There are serious shortcomings in the quality of care for
manyAmericans with cancer, according to a report just released by the
Institute of Medicine National Cancer Policy Board. Deficits in care
identified in the report include underuse of screening tests, lack of
adherence to standards for diagnosis, inadequate patient counseling
regarding treatment options, and underuse of radiation therapy and
adjuvant chemotherapy after surgery. Joseph Simone, MD, medical
director, Huntsman Cancer Foundation and Institute, which is
affiliated with the University of Utah, headed the board that
prepared the report.
The board recommended that patients who need complicated cancer
surgery or chemotherapy be treated at facilities that perform a high
volume of these procedures. Such procedures include removal of all or
part of the esophagus, surgery for pancreatic cancer, removal of
pelvic organs, and complex chemotherapy treatments. Survival rates
immediately following these procedures are two to three times higher
when done in more experienced facilities, according to several
studies reviewed in this report.
Improving cancer care in all settings will require new efforts to
track the quality of individual health plans, and to hold providers
and insurers accountable. The prepublication version of the report
can be downloaded from www.nap.edu.