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:*
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.
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.
These papers are available on the NCPB website (www.nas.edu/cancerbd).