Archive for July, 2009
Quality of Care Issues Reflected in Cancer Statistics
The Panel reviewed current cancer rates and trends for the most prevalent cancers in various population subgroups. For the first time since cancer statistics have been collected, mortality from all cancers declined, albeit only 2.6 percent . These declines accrued principally to those under age 65, and to men more than to women. It is expected that more than 1.2 million new cases of cancer will be diagnosed, and cancer will claim more than a half million Read the rest of this entry »
Coordination of the National Effort Against Cancer
Coordination continues to be an issue in the national cancer effort. Many in the research and clinical communities believe that coordination cannot be achieved without undue structure, control, or an undesirable vesting of power in a single agency or group. The central issues concern autonomy and ensuring that views and ideas outside the mainstream or status quo will be heard, but the issues differ somewhat between the research and delivery Read the rest of this entry »
Scope of the National Effort Against Cancer
The current National Cancer Program, as it is understood by most, is overwhelmingly a research program that places relatively little emphasis on cancer prevention, cancer control, and patient outcomes (i.e., what happens to people with cancer) compared with its emphasis on basic (i.e., laboratory and preclinical) science discoveries.36 To support the application of new discoveries to Read the rest of this entry »
CONCERNS ABOUT CANCER CARE IN THE UNITED STATES
The cancer care needs of special populations formed the principal focus of the Panel’s meetings ; however, these meetings illuminated quality of care and quality of life issues relevant to all populations. Testimony from 54 speakers at three meetings detailed quality issues as they are reflected in cancer statistics, issues specific to our growing aging population, and current health care system concerns that affect the quality of cancer care and patients’ quality of life.
Funding of the National Cancer Effort
In recent years, changes in the health care financing and delivery system-most notably the rise of managed care, increasingly “managed” indemnity insurance, and decreased reimbursements under Medicare and Medicaid-have seriously decreased revenues that academic institutions, cancer centers, hospitals, and clinics have relied upon to subsidize research, train the next generation of cancer researchers and caregivers, provide care for the uninsured, and fund Read the rest of this entry »
Public and Professional Education
Cancer-related education for the public (both youth and adults) is inadequate to ensure that individuals are able to make informed lifestyle and cancer care decisions. Cancer prevention is a lifetime commitment that begins with the development of healthy behaviors in early life and is reinforced through education, communication, and informed medical practices throughout life.56 As noted above, cancer communication and behavioral research are key areas in which research is needed to learn how best to reach people of diverse Read the rest of this entry »
Countervailing Forces
Powerful forces continue to perpetuate and exacerbate the cancer problem. Some of these forces are recognized for their impact on cancer, while others largely are not. For example:
- Tobacco use is responsible for approximately one-third of cancer deaths. Even as governments sue the tobacco companies to recover Medicaid and other health care costs attributable to the tobacco use of public program beneficiaries, government support of the Read the rest of this entry »
Research and Delivery Environments
Unlike the research and health care environments that existed at passage of the National Cancer Act, the current environments are by far more market-driven, specialized, and competitive. For example, deep concerns exist that the profit motive of the private sector may cause research questions with the greatest potential public health benefit to go unexplored; cancer prevention strategies (with the exception of chemoprevention approaches) provide a key example in this Read the rest of this entry »
Quality of Cancer Care and Cancer Disparities
Little professional consensus exists as to what constitutes quality cancer care. Many guidelines exist for the treatment of specific cancers, but these are unknown to or disputed by parts of the medical community. Furthermore, the existence of guidelines, even when there is consensus on their validity, does not guarantee that the recommended care will be accessible or delivered.30 31
A continuing and critical barrier to improved quality of care is the slow Read the rest of this entry »
Major Successes of the National Cancer Program
When the War on Cancer was declared , cancer was believed to be one disease-a formidable but singular foe. Research since then has shown us that in fact, cancer is more than 100 diseases, many of which also have subtypes that require differing treatment regimens. The growth in knowledge about cancer biology and genetics that has accompanied this evolution-and the insights and interventions that have derived from it-are perhaps the greatest success of the national cancer effort since passage of the National Cancer Act.