IOM Issues Recommendations to Improve Cancer Care Delivery

Patricia A. Ganz, MD

Delivering high-quality cancer care continues to be a daunting problem for the US healthcare system because of a combination of factors. These include an aging population, a shrinking work force, the rising cost of therapies, and a complex disease state and treatment regimen.

The Institute of Medicine (IOM) convened a committee of experts to examine the quality of cancer care and devised recommendations for improvements that focus on patient-centered care, greater use of palliative treatments for patients needing pain relief, and increased use of scientific data as a rationale for making clinical decisions

“Most clinicians caring for cancer patients are trying to provide optimal care, but they’re finding it difficult because of a range of barriers,” says Patricia A. Ganz, MD, chair of the committee and director, Cancer Prevention & Control Research, Jonsson Comprehensive Cancer Center at the University of California, Los Angeles.

The report recommends strategies for improving the care of cancer patients, based on six components of high-quality cancer care. The components are listed in order of priority:

1. Engage patients. Help patients make informed medical decisions that are consistent with their needs, values and preferences.
2. Use a team-based approach to deliver care. New models of this type of care can effectively promote coordinated care and respond to shortages in the work force and changes in patient demographics. Adopting this approach will be especially helpful considering that the population accounting for most cancer cases — adults older than 65 – is rapidly increasing.
3. Base clinical decisions on evidenced-based care. Many medical decisions are not supported by sufficient evidence from research sources such as clinical trials and comparative effectiveness research. Evidence of the benefits and harms of treatment options should be used to aid patients and help the cancer care team make informed decisions.
4. Implement a healthcare information system that can learn. Enable real-time analysis of data to improve knowledge and inform medical decisions. Effort will be necessary from professional organizations and government agencies such as the US Department of Health and Human Services to develop and implement the learning healthcare system. Also, payers can provide incentives that encourage clinicians to participate as a system develops.
5. Translate evidence into practice, quality improvement, and performance improvement. Tools and initiatives should be delivered in a timely manner to help clinicians quickly incorporate new knowledge into routine care.
6. Democratize access to cancer care. Disparities in care currently exist among individuals who are of lower socioeconomic status, are racial or ethnic minorities, lack insurance coverage, and are older. New payment models for would reward cancer treatment teams for providing accessible, affordable, high-quality cancer care.

Source: Institute of Medicine. U.S. Faces Crisis in Cancer Care Because of Aging Population, Rising Costs, Complexity of Care, Says New Report; Shift Needed Toward Patient-Centered, Evidence-Based Care. The full report is available at http://www.nap.edu/catalog.php?record_id=18359