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Suggested Citation:"1 Introduction." Institute of Medicine. 2009. Assessing and Improving Value in Cancer Care: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12644.
Page 1
Suggested Citation:"1 Introduction." Institute of Medicine. 2009. Assessing and Improving Value in Cancer Care: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12644.
Page 2

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1 Introduction On February 9 and 10, 2009, a public workshop titled Assessing and Improving Value in Cancer Care was presented to the Institute of ­ edicine’s (IOM’s) National Cancer Policy Forum (the forum). This M workshop was the result of the forum’s discussions of value in oncology during meetings held between March 2007 and October 2008. Those dis- cussions, involving forum chair Harold Moses and led by forum members Scott Ramsey, Peter Bach, Betty Ferrell, Roy Herbst, John Niederhuber, Edith Perez, and Ellen Stovall, among others, resulted in the appointment of a planning group led by Scott Ramsey. During their initial discussions, members of the forum observed that many new treatments in oncology carried increasingly unsustainable eco-  The forum was established as a unit of the IOM on May 1, 2005, with support from the following agencies of the U.S. Department of Health and Human Services (HHS): the National Cancer Institute (NCI), the Centers for Disease Control and Prevention (CDC), the Agency for Healthcare Research and Quality (AHRQ), the Food and Drug Administration (FDA), the Centers for Medicare and Medicaid Services (CMS), and the Health Resources and Services Administration (HRSA); as well as from the following private-sector organiza- tions: the American Cancer Society (ACS), the American Society of Clinical Oncology (ASCO), C-Change, and (for the first year only) UnitedHealthcare Group. The forum is a successor to the IOM and National Research Council’s (NRC’s) National Cancer Policy Board (1997–2005) and was designed to provide its 21 governmental, industry, and academic members a venue for exchanging information and presenting individual views on emerging policy issues in the nation’s effort to combat cancer. 

 assessing and improving value in cancer care nomic costs, and patients, providers, and payors faced the growing challenge of deciding whether or not the benefits of these treatments justified their expense. A clearer understanding of value in cancer care would be integral to support those decisions, and the forum members recognized that value, which is commonly regarded in health care as the benefits of a treatment weighed against its financial cost, deserves particularly careful consideration in oncology. Value in cancer care, the forum members noted, encompasses complex topics including quality end-of-life care, clinical discussions of health care costs, and evidence for treatment effectiveness, among many others. Dr. Ramsey proposed that the forum provide a vehicle for exami- nation of these issues by holding and reporting a workshop on value in cancer care. Shortly after the workshop was proposed, the planning group was expanded to include the nine members of the planning committee on assessing and improving value in cancer care. The planning committee volunteered to work with IOM staff to organize and lead the workshop, which took place in Washington, DC. Throughout the workshop, attendees from a multitude of fields related to cancer care, health economics, ethics, and public policy engaged with the workshop’s two dozen speakers to raise questions, offer thoughts, and contribute suggestions. This workshop summary details the presentations and discussions that took place during this workshop on assessing and improving value in can- cer care. The summary is divided into two parts, matching the format of the workshop itself. The first part focuses on the features of oncology that affect the value proposition and the second part presents viable solutions to improve value in cancer care. The final chapter discusses how value in cancer care can be understood, logical next steps, and ways to promote value in oncology. In addition to informing the forum, this published summary is provided to deliver the information and views that emerged from the workshop to a wider public audience for further dialogue or as an opening to additional IOM study in the future.

Next: 2 Opening Remarks: What Is Value in Cancer Care and Why Is It Important? »
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Unlike many other areas in health care, the practice of oncology presents unique challenges that make assessing and improving value especially complex. First, patients and professionals feel a well-justified sense of urgency to treat for cure, and if cure is not possible, to extend life and reduce the burden of disease. Second, treatments are often both life sparing and highly toxic. Third, distinctive payment structures for cancer medicines are intertwined with practice. Fourth, providers often face tremendous pressure to apply the newest technologies to patients who fail to respond to established treatments, even when the evidence supporting those technologies is incomplete or uncertain, and providers may be reluctant to stop toxic treatments and move to palliation, even at the end of life. Finally, the newest and most novel treatments in oncology are among the most costly in medicine.

This volume summarizes the results of a workshop that addressed these issues from multiple perspectives, including those of patients and patient advocates, providers, insurers, health care researchers, federal agencies, and industry. Its broad goal was to describe value in oncology in a complete and nuanced way, to better inform decisions regarding developing, evaluating, prescribing, and paying for cancer therapeutics.

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