Quality of Care Review: Some Progress, and Toward What Goal?

Abstract

TO THE EDITOR: Drs Lorenz and Ganz brought together a stellar group of investigators providing a comprehensive review on quality of care and supportive care in oncology. I commend the authors for stating up front that an examination of quality of care in oncology needs to include not only the supportive and end-of-life aspects, but also the entire spectrum of clinical care. However, having emphasized the multidisciplinary aspects of palliative care, the authors failed to review the progress of supportive care in surgical and radiologic treatments of the cancer patient. One of the most important contributions of health-related quality-of-life research to clinical care is the inclusion of patient and family input into the decision-making process for the treatment of cancer. Whether the decision is to proceed with a major curative operation or embark on several months of systemic chemotherapy, the decision-making process has largely been based on survival and morbidity-mortality rates, performance status, molecular markers, and other clinical end points. The patient may be provided with a detailed explanation of the scientific basis of the treatment options. However, patient and family involvement in the decision-making process has been peripheral. Today, the patient can choose among several treatment options resulting in better quality of life, and sometimes not take advantage of the curative potential of other, more disabling treatment options. For example, neoadjuvant chemotherapy with complete or partial responses can allow organ preservation with minimal compromise in eventual survival rates. The need for additional research in quality of care has been outlined by several authors. In oncologic surgical care, the need for research into quality of care and palliative surgery has been underestimated. Just as quality-of-life measures have been incorporated into several phase III trials, these measures should also be incorporated into newer, minimally invasive surgical treatment evaluations. Lack of awareness and underuse of supportive care services have also been well documented. There is a general consensus about the need to evaluate quality of care. However, there is neither a consensus nor a clinical standard in the measure of quality of care. These measures need to be simple and easily applied at the bedside or clinic. The adopted measure has to be reproducible among different investigators and clinicians across different institutions. The end points from these measures need to be consistent with other clinical standards, and when applied to patient care, the results will indicate improved, cost-effective patient management.