Abstract
Cancer is one of the most complicated diseases to diagnose and treat, requiring sophisticated pathological and imaging studies that are evaluated by multiple independent health care professionals. Most cancer therapies are expensive and toxic, and patients are treated with them for prolonged periods of time. When a person is told they have cancer, they often “shut down” and no longer hear anything further about the treatments that are being recommended. They enter a complex and fragmented cancer care system in which palliative care and psychosocial support are inadequately provided and hospice referral occurs far too late in the course of treatment. Many of these issues were identified in the transformative 1999 Institute of Medicine (IOM) report “Ensuring Quality Cancer Care,” which recommended structural changes to cancer care delivery and the development of a quality monitoring system. Unfortunately, many of the gaps in cancer care that the IOM identified more than a decade ago have been magnified today as a result of an explosion in knowledge of cancer biology, earlier diagnosis as a result of screening, more indications for adjuvant and multimodal therapies, and increasing numbers of long-term survivors. Cancer care accounts for a substantial proportion of health care expenditures, and the delivery system is being stressed by the aging of the population. The quality of cancer care in the United States is uneven, with few metrics to assess treatment outcomes among practitioners and in various clinical settings. With increasing demand for services, anticipated workforce shortages, and the rising costs of cancer care, delivery of affordable, accessible, high-quality cancer care in the future is in jeopardy. Given this situation, in 2012, an IOM committee composed of 17 individuals from diverse clinical backgrounds (medicine, nursing, oncology specialties, geriatrics, ethics, health outcomes research, palliative care, and patient advocacy) was asked to examine these issues and to make recommendations on how to improve the quality
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