Ensuring Quality Cancer Care (1999) / Chapter Skim
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2 The Cancer Care 'System'
2 The Cancer Care 'System'
Pages 18-45
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From page 18... ...
Since the "War on Cancer" was launched in 1971, a large share of federal medical research funding has been invested at the National Cancer Institute (NCI) to understand the underlying mechanisms of cancer, to evaluate progress against cancer through surveillance, to test promising diagnostic and treatment modalities, and to make information on how to prevent, treat, and live with cancer available to health care providers and to the public.
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From page 19... ...
Nevertheless, most cancer care services are provided by hospitals and centers falling outside the purview of the National Cancer Program, and there is no national effort to coordinate the disparate federal efforts related to the quality of cancer care. The lack of national coordination in cancer-fighting efforts in the public, private, and voluntary sectors is a problem that hinders progress against cancer, according to the findings of the NCI-appointed National Cancer Advisory Board (NCAB)
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From page 20... ...
Distribution (%) All Sites1,22 1,800 100.0 Prostate179,300 14.7 Female breast175,000 14.3 Lung and bronchus171,600 14.0 Colon and rectum129,400 10.6 All other sites566,500 46.4 SOURCE: ACS, 1999.
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From page 22... ...
Kesults or diagnostic and prognostic tests may be reviewed by a team ot specialists as a decision is made on the first approach to treatment. Most newly diagnosed cancer patients go through a series of staging tests, including blood tests, x-rays, and various types of scans, to determine the extent of the disease.
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From page 23... ...
After treatment, the stored bone marrow cells are reinfused into the patient to repopulate the bone marrow and begin producing blood cells. Bone marrow transplantation using marrow from healthy donors (``allogeneic transplantation'')
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From page 24... ...
Cancer patients in the United States have long been interested in treatments not traditionally offered as part of mainstream medicine. The incorporation of some alternative or complementary approaches as adjuncts to conventional treatments is a direct result of patients' desires for better cancer treatment, both curative and palliative, and generally for treatment that leaves them with a better quality of life than they might otherwise expect (Box 2.
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From page 25... ...
Hos pice care is an approach to care during the final stages of life. Encl-of-Life Care One-half of cancer patients die of the disease, making death and end-of-life care importent issues that must be addressed (American Society of Clinical Oncology, 19981.
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From page 26... ...
An estimated ~ percent of oncologists were primarily clinical researchers (AMA, ~ 9981. As of 1997, about 9,000 U.S.-based physicians belonged to the American Society of Clinical Oncology, the largest professional society dedicated to clinical oncology issues (Linda Mock, American Society of Clinical Oncology, personal communication to Maria Hewitt, March ~ 998~.
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From page 27... ...
visit physicians' offices and hospital outpatient departments for cancer care. These visits represent 3 percent of adult ambulatory care visits.
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From page 30... ...
Only one in three of the 5,080 general hospitals in the United States has a cancer program approved by the American College of Surgeons' Commission on Cancer (ACoS-COC) 2These estimates exclude ambulatory care visits to radiologists and to hospital radiology clinics.
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From page 31... ...
CancerRelated Ambulatory Cancer Care Visits, ~ 994-] 996 Cancer Care Visitsa Characteristic Sample Size Distribution (o/oyb Type of cancers Lung, other respiratory 455 7.3 Female breast 1,122 18.4 Prostate 698 12.7 Colon, rectum 606 11.0 Lymphomas, leukemias 705 14.0 Skin (nonmelanoma)
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From page 32... ...
b Percentages are adjusted using sampling weights to produce national estimates. CIn the Ninth Edition of the International Classification of Diseases (ICD-91: larynx, Jung = ~ 6 i, ~ 62; female breast = 1 74; prostate = ~ 85; colon, rectum = 153, 154, lymphomas, leukemias = 200-208; other= all other malignancies.
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From page 33... ...
TABLE 2.4 Characteristics of Hospital Discharges with Primary Diagnosis of Cancer, 1994 Estimate No. ofPercent Sample Cancer-Related HospitalDistribution Characteristic Size Discharges Nationally (seja(seja All cancer discharges 11,021 1,408,600 (66,300)
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From page 34... ...
links community cancer specialists and primary care physicians with clinical cooperative groups and cancer centers to conduct clinical trials. There are currently 48 CCOP offices in 30 states, with 330 participating hospitals at which some 2,300 physicians enter individuals into NCI-approved clinical trials.
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From page 35... ...
This section describes estimates of national cancer care expenditures and, with the limited data that are available, the distribution of costs by cancer site or phase of care. Chapter 3 discusses finallcial costs from a patient perspective and reviews potential financial barriers to access to care related to the absence of insurance coverage or to inadequate insurance coverage for care.
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From page 36... ...
The variation in cost by type of cancer and stage of illness is also seen in a study of Medicare payments. Among the Medicare population, average payments varied among cancer sites, especially in the initial care phase, where payments were highest for Jung and colorectal cancers and lowest for female breast cancer (Table 2.5~.
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From page 37... ...
, less than one-half of newly diagnosed cancer patients are in such a system. This decreased exposure to managed care occurs because 60 percent of individuals newly diagnosed with cancer are elderly and covered by Medicare, and 87 percent of Medicare beneficiaries have opted for traditional fee-for-service (FFS)
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From page 38... ...
In managed care systems, access to oncology specialists is often through a "gatekeeper," a primary care provider who authorizes referrals to specialists. In recent years, nearly one-third of primary care physicians report an increase in the severity and complexity of patient conditions they care for without referring to a specialist (St.
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From page 39... ...
may vary greatly from plan to plan. Licensed health plans are subject to numerous state and federal laws, and many also comply with standards of private accrediting bodies (e.g., National Committee for Quality Assurance, Joint Commission on Accreditation of Healthcare Organizations)
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From page 40... ...
Cancer care is often resource intensive, and some managed care companies are hiring disease management specialists to track costs and manage patient care (Bennett, 1997; Piro and Doctor, ~ 998~. Disease management systems can reduce costs and improve care if they coordinate care
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From page 41... ...
Several versions of a patient's Bill of Rights were considered during the ~ 05th Congress, but no federal legislation was passed (MedicaT Payment Advisory Commission, 19981. A range of protections that are particularly relevant to people with cancer in managed care plans were considered, including guaranteed access to health care specialists, continuity of care if a health provider is dropped in the middle of treatment, reimbursement for care while participating in clinical trials, and access to a meaningful internal and external appeals process for consumers to resolve their differences with their health plans and health care providers.
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From page 42... ...
42 ENSURING QUALITY CANCER CARE :-: - > : :~ :~: : B= 2.4~:~S:~ Laws ~Mandatina~ Cancer Cam Benefit : - : ~ ~ ~ :~ .~ ~.~ ~ .~.
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From page 43... ...
1997. Approaches to prostate cancer by managed care organizations.
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From page 44... ...
Washington, D.C.: National Academy of Sciences, National Cancer Policy Board. Medical Payment Advisory Commission.
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From page 45... ...
1997. Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 1995.
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