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Thursday, September 12, 2013

Problems with Cancer Care

By Heather Millar

doctor speaking with patient

In America, the cancer patient care system is in crisis, according to a report released this week by the Institute of Medicine, a subset of the National Academies. Don’t take my word for it, you can download the report or read it on-line for free, here. Patricia Ganz, a professor at University of California Los Angeles and director of Cancer Prevention and Control Research there, led a committee of 17 nationally-known cancer experts to produce the 322-page report. You may not want to slog through all those details, so here are the main problems identified by the committee:

  • Rates of cancer are increasing: Today, in the United States, more than 1.6 million each year hear those dread words, “You’ve got cancer,” and there are approximately 14 million cancer survivors. By 2030, those numbers are expected to increase to 2.3 million new cancer cases annually and 18 million cancer survivors.
  • Cancer treatment is so complex that treatment plans suffer: According to the committee, clinicians, patients and families often have trouble formulating treatment plans with the necessary speed, quality and precision. Advances in the understanding of cancer biology have increased the amount of information a doctor must master to treat cancer appropriately. As a result—and this is a shocker—“Decisions about cancer care are often not evidence-based.”
  • Patients are too often by-standers to their own cancer treatment. “Many patients do not receive adequate explanation of their treatment goals. They frequently do not know what they have received, or the consequences for their future health.”
  • Patients do not get adequate care for side effects of treatment. Often, the committee says, this is because doctors don’t know how to provide “palliative care,” that is, care that increases the comfort of patients. Or, they don’t think of this kind of care as a priority.
  • Before long,there probably won’t be enough oncology specialists to treat the growing numbers of patients. As a result, cancer care is often fragmented. Family caregivers are providing a significant amount of care with limited training and support.
  • The cost of cancer care is growing exponentially, while financing for that care (the majority of which is provided by Medicare and Medicaid) is struggling. Cancer care cost $72 billion in 2004, and $125 billion in 2010. By 2020, the national bill for cancer care is expected to balloon to $173 billion.

I’ve written about parts of many of these issues on this blog, but it’s really staggering to see all these conclusions in one place, backed by experts from the leading cancer research centers in the nation.

It’s also heartening to read that these experts think a big part of the solution is making cancer care “patient-centered.” That is, they think that patients should be educated about their disease and their care. Patients should be involved in decision-making. There should be more research regarding patients who have “co-morbidities,” that is, serious health issues in addition to cancer. We should collect more data about the experience and outcomes of patients. We should develop a health care “IT” system for cancer care.

Further, the committee calls for a national quality reporting system for cancer care. They call for a national strategy to reduce inequalities in access to cancer care. They call for efforts to reduce the cost of cancer care by reducing waste and reforming payment systems. They say that cancer care should be a team effort. That is, your cancer care should come from professionals from many disciplines who coordinate and communicate with each other.

Obviously, the barriers to achieving all these things are immense. But identifying the need is at least a first step.

Have you experienced any of the problems identified by these experts? Let us know here.

Posted by: Heather Millar at 1:12 pm

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