Even in the absence of financial barriers, individuals may not receive quality care because of where they live, language or cultural barriers, and late adoption on the part of health care providers of effective interventions.

Chapter 4 defines quality cancer care, describes the ways in which it can be measured, and documents important gaps in the quality of care for individuals with breast or prostate cancer, two cancers for which there have been quality assessments.

Chapter 5 summarizes evidence on the ways in which three aspects of the health care delivery system can affect the quality of cancer care: (1) the volume of services provided either by institutions or by individual providers; (2) specialization in cancer care either by institutions or by individual providers; and (3) managed care.

Chapter 6 reviews and critiques the means of monitoring quality and accountability that are in place.

Chapter 7 surveys ongoing health services research that addresses cancer-related quality issues sponsored by selected federal agencies and private organizations.

Chapter 8 summarizes the key findings and presents the Board's recommendations for action by Congress, health care purchasers, health plans, health care providers, individual consumers, and health services researchers.

References

American Cancer Society. 1999. Cancer Facts and Figures1999. Atlanta, GA.


Chassin MR, Gavin RW. 1998. The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. Journal of the American Medical Association 280(11):1000-1005.


Fisher B, Bauer M, Margolese R, et al. 1985. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer . New England Journal of Medicine 312:665-673.


Hillner BE, Smith TJ. 1998. The quality of cancer care: Does the literature support the rhetoric? National Cancer Policy Board commissioned paper.


IOM (Institute of Medicine). 1990. Medicare: A Strategy for Quality Assurance, KN Lohr, ed. Washington, D.C.: National Academy Press.

IOM. 1994. America's Health in Transition: Protecting and Improving Quality. A Statement of the Council of the Institute of Medicine. Washington, D.C.: National Academy Press.


Mandelblatt J, Yabroff KR, Kerner J. 1998. Access to quality cancer care: Evaluating and ensuring equitable services, quality of life and survival. National Cancer Policy Board commissioned paper.


National Cancer Advisory Board. 1994. Cancer at a Crossroads.' A Report to Congress for the Nation. Bethesda, MD: National Cancer Institute.

National Cancer Policy Board. 1998. Taking Action to Reduce Tobacco Use. Washington, D.C.: National Academy Press.

National Center for Health Statistics. 1997. Healthy People 2000 Review. Hyattsville, MD: U.S. Department of Health and Human Services, Public Health Service.


President's Cancer Panel. 1998a. Meeting on Quality of Care/Quality of Life. Los Angeles, California, April 23.

President's Cancer Panel. 1998b. Meeting on Quality of Care/Quality of Life. New Haven, Connecticut, June 2.



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