Recommendations for Optimal Cancer Care
The National Cancer Policy Board, a panel of the Institute of Medicine and National Research Council in Washington, DC, has issued a report titled "Ensuring Quality Cancer Care." Here are the 10 recommendations to create a system of optimal care:
1. Ensure that patients undergoing procedures that are technically difficult to perform and have been associated with higher mortality in lower-volume settings receive care at facilities with extensive experience (i.e., high-volume facilities). Examples of such procedures include removal of all or part of the esophagus, surgery for pancreatic cancer, removal of pelvic organs, and complex chemotherapy regimens.
2. Use systematically developed guidelines based on the best available evidence for prevention, diagnosis, treatment, and palliative care.
3. Measure and monitor the quality of care using a core set of quality measures.
4. Ensure the following elements of quality care for each individual with cancer:
• recommendations about initial cancer management, which are critical in determining long-term outcome, made by experienced professionals;
• agreed-upon care plan that outlines goals of care;
• access to the full complement of resources necessary to implement the care plan;
• access to high-quality clinical trials;
• policies to ensure full disclosure of information about appropriate treatment options;
• mechanism to coordinate services;
• psychosocial support services and compassionate care.
5. Ensure quality of care at the end of life, in particular, the management of cancer-related pain and timely referral to palliative and hospice care.
6. Federal and private research sponsors such as the National Cancer Institute, the Agency for Health Care Policy and Research, and various health plans should invest in clinical trials to address questions about cancer care management.
7. A cancer data system is needed that can provide quality benchmarks for use by systems of care (such as hospitals, provider groups, and managed care systems).
8. Public and private sponsors of cancer care research should support national studies of recently diagnosed individuals with cancer, using information sources with sufficient detail to assess patterns of cancer care and factors associated with the receipt of good care. Research sponsors should also support training for cancer care providers interested in health services research.
9. Services for the uninsured and underinsured should be enhanced to ensure entry to, and equitable treatment within, the cancer care system.
10. Studies are needed to find out why specific segments of the population (e.g., members of certain racial or ethnic groups, older patients) do not receive appropriate care. These studies should measure provider and individual knowledge, attitudes, and beliefs, as well as other potential barriers to access to care.
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