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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
This activity was supported by Contract Nos. HHSN261200900003C and 200-2011-38807 between the National Academy of Sciences and the National Cancer Institute and the Centers for Disease Control and Prevention, respectively. In addition, the National Cancer Policy Forum is supported by the American Association for Cancer Research, the American Cancer Society, the American Society of Clinical Oncology, the Association of American Cancer Institutes, Bristol-Myers Squibb, C-Change, the CEO Roundtable on Cancer, GlaxoSmithKline, Novartis Oncology, the Oncology Nursing Society, and Sanofi Oncology. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity.
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The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
Suggested citation: IOM (Institute of Medicine). 2013. Delivering affordable cancer care in the 21st century: Workshop summary. Washington, DC: The National Academies Press.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.
WORKSHOP PLANNING COMMITTEE1
PATRICIA A. GANZ (Co-Chair), Professor, University of California, Los Angeles, School of Medicine & Public Health, Division of Cancer Prevention & Control Research, Jonsson Comprehensive Cancer Center
YA-CHEN TINA SHIH (Co-Chair), Director, Program in the Economics of Cancer, University of Chicago, IL
PETER B. BACH, Attending Physician, Memorial Sloan-Kettering Cancer Center, New York, NY
EZEKIEL J. EMANUEL, Diane v.S. Levy and Robert M. Levy University Professor, Vice Provost for Global Initiatives, University of Pennsylvania, Philadelphia
THOMAS J. KEAN, President and Chief Executive Officer, C-Change, Washington, DC
SCOTT RAMSEY, Director, Cancer Prevention Program, Division of Public Health Science, Fred Hutchinson Cancer Research Center, Seattle, WA
LOWELL E. SCHNIPPER, Theodore and Evelyn Berenson Professor of Medicine, Harvard Medical School, Clinical Director, Cancer Center, Chief, Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA
DEBORAH SCHRAG, Associate Professor of Medicine, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
Project Staff
ERIN BALOGH, Study Director
PAMELA LIGHTER, Research Assistant
MICHAEL PARK, Senior Program Assistant
SHARYL J. NASS, Director, National Cancer Policy Forum
ROGER HERDMAN, Director, Board on Health Care Services
__________________
1Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
NATIONAL CANCER POLICY FORUM1
JOHN MENDELSOHN (Chair), Director, Khalifa Institute for Personalized Cancer Therapy, MD Anderson Cancer Center, Houston, TX
PATRICIA A. GANZ (Vice Chair), Distinguished University Professor, University of California, Los Angeles, Schools of Medicine & Public Health, Director, Cancer Prevention & Control Research, Jonsson Comprehensive Cancer Center
AMY P. ABERNETHY, Associate Professor of Medicine, Duke University School of Medicine, and Director, Duke Cancer Care Research Program, Durham, NC
RAFAEL G. AMADO, Senior Vice President & Head of R&D, GlaxoSmithKline-Oncology, Collegeville, PA
FRED APPELBAUM, Director, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
PETER B. BACH, Attending Physician, Memorial Sloan-Kettering Cancer Center, New York, NY
EDWARD BENZ, JR., President, Dana-Farber Cancer Institute and Director, Harvard Cancer Center, Harvard School of Medicine, Boston, MA
MONICA BERTAGNOLLI, Professor of Surgery, Harvard University Medical School, Boston, MA
OTIS BRAWLEY, Chief Medical Officer and Executive Vice President, American Cancer Society, Atlanta, GA
MICHAEL A. CALIGIURI, Director, Ohio State Comprehensive Cancer Center, Columbus, OH
RENZO CANETTA, Vice President, Oncology Global Clinical Research, Bristol-Myers Squibb, Wallingford, CT
MICHAELE CHAMBLEE CHRISTIAN, Retired, Washington, DC
WILLIAM DALTON, Chief Executive Officer, M2Gen Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL, and Chair, American Association for Cancer Research Science Policy & Legislative Affairs Committee
__________________
1Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
WENDY DEMARK-WAHNEFRIED, Associate Director for Cancer Prevention and Control, University of Alabama at Birmingham Comprehensive Cancer Center
ROBERT ERWIN, President, Marti Nelson Cancer Foundation, Davis, CA
ROY S. HERBST, Chief of Medical Oncology, Yale Cancer Center, New Haven, CT
THOMAS J. KEAN, President and Chief Executive Officer, C-Change, Washington, DC
MICHELLE M. LE BEAU, Arthur and Marian Edelstein Professor of Medicine and Director, Comprehensive Cancer Center, University of Chicago, IL, and President, Association of American Cancer Institutes
DOUGLAS R. LOWY, Deputy Director, National Cancer Institute, Bethesda, MD
DANIEL R. MASYS, Affiliate Professor, Biomedical Informatics, University of Washington, Seattle
MARTIN J. MURPHY, Chief Executive Officer, CEO Roundtable on Cancer, Durham, NC
BRENDA NEVIDJON, Clinical Professor and Specialty Director, Nursing & Healthcare Leadership, Duke University School of Nursing, Durham, NC, and Past President, Oncology Nursing Society
STEVEN PIANTADOSI, Director, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
LISA C. RICHARDSON, Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
DEBASISH ROYCHOWDHURY, Senior Vice President, Global Oncology, Sanofi Oncology, Cambridge, MA
YA-CHEN TINA SHIH, Director, Program in the Economics of Cancer, University of Chicago, IL
ELLEN SIGAL, Chairperson and Founder, Friends of Cancer Research, Washington, DC
STEVEN STEIN, Senior Vice President, U.S. Clinical Development and Medical Affairs, Novartis Oncology, East Hanover, NJ
JOHN A. WAGNER, Vice President, Clinical Pharmacology, Merck and Company, Inc., Rahway, NJ
RALPH R. WEICHSELBAUM, Chair, Radiation and Cellular Oncology, and Director, Ludwig Center for Metastasis Research, The University of Chicago Medical Center, IL
JANET WOODCOCK, Director, Center for Drug Evaluation and Research, Food and Drug Administration, Rockville, MD
National Cancer Policy Forum Staff
SHARYL J. NASS, Director
LAURA LEVIT, Program Officer
ERIN BALOGH, Associate Program Officer
PAMELA LIGHTER, Research Assistant
MICHAEL PARK, Senior Program Assistant
PATRICK BURKE, Financial Associate
SHARON B. MURPHY, Scholar in Residence
ROGER HERDMAN, Director, Board on Health Care Services
Reviewers
This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:
LINDA S. ELTING, The University of Texas MD Anderson Cancer Center
ROBERT ERWIN, Marti Nelson Cancer Foundation
ROBERT J. GREEN, Cancer Clinics of Excellence
JOSEPH LIPSCOMB, Rollins School of Public Health and Winship Cancer Institute, Emory University
JEFFREY PEPPERCORN, Duke University Medical Center
JOANNE SCHOTTINGER, Southern California Permanente Medical Group
Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Melvin Worth. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteurs and the institution.
Contents
A FINANCIAL CRISIS IN HEALTH CARE
Financial Burden on Patients with Cancer
Overuse and Misuse of Interventions
Variable Care, Lack of Best Practices, and an Inadequate Evidence Base
Patient and Clinician Communication and Education
Evidence Base for Clinical Practice and Reimbursement
Financial Incentives Aligned with Affordable, High-Quality Cancer Care
Boxes and Figures
BOXES
2 ASCO’s Quality Oncology Practice Initiative (QOPI)
4 ASCO’s CancerLinQ Rapid Learning Initiative
FIGURES
1 Total health expenditure per capita and gross domestic product per capita, 2007
4 Medicare spending for Part B drugs administered in physicians’ offices or furnished by suppliers