NEWS

IOM Report on Quality of Cancer Care Highlights Need For Research, Data Expansion

Gwen Moulton

State-of-the-art cancer care is erratically applied across the health care system, according to a report, "Ensuring Quality Cancer Care," published by the Institute of Medicine's National Cancer Policy Board. More research needs to be done to find out why, how to measure the current quality of care, and how to improve the quality of care with practice guidelines and greater information dissemination, the report recommended.

The report, released at a press conference in Washington, D.C., shows differences in what is known and what is being applied today by health care practitioners in the care and treatment of the estimated 8 million people with cancer. It makes clear that some subsets of the population received the best cancer care in the world, while others get far short of even the standard care, according to Robert Young, M.D., president of Fox Chase Cancer Center, Philadelphia, and a board member.



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Dr. Robert Young

 
The report outlines elements that would constitute the ideal in quality care from the standpoints of both the patient and the health care system. For patients, this would include access to comprehensive, coordinated services; confidence in the experience and training of providers; awareness of all treatment options and associated risks and benefits; a prospective plan for treatment and palliation; assurances that the care site met quality standards; and a feeling that providers respected patients and advocated on their behalf. For the system, the ideal in cancer care would articulate goals for quality and implement policies to achieve them; identify barriers to quality care and target interventions to overcome them; coordinate systems of care; ensure provider training; speed the findings of research to practice; monitor and ensure quality; and conduct research to further effective care.

Managed care health insurance plans are not the main barrier to care, the report states. It suggests instead that there are many factors related to access to care. For example, patients have a hard time absorbing information, and make decisions on their care under tremendous stress. The report also calls for enhancing cancer care services to the under- and uninsured.

While anecdotal evidence from patients abounds, there is a lack of research to determine the barriers to treatment and how to help patients navigate the system, according to NCPB member Ellen Stovall, executive director, National Coalition for Cancer Survivorship, Silver Spring, Md.

Major investments are needed in health services research at the National Cancer Institute and the Agency for Health Care Policy Research to help track the quality of cancer care, recommended Diana Petitti, M.D., director, research and evaluation, Kaiser Permanente Medical Care Program, Pasadena, Calif., another NCPB member.

NCI is already moving to include health services research in clinical trials through a higher level of collaboration with AHCPR and through the expansion of NCI's cancer surveillance research program, the report noted. For example, NCI and AHCPR are collaborating in a high-priority, 7-year, randomized clinical trial comparing radical prostatectomy and palliative expectant management for the treatment of clinically localized prostate cancer. Information on patient outcomes and costs are being collected and analyzed.

In the surveillance research arena, the report calls for a cancer data system to provide quality benchmarks for use by systems of care such as hospitals, provider groups, and managed care systems. NCPB will hold several workshops in 1999 to identify how best to meet these data needs, what financial resources are available, and ways to improve currently available data.

The report notes that the database that links information from NCI's Surveillance, Epidemiology and End Results Program with Medicare data is helping to answer important cancer related health services research questions. The SEER program itself is expected over the next few years to undergo a metamorphosis to allow researchers to connect it to many other data collection mechanisms that focus on prevention, risk factors, screening, and treatment interventions. This follows a year-long evaluation by the Surveillance Implementation Group, a review group comprised of 42 scientists from within NCI, other federal agencies, and the extramural community. (See News, April 21.)

This is the second report issued by IOM's National Cancer Policy Board, which was established in March 1997 to address the spectrum of cancer prevention and treatment issues.



             
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