IOM: US faces cancer care crisis

Issue: October 10, 2013

The United States is on the brink of a crisis in cancer care delivery due to increased demand, rapidly rising costs, reductions in the oncology work force and increasingly complex nature of the disease and targeted treatments, according to a report issued today by the Institute of Medicine.

The report included several potential solutions, such as a move toward team-based models of care, more effective clinician–patient communication and efforts to improve clinicians’ core competencies in caring for patients with cancer.

Patricia A. Ganz

“Most clinicians caring for cancer patients are trying to provide optimal care, but they’re finding it increasingly difficult because of a range of barriers,” Patricia A. Ganz, MD, a professor at the UCLA School of Medicine, director of cancer prevention and control research at Jonsson Comprehensive Cancer Center, and chair of the committee that wrote the report, said in a press release. “As a nation, we need to chart a new course for cancer care. Changes are needed across the board, from how we communicate with patients, to how we translate research into practice, to how we coordinate care and measure its quality.”

More than 1.6 million new cases of cancer are diagnosed annually in the United States, and that number is expected to increase to 2.3 million cases per year by 2030. The oncology work force likely will not be able to keep pace with that demand, and it is unlikely training programs will be able to expand quickly enough, according to the report’s authors.

In addition, the cost of cancer care — estimated at $125 billion in 2010 — is expected to increase to $173 billion by 2020. The increased complexity of cancer and the rapid development of targeted therapies has also made it challenging for clinicians and patients to quickly and precisely develop care plans.

“There is a great need for high-quality, evidence-based strategies to guide cancer care and ensure efficient and effective use of scarce resources,” the report reads. “Decisions about cancer care are often not evidenced-based. Many patients also do not receive adequate explanation of their treatment goals, and when a phase of treatment concludes, they frequently do not know what they have received or the consequences on their future health.”

The report includes recommendations to improve cancer care delivery based on several key principles, including:

Patient engagement: Patients and their families should receive clear, thorough information about their prognosis, as well as the benefits, harms and costs associated with their treatments.
Oncology work force: Team-based approaches can effectively promote coordinated care and help alleviate the effects of work force shortages. The report’s authors called on professional organizations that represent those who care for patients with cancer to define the core competencies necessary to provide such care, and institutions must ensure their clinicians possess those skills.
Evidence-based care: Results from scientific research must guide medical decisions, allowing clinicians and patients to weigh potential benefits with harms to make more informed choices about treatment options. The current US system is not adequately prepared to handle the complex needs of older adults with cancer, or cancer patients who also have multiple chronic diseases, the report said. The authors said future research is needed regarding cancer interventions for these populations.
Clinician knowledge: Efforts must be made to ensure clinicians can quickly incorporate new medical knowledge into routine care, and standardized quality measures must be established to help assess the quality of care that is delivered.
Cost: The current fee-for-service reimbursement system encourages a high volume of care but does not reward high-quality care, according to the report. The authors urged professional societies to distribute evidence-based information about cancer care practices that are unnecessary, as well as those that may be associated with greater risks than benefits. Payers are urged to create payment models that provide incentives for care teams to provide care based on the best available evidence that is in alignment with patients’ needs.

“Changes across the board urgently are needed to improve the quality of cancer care,” the report states. “All participants and stakeholders — including cancer care teams, patients and their families, researchers, quality metrics developers, and payers, as well as HHS, other federal agencies, and industry — must re-evaluate their current roles and responsibilities in cancer care and work together to develop a higher-quality cancer care delivery system. By working toward this shared goal, the cancer care community can improve the quality of life and outcomes for people facing a cancer diagnosis.”