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IOM report looks at 'crisis' of U.S. cancer care system

Wednesday September 11, 2013
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The U.S. cancer care delivery system “is in a crisis,” according to a report by the Institute of Medicine.

With 14 million people having been diagnosed with cancer, and 1.6 million new cases a year, care too 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 authors wrote.

Among the problems are rising costs that make care less affordable and create disparities in access to quality care. The report committee also cited shortages of health professionals who are skilled in providing cancer care, which become more acute given an aging population with complex care needs.

As part of a framework for providing better cancer care, the committee suggests incorporating six elements:

• Engaged patients: “In a high-quality cancer care delivery system, cancer care teams should support all patients in making informed medical decisions by providing patients and their families with understandable information at key decision points on such matters as cancer prognosis, treatment benefits and harms, palliative care, psychosocial support and costs of care.” End-of-life care should be consistent with a patient’s needs, values and preferences.

• An adequately staffed, trained and coordinated workforce: “High-quality cancer care is provided by diverse teams of professionals. The cancer care team, in coordination with primary/geriatrics teams and specialist care teams, should implement patients’ care plans and deliver comprehensive, efficient, and patient-centered care. … Moreover, it is critical that cancer care delivery organizations require members of cancer care teams to have the necessary skills to deliver high-quality cancer care, as demonstrated through training certification or credentials.”

• Evidence-based care: “Improving the evidence base will require expanding the breadth and depth of data collected on cancer interventions, including more data on older adults and patients with multiple chronic diseases, as well as more data on patient-reported outcomes, patient characteristics and health behaviors.”

• Healthcare information technology: An optimal healthcare IT system "would enable real-time analysis of data from cancer patients in a variety of care settings to improve knowledge and inform medical decisions. This IT system would collect and analyze data from clinical practice, implement changes to improve care, evaluate the outcomes of these changes and generate new hypotheses to test and implement.” The U.S. Department of Health and Human Services should work with professional organizations to develop such a system, according to the committee.

• Translation of evidence into clinical practice, quality measurement and improvement: “Measurement and assessment of progress in improving the delivery of cancer care, public reporting of information gathered and development of innovative strategies to facilitate performance improvement will be needed.” The committee wrote that HHS and professional organizations should work together to “create and implement a formal long-term strategy for publicly reporting quality measures for cancer care.”

• Accessible and affordable care: “A high-quality cancer care delivery system should be accessible to all patients, including vulnerable and underserved populations. This system should also reward cancer care teams for providing patient-centered, high-quality care and eliminating wasteful interventions.” Among the committee’s recommendations, “HHS should support the development of innovative programs, identify and disseminate effective community interventions and provide ongoing support to successful community interventions. In addition, payers should design and evaluate new payment models that encourage cancer care teams to provide care that is based on the best available evidence and aligns with their patients’ needs, values and preferences.”

Report: http://www.nap.edu/openbook.php?record_id=18359


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