NEWS

NCI Addresses "Inconsistencies" In Cancer Care Quality

Stacye Poer

Within days of a Congressional hearing examining "inconsistencies" in the nation's quality of cancer care, the National Cancer Institute announced a two-tiered research and policy initiative to ensure that all Americans receive the highest quality cancer care possible.

The NCI initiative, which aims to strengthen both the monitoring and the delivery of quality cancer care, as well as the application of cancer research findings to improve quality of care in federally funded health care programs, is consistent with the recent recommendations of the Institute of Medicine's National Cancer Policy Board and NCI's President's Cancer Panel. The IOM report, "Ensuring Quality Cancer Care," characterized the cancer care system in the United States as "fragmented."

Through a federal task force endorsed by the Health and Human Services Secretary, NCI indicated it will work with other HHS agencies to implement a plan for translating research findings into cancer care and to address the overarching issue of unequal access to quality cancer care.

At the Congressional hearing on cancer care in the United States early last month, Connie Mack (R-Fla.) and Dianne Feinstein (D-Calif.), the only members of the Senate Cancer Coalition in attendance, listened as a patient described some of her problems.



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Sen. Dianne Feinstein

 
Nyrvah Richard, an ovarian cancer survivor representing SHARE and the Ovarian Cancer National Alliance, related her ordeal as an inner-city cancer patient with no insurance coverage. She described invasive medical tests and treatments and multiple missed diagnoses, before surgeons finally removed a tumor weighing in excess of 10 pounds and she began extensive chemotherapy. Getting and keeping Medicaid assistance proved among the most difficult of the obstacles, Richard said, adding that there is a "wide gulf between the ideal and what is really experienced by cancer patients."

Other panelists outlined measures that could prevent Richard's experience from happening to future cancer patients.

An oncologist practicing in Missoula, Mont., Judy Schmidt, M.D., said her approach to patient care includes forming a partnership with her patients for making treatment and palliative care decisions, and total control of all aspects of each patient' s disease management. Although, she never hesitates to avail herself of all cancer information resources and the opinions of trusted colleagues, she said, she values the freedom she and her patients have to make their own decisions: "We don't have someone telling us what to do." After her testimony, Feinstein remarked that " we should clone Dr. Schmidt."

One idea that was especially appealing to the committee was that proposed by Joseph Simone, M.D. of the University of Utah and the Huntsman Cancer Institute. In his "pediatric model" of cancer care, Simone said, some aspects of the care delivery system already in place for children with cancer may translate well to a system that optimizes cancer care quality for adults.

First, Simone said, almost every child diagnosed with cancer has a "quarterback" physician who develops a treatment strategy and shepherds the child and family through the process. Second, improvement in cure rates in children over the past 40 years can be related to increased participation in clinical trials, whereas only 2% to 3% of adults enroll in clinical trials. And while Simone admitted that not every adult cancer patient can or should be in clinical trials, "We are so far from the mark that there is enormous room for progress."

Robert Hiatt, M.D., Ph.D., of the NCI told the coalition that there is a need for solid, evidence-based medicine to provide the foundation for ensuring quality cancer care. He described NCI's expanded research agenda in recent years to include a core set of outcome measures to determine which medical interventions improve cancer outcomes; to identify and remove access barriers to cancer care for specific segments of the population; and to improve communication of cancer information to the public. Hiatt testified that many of these initiatives are already under way and declared NCI's interest in "contributing through [its most recent] research initiative" to a better understanding of "how to define and improve the quality of health care overall."



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Dr. Robert Hiatt

 



             
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