do not have access to alternative plans. Individuals may use available quality indicators to choose doctors and hospitals within their plans, and perhaps to choose alternative courses of treatment, but evidence suggests that individual consumers can exert only a modest ''market'' pressure for quality improvement through access to better information about the quality of cancer care. Large purchasers, such as employers are likely to exert more leverage and to have designated staff to assess alternative plans.
Cancer care quality measures should 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.
Quality measures enable consumers and purchasers to judge the quality of a system of care by its performance relative to evidence-based standards.
RECOMMENDATION 4: Ensure The Following Elements Of Quality Care For Each Individual With Cancer:
Some elements of care simply make sense—that is, they have strong face validity and can reasonably be assumed to improve care unless and until evidence accumulates to the contrary. This recommendation amounts to a statement of the ideal, based on principles of cancer care articulated by cancer survivors. Details of how to interpret and apply the principles will vary according to health plan, cancer type, stage of disease, and preferences of the individual needing care.
RECOMMENDATION 5: Ensure quality of care at the end of life, in particular, the management of cancer-related pain and timely referral to palliative and hospice care.
Cancer is the second leading cause of death in the United States. A strong body of evidence suggests that the experience of dying for many with cancer can be greatly improved with better palliative care (IOM, 1997). Many individuals with cancer suffer pain needlessly and have their treatment preferences ignored. Practice guidelines are available to assist health care providers in this area, but they have not been adopted widely. Financial barriers limit effective care for