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identifies major barriers that impede access to quality cancer care;
defines quality cancer care and describes its measurement;
provides examples of problems that limit early detection, accurate diagnosis, optimal treatment, and responsive supportive care;
reviews and critiques systems of accountability that are in place to help ensure the receipt of quality cancer care;
assesses whether ongoing cancer-related health services research is addressing outstanding questions about the quality of cancer care; and
presents recommendations to enhance cancer care for consideration by Congress, public and private health care purchasers, health plans, individual consumers, health care providers, and researchers.
The NCPB convened a public forum on March 31, 1997 and also listened to presentations by federal agency representatives at its quarterly meetings. Staff and Board members participated in a series of President's Cancer Panel meetings on quality issues in cancer care (PCP, 1998a-c). In addition, five background papers on cancer care quality issues were commissioned to support this report:*
two reviews of the health services literature related to quality cancer care (Hillner and Smith, 1998; Schuster et al., 1998);
a case study of model cancer care programs (Smith et al., 1998);
an analysis of the state of clinical practice guidelines for cancer care (Smith et al., 1998); and
a review of the literature on barriers to access to cancer care (Mandelblatt et al., 1998).
Primary cancer prevention (i.e., preventing people from getting cancer in the first place), recognized as key to effectively curbing cancer, was viewed by the NCPB as outside the scope of this report. The Board believes strongly in the value of prevention, as witnessed by its first report on tobacco control, but prevention merits its own specific attention and fits better into other activities the Board anticipates undertaking in the future than into this report, which focuses on the system of medical care.
Framework of the Report
Chapter 2 describes the trajectory of cancer management, from early detection and treatment to end-of-life care, and the existing cancer care infrastructure. The chapter concludes with a summary of the effects on cancer care of recent changes in the organization, financing, and delivery of health care.
Chapter 3 discusses barriers to access to cancer care. A new diagnosis of cancer in the absence of comprehensive health insurance coverage provides a case illustration of the difficulties of achieving access to care and the potentially devastating financial consequences of cancer.