Report: Cancer care could use a makeover

Hospital role is small but crucial

Most cancer care takes place in the community. Patients with cancer come into the hospital for surgery, for outpatient procedures, or sometimes, sadly, at the end of their life. But all of healthcare is changing, and who is responsible for patient care when isn't a matter of bright lines of demarcation any more. So when the Institute of Medicine released a report last fall saying that the cancer care system was in crisis, it was something that every part of the healthcare continuum ought to pay attention to. (The report can be seen at http://iom.edu/Reports/2013/Delivering-High-Quality-Cancer-Care-Charting-a-New-Course-for-a-System-in-Crisis.aspx.)

Many hospitals are already working on one area of concern — to improve palliative care services and make sure they are available not just at the end of life, but whenever they are needed, says Patricia Ganz, MD, a professor at the UCLA Fielding School of Public Health and Geffen School of Medicine and the lead author of the report. "The palliative care world has been working very hard to disengage their work from the end of life world. It's about more than that. It isn't about dying, but about being comfortable from the time a patient is diagnosed," she says.

Quality measures for cancer

An area that hospital quality managers have expertise in, and where they may be of service to others on the care continuum, is to help develop, collect, and analyze data related to quality care for cancer patients. "We don't have good quality measures for cancer right now," says Ganz. "The Commission on Cancer is working on accreditation standards for implementation in 2015, though, and about 90% of hospitals will be involved in that."

If you aren't looking at these kinds of measures yet, you might want to. The American College of Surgeons Commission on Cancer website, http://inspiringquality.facs.org/about/commission-on-cancer/, has links to information related to standards.

Ganz says that with the dearth of outcomes measures related to cancer — there is a call in the IOM paper for oncologists to suggest some — it might be worth your while to sit down with your affiliated oncologists and ask them what data they think it might be useful to collect. Even if you don't start collecting it yet, having a list of the important bits could put you ahead of the game later on.

"Systems don't exist for knowing how a particular kind of patient will do with a certain treatment," she says. Eventually, registries akin to the tumor registry will be created, though, and that information will help physicians and patients make better decisions about their care. "I want to be able to tell a patient that this is how a patient like you will likely do on this treatment and have it be based in reality," says Ganz. "That's why this kind of outcome measurement is important."

Patient access to data

As for whose responsibility it is to capture and manage the data, accountable care organizations may blur those lines so much that it doesn't matter who does it as long as it gets done. What will matter is that you cooperate with the other players on the continuum to provide care that the IOM isn't writing reports about that include the phrase "in crisis."

Patients will have access to data in the future about which hospital has the best record with which cancer, which doctor does best with what surgery, so figuring out what data is important to collect related to cancer, collecting it, and then mining it for information is in your interest as much as the patient's, notes Ganz. At the very least, put the people around the table and ask them what their data wish list is. It's entirely possibly you already collect it. And if you don't, it's entirely possible that come 2015, you'll have to anyway.

For more information on this topic, please contact Patricia A. Ganz, MD, Distinguished University Professor, UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA, Director, Cancer Prevention & Control Research, Jonsson Comprehensive Cancer Center, Los Angeles, CA. Email: [email protected].