Next, observations of current medical practice—for example, through reviews of a sample of medical records—reveal the extent to which effective care is being applied. Measures of quality may assess structural aspects of the health care delivery system (e.g., hospital case volume), processes of care (e.g., use of screening), or outcomes of care (e.g., survival, quality of life).

What Problems Are Evident in the Quality of Cancer Care and What Steps Can Be Taken to Improve Care?

Based on the best available evidence, some individuals with cancer do not receive care known to be effective for their condition. The magnitude of the problem is not known, but the National Cancer Policy Board believes it is substantial.

The National Cancer Policy Board has identified some specific ways to improve cancer care, which require systemic changes in the health care system and in the components that deal directly with cancer. Implementation of these recommendations may vary by locality and by system of care with, for example, different mechanisms needed in rural versus urban areas, or for particularly high-risk or underserved populations.

Cancer care is optimally delivered in systems of care that:

Recommendation 1: Ensure that patients undergoing procedures that are technically difficult to perform and have been associated with higher mortality in lower-volume settings receive care at facilities with extensive experience (i.e., high-volume facilities). Examples of such procedures include removal of all or part of the esophagus, surgery for pancreatic cancer, removal of pelvic organs, and complex chemotherapy regimens.

Recommendation 2: Use systematically developed guidelines based on the best available evidence for prevention, diagnosis, treatment, and palliative care.

Recommendation 3: Measure and monitor the quality of care using a core set of quality measures. Cancer care quality measures should

  • span the continuum of cancer care and be developed through a coordinated public-private effort:
  • be used to hold providers, including health care systems, health plans, and physicians, accountable for demonstrating that they provide and improve quality of care;
  • be applied to care provided through the Medicare and Medicaid programs as a requirement of participation in these programs; and
  • be disseminated widely and communicated to purchasers, providers, consumer organizations, individuals with cancer, policy makers, and health services researchers, in a form that is relevant and useful for health care decision-making.

Recommendation 4: Ensure the following elements of quality care for each individual with cancer:

  • that recommendations about initial cancer management, which are critical in determining long-term outcome, are made by experienced professionals;


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