Cancer care in the United States is not patient-centered, and many clinical decisions are not made based on the latest scientific evidence — rendering a care delivery crisis — according to a new report from the Institute of Medicine.
The IOM formed a committee in in 2012 to examine U.S. cancer care quality and recommend improvements. The committee developed this report, which totals more than 300 pages. Here are some deficiencies the committee identified in today's cancer care delivery system:
• The system is facing duel pressures: The population of adults 65 years and older is expected to double by 2030, and this group comprises the majority of cancer diagnoses, survivors and deaths. At the same time, the workforce of cancer care professionals faces a widening shortage, and training programs lack the ability to expand and meet demand.
• Cancer care costs are growing faster than other sectors of medicine, and researchers estimate the costs could reach $173 billion in 2020 — a 39 percent increase from 2010. A significant portion of costs are tied to more expensive targeted therapies and new technologies, but leaders in the cancer community have said many of these treatments provide only marginal benefits.
• Cancer patients are rarely at the center of the fragmented care delivery process, and shared decision-making is suboptimal. The report cites the story of Jessie Gruman, a four-time cancer survivor, who received care from eight physicians throughout one year. Ms. Gruman saw two of those physicians directly communicate with each other only once in that time. Such disconnect can leave patients confused as to who is responsible for what aspects of their cancer care, according to the report.
• Care decisions by clinicians and patients are inadequately informed by evidence. The committee expressed particular concern for the lack of clinical trial research focused on older adults.
• Many patients lack access to affordable, high-quality cancer care. There are disparities in outcomes depending on patients' socioeconomic status, race, ethnicity or insurance coverage, and these disparities are likely to widen as the U.S. population becomes older and more diverse. Furthermore, cancer care can severely harm patients' and their families' finances, putting them at a higher risk of bankruptcy.
Below is an overview of the committee's central recommendations for action to improve the cancer care delivery system. Throughout the report, the IOM committee broke down these broad recommendations into actionable requests to certain bodies, such as Congress, the National Cancer Institute, CMS, commercial payers and accreditation organizations.
1. Provide patients and their families with understandable information about cancer prognosis, treatment benefits and harms, palliative care, psychosocial support and costs.
2. Provide patients with end-of-life care that meets their needs, values and preferences.
3. Ensure coordinated and comprehensive patient-centered care.
4. Ensure all individuals caring for cancer patients have appropriate core competencies.
5. Expand the breadth of data collected in cancer research for older adults and patients with multiple comorbidities.
6. Expand the depth of data collected in cancer research through a common set of data elements that capture patient-reported outcomes, relevant patient characteristics and health behaviors.
7. Develop a learning healthcare information technology system for cancer that enables real-time analysis of data from cancer patients in a variety of care settings.
8. Develop a national quality reporting program for cancer care as part of a learning healthcare system.
9. Implement a national strategy to reduce disparities in access to cancer care for underserved populations by leveraging community interventions.
10. Improve the affordability of cancer care by leveraging existing efforts to reform payment and eliminate waste.
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