National Academies Press: OpenBook

Ensuring Quality Cancer Care (1999)

Chapter: Front Matter

Suggested Citation:"Front Matter." Institute of Medicine and . 1999. Ensuring Quality Cancer Care. Washington, DC: The National Academies Press. doi: 10.17226/6467.
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Ensuring Quality Cancer Care

Maria Hewitt and Joseph V. Simone, Editors

National Cancer Policy Board

Institute of Medicine and Commission on Life Sciences,

National Research Council

NATIONAL ACADEMY PRESS
Washington, D.C.

Suggested Citation:"Front Matter." Institute of Medicine and . 1999. Ensuring Quality Cancer Care. Washington, DC: The National Academies Press. doi: 10.17226/6467.
×


NATIONAL ACADEMY PRESS
2101 Constitution Avenue, N.W. Washington, D.C. 20418

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. The members of the National Cancer Policy Board, which is responsible for the report, were chosen for their special competences and with regard for appropriate balance.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy’s 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine 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. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

This study was supported through funding provided by the National Cancer Institute (Contract No. NO2-CO-71024); the Centers for Disease Control and Prevention; the American Cancer Society; Amgen, Inc.; Abbott Laboratories; and Hoechst Marion Roussel, Inc. The views presented in this report are those of the National Cancer Policy Board and are not necessarily those of the funding organizations.

The full text of this report is available on line at www.nationalacademies.org/publications/

For more information about the Institute of Medicine and the National Cancer Policy Board, visit www4.nationalacademies.org/iom/iomhome.nsf

Library of Congress Cataloging-in-Publication Data

Ensuring quality cancer care / Maria Hewitt and Joseph V. Simone, editors ; National Cancer Policy Board, Institute of Medicine and Commission on Life Sciences, National Research Council.

p. cm.

Includes bibliographical references and index.

ISBN 0-309-06480-5 (pbk.)

1. Cancer—Treatment—United States. 2. Cancer—Treatment—Quality control. 3. Cancer—Patients—Care—United States. I. Hewitt, Maria Elizabeth. II. Simone, Joseph V. III. National Cancer Policy Board (U.S.)

RA645.C3 E57 1999

362.1'96994'00973—dc21

99-6488

CIP

Cover: Constellation Cancer, the Crab. “Cancer” comes from the Latin word meaning “crab, malignant tumor.”

Copyright 1999 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested Citation:"Front Matter." Institute of Medicine and . 1999. Ensuring Quality Cancer Care. Washington, DC: The National Academies Press. doi: 10.17226/6467.
×

NATIONAL CANCER POLICY BOARD

PETER HOWLEY (Chair), George Fabyan Professor and Chairman,

Department of Pathology, Harvard Medical School

JOSEPH SIMONE (Vice Chair), Medical Director,

Huntsman Cancer Foundation and Institute, University of Utah

JOHN BAILAR, Chairman,

Department of Health Studies, University of Chicago

NORMAN DANIELS, Professor of Philosophy,

Tufts University

JOSEPH DAVIE, Vice President of Research,

Biogen, Inc., Cambridge, Massachusetts

ROBERT DAY, Emeritus President and Director, and Member,

Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.

KATHLEEN FOLEY, Chief,

Pain Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York City

BERTIE FORD, Manager,

Oncology Research and Registry, Grant/Riverside Hospital, Columbus, Ohio

ELLEN GRITZ, Professor and Chair,

Department of Behavioral Sciences, M.D. Anderson Cancer Center, Houston, Texas

ELIZABETH HART, President and Chief Executive Officer,

Hart International, Dallas, Texas

THOMAS KELLY, Boury Professor and Chairman,

Department of Molecular Biology and Genetics, Johns Hopkins University School of Medicine

JOHN LASZLO,

Atlanta, Georgia

WILLIAM McGUIRE, Chief Executive Officer,

United HealthCare Corporation, Minnetonka, Minnesota

DIANA PETITTI, Director,

Research and Evaluation, Kaiser Permanente of Southern California, Pasadena

AMELIE RAMIREZ, Associate Professor,

Department of Medicine, Baylor College of Medicine

JOHN SEFFRIN, Chief Executive Officer,

American Cancer Society, Atlanta, Georgia

JANE E. SISK, Professor,

Division of Health Policy and Management, Joseph L. Mailman School of Public Health, Columbia University, New York City

ELLEN STOVALL, Executive Director,

National Coalition for Cancer Survivorship, Silver Spring, Maryland

FRANCES VISCO, President,

National Breast Cancer Coalition, Washington, D.C.

ROBERT YOUNG, President,

Fox Chase Cancer Center, Philadelphia

STAFF

MARIA HEWITT, Study Director,

ROBERT COOK-DEEGAN, Director,

National Cancer Policy Board

HELLEN GELBAND, Senior Program Officer

ELLEN JOHNSON, Administrative Assistant

ANNIKA OLSSON, Research Assistant

ELIZABETH KIDD, Intern

AMANDA GREENE, Intern

Suggested Citation:"Front Matter." Institute of Medicine and . 1999. Ensuring Quality Cancer Care. Washington, DC: The National Academies Press. doi: 10.17226/6467.
×

CONSULTANTS

BRUCE E. HILLNER,

Medical College of Virginia Campus, Virginia Commonwealth University

JEANNE S. MANDELBLATT,

Georgetown University Medical Center

MARK A. SCHUSTER,

University of California at Los Angeles and RAND, Santa Monica

THOMAS J. SMITH,

Medical College of Virginia Campus, Virginia Commonwealth University

Suggested Citation:"Front Matter." Institute of Medicine and . 1999. Ensuring Quality Cancer Care. Washington, DC: The National Academies Press. doi: 10.17226/6467.
×

Independent Report Reviewers

This report 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 Institute of Medicine in making the published report as sound as possible and to ensure that the report 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 deliberative process. The Board wishes to thank the following individuals for their participation in the review of this report:

LU ANN ADAY, Professor, University of Texas School of Public Health

KATHLEEN ANGEL, Midway, Massachusetts

PAUL CALABRESI, Professor of Medicine and Chairman Emeritus, Brown University School of Medicine

WILLIAM H. DANFORTH, Chairman, Board of Trustees, Washington University

HAROLD P. FREEMAN, Director of Surgery, Harlem Hospital Center, and Professor of Clinical Surgery, Columbia University College of Physicians and Surgeons

PATRICIA A. GANZ, Professor, Schools of Medicine and Public Health, University of California at Los Angeles, andDirector, Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California at Los Angeles

DONALD R. MATTISON, March of Dimes Birth Defects Foundation, White Plains, New York

RUTH McCORKLE, Professor and Director, Center for Excellence in Chronic Illness Care and Chair, Doctoral Program, Yale University School of Nursing

DAVID P. RALL, Former Director of the National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina

ROSEMARY ROSSO, Greater Baltimore-Washington Breast Cancer Advocacy Group, Washington, D.C.

While the individuals listed above have provided constructive comments and suggestions, it must be emphasized that responsibility for the final content of this report rests entirely with the authoring Board and the Institute of Medicine.

Suggested Citation:"Front Matter." Institute of Medicine and . 1999. Ensuring Quality Cancer Care. Washington, DC: The National Academies Press. doi: 10.17226/6467.
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Phase 4: Posttreatment Surveillance and Recurrence Care,

 

63

   

Phase 5: End-of-Life Care,

 

63

   

Key Findings,

 

66

4

 

Defining and Assessing Quality Cancer Care

 

79

   

Defining Quality of Care,

 

79

   

Why Measure Quality of Cancer Care?

 

80

   

How Is Quality Measured?

 

80

   

Structural Quality,

 

80

   

Process Quality,

 

81

   

Outcomes,

 

84

   

Variations in Care,

 

88

   

How Is Quality-of-Care Information Collected?

 

88

   

Evidence of Cancer Care Quality Problems,

 

90

   

Breast Cancer,

 

91

   

Prostate Cancer,

 

103

   

Key Findings,

 

108

5

 

Health Care Delivery and Quality of Cancer Care

 

116

   

Evaluating the Strength of Evidence from Health Services Research,

 

117

   

Case Volume for Hospitals or Individual Physicians,

 

118

   

High-Risk Cancer Surgery,

 

119

   

Prostate Cancer,

 

125

   

Breast Cancer Surgery,

 

126

   

Evidence on the Volume-Outcome Relationship from Other Countries,

 

126

   

Specialization,

 

128

   

Specialization of Facilities,

 

128

   

Specialization of Physicians,

 

130

   

Managed Care Versus Fee-for-Service Care,

 

133

   

Key Findings,

 

137

6

 

Cancer Care Quality Assurance

 

144

   

Quality Assurance: An Individual Consumer Perspective,

 

145

   

Choosing Insurers,

 

145

   

Choosing Physicians and Hospitals,

 

146

   

Choosing Treatment Options,

 

148

   

Use of Quality Information by Consumers,

 

148

   

Quality Assurance: A Market Approach,

 

150

   

Quality Assurance: The Public-Sector Approach,

 

151

   

Health Care Financing Administration,

 

152

   

Public Health Monitoring,

 

154

   

Agency for Health Care Policy and Research,

 

154

   

Quality Assurance: The Health Care Professional Approach,

 

155

   

Joint Commission on Accreditation of Healthcare Organizations,

 

155

   

National Committee for Quality Assurance,

 

156

Suggested Citation:"Front Matter." Institute of Medicine and . 1999. Ensuring Quality Cancer Care. Washington, DC: The National Academies Press. doi: 10.17226/6467.
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Next: Summary »
Ensuring Quality Cancer Care Get This Book
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We all want to believe that when people get cancer, they will receive medical care of the highest quality. Even as new scientific breakthroughs are announced, though, many cancer patients may be getting the wrong care, too little care, or too much care, in the form of unnecessary procedures.

How close is American medicine to the ideal of quality cancer care for every person with cancer? Ensuring Quality Cancer Care provides a comprehensive picture of how cancer care is delivered in our nation, from early detection to end-of-life issues. The National Cancer Policy Board defines quality care and recommends how to monitor, measure, and extend quality care to all people with cancer. Approaches to accountability in health care are reviewed.

What keeps people from getting care? The book explains how lack of medical coverage, social and economic status, patient beliefs, physician decision-making, and other factors can stand between the patient and the best possible care. The board explores how cancer care is shaped by the current focus on evidence-based medicine, the widespread adoption of managed care, where services are provided, and who provides care. Specific shortfalls in the care of breast and prostate cancer are identified. A status report on health services research is included.

Ensuring Quality Cancer Care offers wide-ranging data and information in clear context. As the baby boomers approach the years when most cancer occurs, this timely volume will be of special interest to health policy makers, public and private healthcare purchasers, medical professionals, patient advocates, researchers, and people with cancer.

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