forward.
Translation of evidence into practice, quality measurement, and performance improvement
“Standards and measurements” – the backbone of any business – need to be applied to cancer care. Communication around standards of treatment needs to be improved; and measurements taken gauging the success (or failure) of any treatment.
Accessible and affordable cancer care
The report calls for the Department of Health and Human Services to “develop a national strategy... to provide accessible and affordable cancer care” to all. Currently, the level of care is often based on socio-economic status, and/or whether or not the patient has health insurance. The report urges the current fee-for-service reimbursement program, which encourages volume rather than quality of care, to be replaced by a model that incentivizes cancer care teams to provide treatment based on the “best available evidence and that aligns with their patients’ needs.”
Will any of these initiatives actually happen? Past experience makes it seem doubtful. A similar report, with similar recommendations, was issued in 1999. The result? “Limited uptake,” according to committee chair Ganz.
Walsh, J. (2013, September 09). U.S. faces crisis in cancer care because of aging population, rising costs, complexity of care, says new report; shift needed toward patient-centered, evidence-based care. Retrieved from http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=18359
Begley, S. (2013, September 10). U.S. cancer-care delivery is 'in crisis': report. Retrieved from http://www.reuters.com/article/2013/09/10/us-usa-health-cancer-idUSBRE9891EI20130910