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Ensuring Quality Cancer Care (1999)

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

Index

A

Access to care, general, 1, 2, 11, 15, 46-67, 144, 146, 181, 182, 213, 214, 220

coordination of care, 2, 7, 26, 30, 40-41, 46, 133, 175, 214, 215, 220

federal, 2, 19, 41, 145, 175

defined, 46

educational attainment, 11, 47, 53, 61, 134, 148

fee-for-service care, 37, 39, 40, 43, 99, 116, 117, 133-137, 138, 152

financial barriers, general, 7-8, 15-16, 47, 55;

see also Costs

geographic barriers, 11, 46, 224

HEDIS, 157

nonfinancial barriers, 11, 46, 47, 52, 54-59, 64-65, 66, 205, 215, 224;

see also Attitudes and beliefs;

Cultural factors

referral to care, 38, 39, 96, 146, 151, 224

utilization reviews, 38

see also Demographic factors;

Health insurance;

Managed care;

Socioeconomic

status

Accountability, 6, 15, 18, 39-40, 67, 144-145, 154, 158, 175, 212, 218-219

see also Standards

Accreditation/approval, organizations, 6, 30-31, 39, 81, 146-147, 148, 151-152, 155-164, 174, 219

insurers, 6, 39, 151-52, 174, 175, 219

Adjuvant therapy, 22-23, 61, 82, 153

breast cancer, 94-95, 98, 99, 101-102, 108, 109, 153, 171, 173

colorectal cancer, 173

Advisory Board Company, 165

Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 5, 145, 175

African Americans, 20, 191, 192, 194, 200, 202-203

hospitalizations, 33

incidence, 20, 21

screening, 51, 53, 54-55, 58, 62, 189, 198

survival rates, 20, 21, 47

treatment, 59, 62, 63, 205

Age factors, 20, 31, 33, 89

breast cancer, 54, 91, 99-101, 167

clinical trials, 62, 63

cost of care and, 36

insurance coverage, 117

mammography, 54, 91, 167

prostate cancer, 103, 105, 202

treatment, general, 60-61, 62, 99-101, 120

see also Children;

Elderly persons

Agency for Health Care Policy and Research, 8, 19, 153, 154-155, 170, 175, 180, 185, 193-196, 209

Alternative treatments, 24, 204

Ambulatory care, 9, 10, 27-32, 163

American Accreditation Health Care Commission, Inc./URAC, 158

American Association of Health Plans, 154-155

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

American Board of Internal Medicine, 26

American Board of Obstetrics and Gynecology, 26

American Board of Pediatrics, 26

American Board of Radiology, 26, 90

American Cancer Society, 49, 104, 203-206

consumer information, 148

National Cancer Data Base, 9, 89-90, 109, 124, 160, 222

American College of Radiology, 90, 106-107

American College of Surgeons, 6, 30-31, 147, 155, 158, 160, 174, 203

National Cancer Data Base, 9, 124

American Indians, see Native Americans

American Joint Committee on Cancer, 160

American Medical Association, 26

American Pain Society, 153

American Society of Clinical Oncology, 26, 166-167

American Urological Association, 90, 104, 105, 106, 166, 179-171

Approaching Death: Improving Care at the End of Life, 65, 67

Asians, 54, 190, 206

Association of Community Cancer Centers, 160-163

Attitudes and beliefs

patient, 2, 11, 13, 14, 23, 46, 47, 62, 64, 65, 79, 85-86, 153, 157, 159

fatalism, 11, 53

physician, 54, 55, 59, 60, 63, 85

public opinion, 1, 2, 13, 14, 150;

see also Mass media

screening, 53, 54

see also Cultural factors; Public opinion

B

Beliefs, see Attitudes and beliefs

Bing Foundation, 108

Biopsies, 92-93, 156

Bladder cancer, 61, 88

Bone and bone marrow, 23, 59, 60, 127, 190, 203

see also Leukemia

Breast cancer, 3, 10, 11, 53, 91-103, 108-109, 151, 156, 159, 187, 189-190, 192, 193, 198, 203, 216

adjuvant therapy, 94-95, 98, 99, 101-102, 108, 109, 153, 171, 173

age factors, 54, 91, 99-101, 167;

see also ''elderly persons'' infra

chemotherapy, 60, 82, 94-95, 96, 98-99, 109, 129, 167, 171, 173, 174

clinical practice guidelines, 99, 165, 166, 167, 169, 171, 173, 174

cost of, 36

DoD program, 199-200, 201

elderly persons, 14, 42, 51, 54, 99-101, 134-135, 194, 196

mammography, 14, 42, 51, 54, 192, 197

incidence, 20, 91, 157

outcome analysis, 109, 126, 152, 185-186, 194;

see also "survivorship" infra

radiation therapy, 97, 98, 100, 101, 102, 108, 134, 159, 171, 173, 174

research funding, 8, 10, 185, 186, 187, 199

screening, 3, 14, 22, 42, 50-57 (passim), 83, 87, 91-94, 156, 167, 185-186, 189, 198, 200, 201, 205, 216, 224;

see also Mammography SEER, 60, 100, 108-109, 186

specialty care, 128, 129-130

standards, 3, 92, 102, 167, 173

surgery, 14, 59, 88, 94, 95-102, 109, 126, 129, 133-135, 153, 159, 160, 165, 173, 189, 204, 217

survivorship, 46, 88, 94, 126, 128, 129, 133, 134-136, 159

treatment, 3, 14, 23, 27, 28, 30, 31, 42, 46, 58, 59, 60-62, 82, 92, 94-103, 126, 108, 109, 126, 128, 129-130, 132, 133, 134-136, 153, 156, 159, 186, 189, 200, 201;

see also "chemotherapy," "clinical practice guidelines," and "radiation therapy" supra

Breast Cancer Surveillance Consortium, 185-186

Bronchial cancer

incidence, 20

survival rates, 47

treatment, 30

C

Canada, 51, 129, 130, 132-133, 171

Cancer at the Crossroads, 13

Cancer Care, 49

Cancer care centers, 18, 19, 34, 90, 146-147, 160-163, 165, 171

National Comprehensive Cancer Network, 90, 165, 166, 167

Cancer registries, 89, 90, 98, 100, 117, 136, 153, 154, 161, 185, 194, 203

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

see also National Cancer Data Base;

Surveillance, Epidemiology, and End Results program

Cancer Surveillance Research Program, 185

Centers for Disease Control and Prevention, 11, 18-19, 49, 154, 180 , 185, 197-199, 224

Cervical cancer, 11, 14, 22, 42, 51, 171, 187, 189, 190, 192, 193

Pap smears, 22, 51, 54-55, 56, 57, 190

research funding, 185, 187

Cervical Cancer Early Detection Program, 11

Chemotherapy, 3, 4, 22, 23, 30, 31, 49, 58, 60, 62, 82, 83, 88, 217

breast cancer, 60, 82, 94-95, 96, 98-99, 109, 129, 167, 171, 173, 174

clinical practice guidelines, 166, 169-170, 173, 174

insurance coverage, 50, 59

international perspectives, 171-172

lung cancer, 166-167, 190

prostate cancer, 107

side-effects, 24

specialty care and, 128, 129, 130, 131

standards, 164

see also Drugs

Children, 19, 49, 188, 195-196, 206

incidence, 20

treatment, 34, 62

Clinical practice guidelines, 4-5, 7-8, 15, 18, 23, 34, 43, 62, 64 -65, 99, 119, 133, 144, 148, 154-155, 164-174, 175, 195, 212, 220

American Society of Clinical Oncology, 26, 166-167

breast cancer, 99, 165, 166, 167, 169, 171, 173, 174

chemotherapy, 166, 169-170, 173, 174

colorectal cancer, 166, 169, 171, 172, 173, 174

defined, 164-165

lung cancer, 166-167, 169, 172

managed care, 172

ovarian cancer, 171, 172, 174

patient education, 165, 168, 173

proprietary, 166

prostate cancer, 165, 170-171, 172

surgery, 99, 133, 166, 167, 170-171, 172

Clinical trials, 4, 8, 23, 62-63, 117, 129, 146, 181, 182, 187, 191 , 194-195, 200, 213, 217, 220, 221

age factors, 62, 63

breast cancer, 94, 132

evidence criteria, 82, 194

funding, 8, 43, 221

insurance coverage, 43, 63

international perspectives, 34

managed care, 37, 41, 63

minority groups, 34, 62-63

NCI, 34, 62, 99

postoperative survival, 83

private sector, 8, 213

prostate cancer, 103

publication bias, 118, 138

standards, 162

women, 62-63, 94, 132

Cochrane Collaboration, 207, 208-209

Colorectal cancer, 88, 156

adjuvant therapy, 173

chemotherapy, 83, 173

clinical practice guidelines, 166, 169, 171, 172, 173, 174

cost of, 36, 199

elderly persons, 51, 153

incidence, 20

insurance, 42, 136

minorities, 47

screening, 22, 42, 51, 54, 57, 58, 193, 198, 199, 203, 205

treatment, 27, 28, 30, 31, 61, 82, 83, 88, 132-133, 153, 156, 173, 203, 204

Community Clinical Oncology Program, 34, 99

Community Hospital Oncology Program, 168-169

Complementary treatments, 24, 204

Continuous quality improvement programs, 163-164

Cooperative Group Program, 34

Coordination of care, 7, 26, 30, 41, 46, 214, 215, 220

disease management specialists, 40-41, 133

federal, 2, 19, 41, 145, 175

Costs, 20, 35-36, 182, 194, 206

age factors, 36

breast cancer, 36

clinical practice guidelines, 172-173

colorectal cancer, 36, 199

disease management specialists, 40-41, 133

individual patient, 10, 20, 35, 47, 48, 50, 64

insurance premiums, 47, 48, 50, 52

national costs of cancer, general, 20, 35-36, 41

out-of-pocket, 50, 52, 57, 59, 64, 66

screening, 50, 52, 57, 186, 189, 190

treatment, general, 35, 186, 189, 190

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

Counseling, see Patient education and counseling; Psychosocial impacts and support

Cultural factors, 14, 16, 24, 46, 47, 53, 66, 79

see also Language factors

D

Databases, 8-9, 57, 138-139, 152, 221

CONQUEST, 194

consumer education, 148

HEDIS, 152, 154, 156-158

insurance, 9, 98, 152, 154, 156-158

NLM/HSRProj, 181-183, 184, 192, 197, 206

screening, 57, 157

see also Cancer registries

Data collection and surveillance, 88-90, 138-139, 154, 180-209, 213 , 220-223

breast and colorectal cancer, 166

funding, 8, 10, 18

HCFA, 152, 197

national studies, 10

patient records, 3, 88-89, 98, 101, 117, 123-124, 125, 160, 212

posttreatment surveillance, 25, 63, 203

recommendations, 8-9

see also Cancer registries;

Clinical trials;

Monitoring and reporting;

National Cancer Data Base;

Surveillance, Epidemiology, and End Results

program

Decision making, 148, 201, 220

consumer information, 146-148;

see also Public education

patient-centered care, 23, 79, 165, 194

public policy, 80

treatment options, 2, 3, 6-7, 59, 62, 80, 83, 105-106, 170-171, 175 , 220

Demographic factors, 11, 47

data collection practices, 9, 90

rural areas, 4, 54, 56, 58, 129, 198, 212, 216

urban areas, 4, 54, 58, 93, 129, 134, 135, 136, 198, 212, 216

see also Age factors;

Educational attainment;

Gender differences;

Geographic factors;

Minority groups;

Poverty;

Socioeconomic status

Department of Defense, 180, 199-202

Department of Health and Human Services, 184-199

see also National Cancer Institute;

other specific agencies and offices

Department of Veterans Affairs, 104, 125, 180, 202-203

Depression, 64-65

Diagnoses, 2, 15, 19, 20, 22, 41, 79, 154

biopsies, 92-93, 156

guidelines, 4-5

HEDIS, 157

insurance, 41, 48

late-stage cancers, 8, 51, 117-118, 128

lung cancer, 117

national statistics, 13

see also Screening

Diet and nutrition, 24, 162

Documented Outcomes Collection System, 90

Drugs

end-of-life care, 64

insurance coverage, 10, 43, 49, 50, 66, 223-224

Medicare coverage, 50, 66

prostate cancer, 107

standards, 162, 164, 168

see also Chemotherapy;

Hormone therapy;

Pain and pain management

E

Economic factors, 13-14, 15, 116, 181, 182

fee-for-service care, 37, 39, 40, 43, 99, 116, 117, 133-137, 138, 151-152

loss of earnings, 20, 35

market forces, general, 145, 150-151

screening incentives, 55, 56

see also Costs;

Health insurance;

Poverty;

Socioeconomic status

Education, see Patient education and counseling: Professional education; Public education

Educational attainment, 11, 47, 53, 61, 134, 148

Elderly persons, 224, 225

breast cancer, 14, 42, 51, 54, 99-101, 134-135, 194, 196

mammography, 14, 42, 51, 54, 192, 197

clinical trials, 62

colorectal cancer, 51, 153

educational interventions, 191

incidence, 20, 37, 145-146

pain management, 47, 64, 191

prostate cancer, 103, 152, 153

screening, 54;

see also "breast cancer-mammography" supra

SEER, 186

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

treatment, 11-12, 30, 31, 32, 33, 59, 60-61, 62, 66, 99-101, 121, 128, 136, 152, 196

see also Medicare

Emotional support, see Psychosocial impacts and support

Employee Retirement Income Security Act, 39-40, 41

End-of-life care, 25-26, 33, 63-66, 67, 191, 193, 194, 213, 220

chemotherapy, 167

hospice care, 65, 149, 152, 163, 197

Medicare, 64

patient education, 25-26, 64-65

England, 129, 130, 133

Esophageal cancer, 4, 121, 122

Ethnicity, see Minority groups

F

Federal government, general, 16, 18-19, 144, 151

clinical trials, funding, 8

coordination of agencies, 19, 145

coordination of care, 2, 19, 41, 175

research sponsorship, 180, 184-203

see also Legislation, federal;

specific departments and agencies

Fee-for-service care, 37, 39, 40, 43, 99, 116, 117, 133-137, 138, 151-152

see also Medicare

Food and Drug Administration, 92

Foreign countries, see International perspectives; specific countries

Foundation for Accountability, 146, 158, 159

France, 171-172, 174

Funding

breast cancer research, 8, 10, 185, 186, 187, 199

research, other, 8, 18, 180, 181, 185, 187, 193, 197, 200, 202, 203 , 205, 209

G

Gender differences

incidence, 20

physician attitudes toward screening, 55

treatment, 61, 135

see also Men;

Women

General Accounting Office, 81-82

Geographic factors, 14

as access barrier, 11, 46, 224

insurance, 197

screening, 136, 152

SEER, 9, 89, 222

survivorship, 118

treatment, 58-59, 62, 95-96, 133, 136, 204

see also Regional factors;

Rural areas;

Urban areas

Guidelines, see Clinical practice guidelines

H

Health Care Financing Administration, 6, 19, 39, 146, 151-154, 175 , 185, 196-197, 209, 219

SEER-Medicare data, 9, 89, 108, 121, 123, 134, 138, 185, 186, 196

Health Care Quality Improvement Program, 152

Health insurance, 1, 6-7, 14, 15, 18, 32, 47, 117, 133-137, 146, 149

accountability, 144

accreditation, 6, 39, 151-152, 174, 175, 219

age factors, 117

colorectal cancer, 42, 136

complaints and appeals, 39-40

costs to individuals

out-of-pocket, 50, 52, 57, 59, 64, 66

premiums, 47, 48, 50, 52

databases, 9, 98, 152, 154, 156-158

disease management specialists, 40-41, 133

drugs, 10, 43, 49, 50, 66, 223-224

chemotherapy, 50, 59

HMOs, 35, 36, 37, 38, 39, 54, 57, 117, 133-137, 138, 152, 186-187, 199

legislation, federal, 38, 48

legislation, state, 11, 39, 40, 41, 42-43

mammography, 42

preferred provider organizations, 152, 155, 158

standards, 175;

see also "accreditation" supra

treatment, 10, 41, 42, 43, 49, 50, 59, 66, 98, 99, 223-224

uninsured/underinsured persons, 10, 11, 13-14, 15, 35, 48-49, 66, 213, 223-224

see also Managed care;

Medicaid;

Medicare

Health Insurance Portability and Accountability Act, 48

Health Maintenance Organization Act, 38

Health maintenance organizations, 35, 36, 37, 38, 39, 54, 57, 117, 133-137, 138, 151-152, 186-187, 199

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

Cancer Research Network, 186-187

Health Plan Employer Data Information Set (HEDIS), 152, 154, 156-158

Health services research, defined, 181

Healthy People 2000, 154

Hematopoietic growth factors, 169-170

Hill-Burton Act, 48

Hispanics, 47, 190, 191

screening, 53, 54-55

treatment, 59

HMO Cancer Research Network, 186-187

Hodgkin' s disease, 82, 129

Home care, 32, 163

Hormone therapy, 22, 23, 32, 60, 94-95, 98, 107, 174, 188

Hospice care, 65, 149, 152, 163, 197

Hospitals, 19, 30-34, 59, 118

approval/accreditation status, 6, 30-31, 146-147, 152, 155, 158, 219

breast cancer surgery, 42, 97, 101, 135

charity requirements, 48

clinical trials, 34

costs, 35

National Cancer Data Base, 89-90

pain management, 153

specialist, 128-130, 133

volume-outcome relationship, 4, 116, 118-128, 151, 212, 217

see also Cancer care centers;

Surgery

HSRProj, 184, 192, 197, 206

I

Immune system, 23

Incidence, 13, 20

African Americans, 20, 21

breast cancer, 20, 91, 157

by cancer site, 21-22

elderly persons, 20, 37, 145-146

Insurance, see Health insurance

Interdisciplinary approaches, 26, 36, 61, 65, 119, 130, 139, 149, 161, 162, 167

continuous quality improvement programs, 163-164

patient education, 26, 30, 65

research, 180, 181

see also Specialists and specialist care

International Bone Marrow Transplant Registry, 127

International perspectives, 126-128

chemotherapy, 171-172

clinical trials, 34

specialty care, 129

see also specific countries

Internet, 15 (footnote), 145, 146, 155, 158, 184, 185, 194, 197

Italy, 171, 173

J

Joint Commission on Accreditation of Healthcare Organizations, 146 , 155, 156, 160

L

Language factors, 11, 46, 47

Larnyx cancer, 27, 28

Legislation, federal, 18, 19, 39, 182

Employee Retirement Income Security Act, 39-40, 41

Health Insurance Portability and Accountability Act, 48

Health Maintenance Organization Act, 38

Hill-Burton Act, 48

Mammography Quality Standards Act, 186

National Cancer Act, 13, 18, 19, 89

National Institutes of Health Revitalization Act, 62-63, 165

Patient's Bill of Rights, 41

Legislation, state, 18, 19, 67, 182

insurance, 11, 39, 40, 41, 42-43

Leukemia, 4, 27, 28, 30, 61, 127-128, 190

Liver cancer, 102, 121, 122

Local factors, 2, 4, 166

Lung cancer, 4, 10, 156

chemotherapy, 166-167, 190

clinical practice guidelines, 166-167, 169, 172

incidence, 20

SEER, 185

survivorship, 47, 88, 117-118

treatment, 27, 28, 30, 31, 59, 60, 61, 82, 117-118, 119-122, 156, 166-167, 185, 190, 203

Lymphoma, 27, 28, 30, 31, 61, 82, 88

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

M

Mammography, 3, 14, 22, 50-57 (passim), 83, 87, 91-92, 102, 108, 159, 167, 185-186, 189, 196, 198, 205, 216

age factors, 54, 91, 167

insurance, 42

standards, 3, 92, 102, 167, 173

Mammography Quality Standards Act, 186

Managed care, 6, 16, 36, 37-43, 116, 133-137, 138, 146, 144, 196

clinical practice guidelines, 172

clinical trials, 37, 41, 63

defined, 37, 38

HMOs, 35, 36, 37, 38, 39, 54, 57, 117, 133-137, 138, 152, 199, 186 -187

Medicare, 36, 37, 39, 134-135, 151-152

pain management, 193

preferred provider organizations, 152, 155, 158

screening, 40-41, 42, 52, 54

specialist care, 37-38, 40-41, 133

surgery, 38, 42

see also Employer-based plans

Market forces, 145, 150-151

Mass media, 147, 198

Internet, 15

(footnote), 145, 146, 155, 158, 184, 185, 194, 197

see also Public education

M.D. Anderson Cancer Center, 165

Measurement issues, 1, 2, 3, 5, 15, 16, 67, 80-88, 107-109, 116-139 , 145, 212, 215-216, 218-219

managed care vs fee-for-service care, 133-137

process quality, 80, 81-84, 94, 108, 116, 126, 128, 135, 152, 181

structural quality, 80, 80-81

see also Monitoring and reporting;

Outcome analysis

Medicaid, 6, 10, 34, 42, 43, 48, 52, 66, 99, 153, 197, 198, 212, 219

complaints and appeals, 39

Medical records, 3, 88-89, 98, 101, 117, 123-124, 125, 160, 212

Medicare, 2, 6, 10, 30, 34, 48, 52, 66, 99, 100, 136, 145-146, 175 , 196-197, 198, 212, 219

certification of providers, 151-153

complaints and appeals, 39

coverage options, 152

drug coverage, 50, 66

end-of-life care, 64

managed care, 36, 37, 39, 134-135, 151-152

out-of-pocket costs, 50, 64

SEER linked to, 9, 89, 108, 121, 123, 134, 138, 185, 186, 196-197

Medline, 181-183

Memorial Sloan-Kettering Cancer Center, 165

Men, 33, 58

incidence, 20

see also Prostate cancer

Minority groups, 11, 47, 190, 191, 198, 202, 224

Asians, 54, 190, 206

clinical trials, 34, 62-63

Hispanics, 47, 53, 54-55, 59, 190, 191

hospitalizations, 33

Native Americans, 47, 191, 198

pain management, 64

screening, 51, 53-55, 58, 62, 189, 190, 198

survival rates, 20, 21, 47

treatment, 59, 61, 62-63, 66, 205

see also African Americans

Monitoring and reporting, 2, 5, 6, 117-118, 215, 218, 220-223

see also Data collection and surveillance

Mortality rates, 4, 9, 86

breast cancer, 91

national statistics, 13

prostate cancer, 103

volume-outcome relationship, 4, 116, 118-128, 151, 212, 217

see also Survivorship

Multidisciplinary care, see Interdisciplinary approaches; Specialists and specialist care

N

National Ambulatory Medical Care Survey (NAMCS), 27, 30

National Cancer Act, 13, 18, 19, 89

National Cancer Advisory Board, 19

National Cancer Data Base, 9, 89-90, 109, 124, 160, 222

National Cancer Institute, 8, 18, 19, 34, 99, 104, 148, 185-192, 209

clinical trials, 34, 62, 99

funding, 185, 186

Office of Cancer Survivorship, 187-188

see also Surveillance, Epidemiology, and End Results program

National Cancer Policy Board, 65-66, 180, 181, 184, 211, 214-215, 216

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

National Cancer Program, 19

National Center for Chronic Disease Prevention and Health, 198-199

National Center for Health Statistics, 27, 199

National Coalition of Cancer Survivors, 149

National Committee for Quality Assurance, 6, 146

HEDIS, 152, 154, 156-158

National Comprehensive Cancer Network, 90, 165, 166, 167

National Hospital Ambulatory Medical Care Survey (NHAMCS), 27, 30

National Institute of Dental Research, 192

National Institute on Aging, 192

National Institutes of Health, 185-192

see also National Cancer Institute

National Institutes of Health Revitalization Act, 62-63

National Library of Medicine, 181, 192

Native Americans, 47, 191, 198

Nontraditional treatments, see Alternative treatments

Norway, 130

Nurses and nursing, 26, 30, 162, 200, 204

Nutrition, see Diet and nutrition

O

Office of Cancer Survivorship, 187-188

Organ Transplant Fund, 49

Outcome analysis, 9, 10, 40, 66, 80, 81, 84-87, 90, 116, 117, 154, 181, 194, 205

breast cancer, 109, 126, 152, 185-186, 194

funding, 185

process and, 83-84, 116, 130

prostate cancer, 104, 105, 106, 109, 125, 185, 194, 200, 205

specialist care, 128-133, 137-138

survival rates in, 84-85, 86, 88, 117-118, 122-133

volume-outcome relationship, 4, 116, 118-128, 137, 151, 212, 217

see also Survivorship

Outcomes and Assessment Information Set (OASIS), 152

Outpatient care, see Ambulatory care

Ovarian cancer, 88, 128, 130-131, 171, 172, 174, 200

P

Pacific Business Group on Health, 151

Pain and pain management, 7-8, 10, 24, 25, 30, 64, 67, 149, 153, 190, 191, 194

American Pain Society, 153

attitudes toward pain, 53

clinical guidelines, 4-5, 165, 170

elderly persons, 47, 64, 191

managed care, 193

prostate cancer, 107

socioeconomic status, 47

standards, 4-5, 153, 163, 165

Palliative care, see Pain and pain management

Pancreatic cancer, 4, 119, 121, 122, 124-125, 128-129, 190

Pap smears, 22, 51, 54-55, 56, 57, 190

Patient education and counseling, 23, 30, 105, 148, 149, 150, 153, 182, 188

clinical practice guidelines, 165, 168, 173

diagnosis, 2

end-of-life care, 25-26, 64-65

insurance coverage, 55

interdisciplinary, 26, 30, 65

screening, 55, 57

side-effects, 59

standards, 161, 162, 165, 168, 173

telephone services, 57, 148, 205

treatment options, 2, 3, 6-7, 59, 62, 80, 83, 105-106, 170-171, 175 , 220

see also Psychosocial impacts and support

Patient Outcomes Research Teams, 194

Patterns of Care studies, 90, 185, 192, 204

Peer review organizations, 152, 153

Pharmaceuticals, see Chemotherapy; Drugs; Hormone therapy

Physician Data Query system, 148

Physicians, 14, 18, 26, 27, 31, 130-133, 138, 146, 197, 204

access to, 54-55

accountability, 6, 40

ambulatory care, 27-30

attitudes and beliefs of, 54, 55, 59, 60, 63, 85

board certification, 6, 26, 219

clinical trials, 34

costs associated with, 35

elderly patients, 54, 60

managed care and, 38, 40

performance assessment, 83

referral to specialists, 38

screening variables, 54, 55, 56, 66

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

specialty care, 130-133, 138, 146

treatment variables, 59, 60, 61-62

volume-outcome relationship, 118

Poverty, 66, 190, 224

cervical cancer, 51, 224

end-of-life care, 64

screening, 19, 43, 49, 51, 53, 56, 224

survival rates, 47

treatment, 43, 59

uninsured/underinsured, 10, 11, 13-14, 15, 35, 48-49, 66, 213, 223-224

Preferred provider organizations, 152, 155, 158

Preventive interventions, 11, 15, 87, 90-91, 134, 149, 154, 188, 189, 190-191, 193

guidelines, 4-5, 162

NCI, 19

smoking, 87, 187

see also Screening

Preventive Services Task Force, 104, 195

Private sector, general, 15, 16, 144, 175, 203-209, 218

clinical practice guidelines, 165

clinical trials, 8, 213

market forces, 145, 150-151

public-sector collaboration, 5, 175, 212, 218

research sponsorship, 180

see also Health insurance;

specific organizations

Professional education, 2, 9, 182, 212

end-of-life care, 67

health services research, 10

lack of appropriate, 47

screening, 56

standards, 161, 162, 168

see also Clinical practice guidelines

Prostate cancer, 4, 88, 103-109, 125, 194, 198-199, 200-201, 202-203, 205-206

age factors, 103, 105, 202

American Urological Association, 90, 104, 105, 106, 166, 179-171

chemotherapy, 107

clinical practice guidelines, 165, 170-171, 172

cost of, 36, 201

elderly persons, 103, 152, 153

incidence, 20, 103

insurance, 42, 136

radiation therapy, 105-107, 170-171

screening, 22, 42, 103, 104-105, 186, 190, 193, 198-199, 200, 201, 202

surgery, 103, 105, 106, 107, 125, 152, 153, 170-171, 204, 217

survivorship, 104, 105, 107, 108

treatment, 27, 28, 30, 31, 61, 103-108, 125, 170-171, 186, 190, 199, 200

Prostate Cancer Intervention Versus Observation Trial, 103

Prostate, Lung, Colorectal, and Ovarian screening trial, 103

Psychosocial impacts and support, 7, 25-26, 30, 149, 150, 153, 163, 187, 188, 190, 198, 200, 201, 205, 206, 220

end-of-life care, 64-66

pastoral care, 162

see also Decision making

Public education, 34, 57, 146-150, 151, 158, 182, 198, 212, 220

Internet, 15 (footnote), 145, 146, 155, 158, 184, 185, 194, 197

mass media, 147, 198

standards, 161

Public opinion, 1, 2, 13, 14, 150

see also Mass media

Put Prevention into Practice, 195

Q

Quality Interagency Coordination Health Care Task Force, 145

Quality of care, defined, 79, 116, 211-213, 215-216

R

Race/ethnicity, see Minority groups

Radiation therapy, 3, 22, 23, 61, 62, 83, 88, 90, 128

American College of Radiology, 90, 106-107

attitudes toward, 53

breast cancer, 97, 98, 100, 101, 102, 108, 134, 135, 159, 171, 173, 174

insurance coverage, 59

prostate cancer, 105-107, 170-171

specialist certification, 26

RAND, 108

Recurrent cancers, 8, 25, 104, 188

Rectal cancer, see Colorectal cancer

Referral to care, 38, 39, 96, 146, 151, 224

Regional factors, 2, 62, 116

breast cancer, 95, 97

Medicare reporting, 6

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

see also Geographic factors;

Rural areas;

Urban areas

Reporting systems, see Data collection and surveillance; Monitoring and reporting

Reproductive effects, see Sexual and reproductive effects

Research Data Assistance Center, 197

Road to Recovery, 49

Rural areas, 4, 54, 56, 58, 129, 191, 198, 212, 216

S

Scotland, 126-127, 130, 132, 172

Screening, 3, 5, 11, 22, 48-49, 50-56, 90-91, 149, 154, 189, 190, 198

African Americans, 51, 53, 54-55, 58, 62, 189, 198

breast cancer, 3, 14, 22, 42, 50-57 (passim), 83, 87, 91-94, 156, 167, 185-186, 189, 198, 200, 201, 205, 216, 224;

see also Mammography

cervical cancer, 11, 14, 51, 185

colorectal cancer, 22, 42, 51, 54, 57, 58, 193, 198, 199, 203, 205

costs of, 50, 52, 57, 186, 189, 190

databases, 57, 157

follow-up, 5, 56-58, 91-94

geographic factors, 136, 152

HEDIS, 157

Hispanics, 53, 54-55

insurance coverage, 40-41, 42, 52

managed care, 40-41, 42, 52, 54

minority groups, 51, 53-55, 58, 62, 189, 190, 198

patient education, 55, 57

poor persons, 19, 43, 49, 51, 53, 56, 224

prostate cancer, 22, 42, 103, 104-105, 186, 190, 193, 198-199, 200, 201, 202

standards, 162, 167, 168

women, general, 51, 53, 55, 57, 190;

see also Mammography;

Pap smears

Sexual and reproductive effects, 188

Side-effects, 24, 59, 64, 187, 188, 225

prostate cancer, 103, 105-106

Skin cancer, 22, 27, 28, 30, 31, 192, 203

Smoking, 87, 187

women, 20

Social factors, see Cultural factors; Demographic factors; Psychosocial impacts and support; Socioeconomic status

Social Security Administration, 39

Society for Surgical Oncology, 166

Socioeconomic status, 14, 47, 48, 224

breast cancer survival, 136

educational attainment, 11, 47, 53, 61, 134, 148

end-of-life care, 64

prostate cancer, 198

treatment, 61, 66

see also Poverty

Specialists and specialist care, 16, 26-27, 55, 116, 128-133

ambulatory care, 27

breast cancer, 128, 129-130

certification, 26, 146

chemotherapy, 128, 129, 130, 131

diagnosis, 22

hospitals, 128-130, 133

insurance, disease management specialists, 40-41, 133

international perspectives, 129

managed care and, 37-38, 40-41, 133

surgery, 129, 130-133

survival rates and, 128-133

see also Interdisciplinary approaches

Standards, 2, 23, 37, 81, 102, 155, 214

accreditation/approval, 6, 30-31, 39, 81, 146-147, 148, 151-152, 155-164, 174, 219

insurers, 6, 39, 151-152, 174, 175, 219

ambulatory care, 163

breast cancer, 3, 92, 102, 167, 173

chemotherapy, 164

continuous quality improvement programs, 163-164

data collection, 154, 164, 175

diagnostic/screening, 154

drugs, 162, 164, 168

HEDIS, 157

hospital program approval, 6, 30-31

mammography, 3, 92, 102, 167, 173

National Coalition for Cancer Survivorship, 149-150

pain management, 4-5, 153, 163, 165

patient education, 161, 162, 165, 168, 173

professional education, 161, 162, 168

public education, 161

research, 13, 82, 83

screening, 162, 167, 168

specialist certification, 26

staging classification, 198

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

survivorship, 161

see also Clinical practice guidelines

State-level actions, 144, 151, 154, 203

insurance, 11, 39, 40, 41, 42-43, 49

legislation, 18, 19, 67, 182

insurance, 11, 39, 40, 41, 42-43

National Cancer Data Base, 9, 89-90, 109, 124, 160, 222

peer review organizations, 152, 153

Supplemental Security Income, 48

Surgery, 22-23, 59, 61, 83, 88, 90, 190, 217

ambulatory care, postoperative, 30

American College of Surgeons, 6, 9, 30-31, 124, 147, 155, 158, 160, 174, 203

breast cancer, 14, 59, 88, 94, 95-102, 109, 126, 129, 133-135, 153, 159, 160, 165, 173, 189, 204, 217

clinical practice guidelines, 99, 133, 166, 167, 170-171, 172

high-risk, 4, 119-125, 217

managed care, 38, 42

ovarian cancer, 130-131

prostate cancer, 103, 105, 106, 107, 125, 152, 153, 170-171, 204, 217

specialty care, 129, 130-133

volume-outcome relationship, 4, 116, 118-128, 137, 151, 212, 217

see also American College of Surgeons

Surveillance, see Data collection and surveillance

Surveillance, Epidemiology, and End Results program, 9, 89, 90, 185, 186, 222

breast cancer, 60, 100, 108-109, 186

elderly persons, 186

geographic coverage, 9, 89, 222

incidence, by race, 21

Medicare linked to, 9, 89, 108, 121, 123, 134, 138, 185, 186, 196

overview and goals, 89

specialist care, 128, 129

survival rates, 21, 88

treatment, 9, 82, 185

Survivorship, 7, 117-118, 149-150, 187-188, 204

African Americans, 20, 21, 47

breast cancer, 46, 88, 94, 126, 128, 129, 133, 134-136, 159

costs and, 36-37

follow-up care, 8, 13, 25, 96, 102-103, 149-150

geographic factors, 118

insurance and, 48

length of, 9

lung cancer, 47, 88, 117-118

minority groups, 20, 21, 47

national statistics, 13

outcome measures, survival rates as, 84-85, 86, 88, 117-118, 122-133

patient overestimation, 65

process measures, 81-82, 116, 130

prostate cancer, 104, 105, 107, 108

rates, by cancer site, 88

rates, by race, 21

special care and, 128-133

standards, 161

see also End-of-life care;

Outcome analysis

Susan Komen Foundation, 187

Sweden, 130

T

Taking Action to Reduce Tobacco Use, 14

Tamoxifen, 94-95, 171

see also "chemotherapy" under Breast cancer

Telephone services, 57, 148, 205

Testicular cancer, 4, 126, 129, 130

Time-series studies, 82

Total quality management programs, see Continuous quality improvement programs

Transportation, 49

Treatment, 9, 13, 15, 18, 20, 22-26, 49, 58-63, 89, 138, 149, 167, 187, 189, 193-194

African Americans, 59, 62, 63, 205

age factors, 60-61, 62, 99-101, 120

alternative, 24, 204

appropriateness of, 2, 59, 81, 128

children, 34, 62

costs, general, 35, 186, 189, 190

decision making, treatment options, 2, 3, 6-7, 59, 62, 80, 83, 105-106, 170-171, 175, 220

elderly persons, 11-12, 30, 31, 32, 33, 59, 60-61, 62, 66, 99-101, 121, 128, 136, 152, 196

follow-up care, 8, 13, 25, 96, 102-103, 149-150

gender differences, 61, 135;

see also Women

geographic factors, 58-59, 62, 95-96, 133, 136, 204

Hispanics, 59

insurance coverage, 10, 41, 42, 43, 49, 50, 59, 66, 98, 99, 223-224

minorities, 59, 61, 62-63, 66, 205

physician variables, 59, 60, 61-62

posttreatment surveillance, 25, 63, 203

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

recurrent/late-stage cancers, 8, 25

SEER, 9, 82, 185

women, general, 59, 60, 61, 62-63;

see also Breast cancer;

Cervical cancer;

Ovarian cancer

see also Adjuvant therapy;

Ambulatory care;

Clinical trials;

Drugs;

Interdisciplinary approaches;

Outcome analysis;

Pain and pain management;

Radiation therapy;

Side-effects;

Specialists and specialist care;

Surgery;

''treatment'' subheads under specific cancers/cancer sites

U

Unconventional treatments, see Alternative treatments

United Kingdom, 129, 130-131, 133, 182

Scotland, 126-127, 130, 132

Urban areas, 4, 54, 58, 93, 129, 134, 135, 136, 191, 198, 212, 216

Utilization reviews, 38, 46, 182

V

Volume-outcome relationship, 4, 116, 118-128, 137, 151, 212, 217

W

War on Cancer Act, see National Cancer Act

Women, 33

clinical trials, 62-63

colorectal cancer, 51

female physicians, 55

pain relief, 47

screening, general, 51, 53, 55, 57, 190;

see also Mammography;

Pap smears

smoking, 20

treatment, general, 59, 60, 61, 62-63

see also Breast cancer;

Cervical cancer;

Ovarian cancer

World Wide Web, see Internet

Suggested Citation:"Index." 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 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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