Cancer Care Needs Are Falling Short of Demand

Approximately 14 million Americans – about 4 in 100 — have had cancer. As explained on MedPage, that number is expected to grow to 18 million by 2030 with 2.3 million new cases each year. But the number of several health-care professions specializing in cancer care is expected to fall short of the increasing demand.

That scenario was drawn earlier this month by the Institute of Medicine (IOM), a highly respected, independent, nonprofit organization that provides objective, authoritative advice to decision makers and the public. The organization’s report, “Delivering High-Quality Cancer Care,” calls for a new course for cancer care that improves data collection about the quality and outcomes of care, and for better coordination of care to address what it calls a “crisis in cancer care delivery.”

“Most clinicians caring for cancer patients are trying to provide optimal care, but they’re finding it increasingly difficult because of a range of barriers,” Dr. Patricia Ganz, IOM committee chair, said in a news release about the report. “As a nation we need to chart a new course for cancer care. 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.”

The cost of treating cancer is rising at a faster rate than other kinds of medical treatment; from 2004 to 2010, it rose nearly 75%, from $72 billion to $125 billion. By 2020, the cost is expected to rise by more than one-third, to $173 billion.

Part of that inflation, we presume, must be due to our lust for new technologies that might be appropriate in some cases, but are used more than they should be because they’re new and shiny, and their expense must be recovered. (See our blog, “When You’re a Hammer, Everything Looks Like a Nail.”)

In fact, the IOM committee concluded that too often decisions about cancer care are not evidence-based; that is, they aren’t based on the process of applying common sense and information from solid, scientific literature to a specific clinical problem in order to achieve the best outcome.

In addition, the IOM said, many patients don’t receive palliative care to manage their symptoms and the side effects of treatment.

Those seem like fairly basic approaches to treatment. If we don’t even follow them, what are the chances we’re adept at coordinating care? Not good, said the IOM, which found that the current delivery system often fails to provide cancer care for older adults who need special attention for multiple comorbidities (the presence of more than one disease), social support and possible functional and cognitive impairment.

“Many patients also do not receive adequate explanation of their treatment goals, and when a phase of treatment concludes, they frequently do not know what they have received or the consequences on their future health,” according to the report.

The authors call for the National Cancer Institute, the Department of Health and Human Services’ (HHS) Agency for Healthcare Research and Quality and the nonprofit Patient-Centered Outcomes Research Institute to evaluate the role of standard and novel interventions and technologies used in cancer care. They said professional societies should work with HHS to report quality measures for cancer care.

Specifically, the IOM says that cancer care should:

  • provide patients and their families with understandable information about prognosis, treatment benefits and harms, palliative care, psychosocial support and costs;
  • provide patients with end-of-life care that meets their needs, values and preferences;
  • ensure coordinated and comprehensive patient-centered care;
  • ensure that all individuals caring for patients have appropriate core competencies;
  • expand the breadth of data collected in research for older adults and patients with multiple comorbid conditions;
  • expand the depth of data collected in research to capture patient-reported outcomes, relevant patient characteristics and health behaviors;
  • develop a learning health-care information technology system that enables real-time analysis of data from patients in a variety of care settings;
  • develop a national quality reporting program for care as part of a learning health-care system;
  • implement a national strategy to reduce disparities in access to care for underserved populations by leveraging community interventions;
  • improve the affordability of care by leveraging existing efforts to reform payment and eliminate waste.
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