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.