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AAMC Reporter: February 2009
Viewpoint: A Blueprint for Better Cancer Care
William Jennings Bryan once said, "Destiny is not
a thing to be waited for; it is a thing to be achieved." In the
field of cancer, medical researchers, health care providers, and
patient advocates are the architects of our destiny. These individuals
push science, patient care, and policy toward achievable goals.
Their approach toward cancer prevention, diagnosis, and treatment
is thoughtful and deliberate, and it results in a blueprint for
a course of life with cancer we call survivorship.
As physicians, educators, and medical students, you
know only too well the ravages of cancer. Soon to surpass heart
disease as the leading cause of death in this country, one out of
two men and one out of three women is currently diagnosed with cancer
during their lifetimes. Thankfully, because of improved prevention,
detection, and treatments, more people are surviving cancer and
we are seeing a shift in some cancers from an acute disease to a
manageable chronic disease. A recent American Cancer Society report
tells us that while 1.4 million people are diagnosed with cancer
each year, fewer men and women are dying. According to the National
Coalition for Cancer Survivorship (NCCS), there are now nearly 12
million cancer survivors.
To continue to enhance cancer survivors' quality of
life, we must carefully examine and improve the distinct health
care needs of this growing population. Physical, psychological,
social, spiritual, and financial concerns play key roles in every
facet of cancer care. Everyone with a history of cancer, whether
their survivorship is measured in days, months, or decades, deserves
appropriate care before, during, and after treatment. As "architects"
of survivorship, we must continue to drive optimal outcomes with
courage, sensitivity, and commitment.
To that end, a multidisciplinary group of stakeholders
in the cancer community known as the Cancer Quality Alliance (CQA),
co-chaired by NCCS, recently developed and released the "Blueprint
for a Better Cancer Care System." This document attempts to illustrate
a collaborative vision of coordinated cancer care using existing
and imagined best practices. The blueprint shows on a case-by-case
basis some of the gaps in the current health care system and how
filling those gaps with quality improvement initiatives and treatment
and survivorship planning could transform the system to benefit
all cancer survivors.
Five case studies featuring soft tissue sarcoma, breast
cancer, rectal cancer, and Hodgkin's disease are examined in the
CQA blueprint. As each case description moves through the cancer
care trajectory—detection, diagnosis, treatment, post-treatment/survivorship, and end-of-life care—the cases are examined according
to standards set forth by the Institute of Medicine: safety, effectiveness,
patient-centeredness, timeliness, efficiency, and equity. Each is
presented in a best-case/worst-case scenario narrative that illustrates
many of the complexities and challenges of the health care system,
such as inadequate clinical information technology, incomplete evidence
on best practices, staffing shortfalls, complex reimbursement policies,
administrative burdens, and other system barriers to quality care.
Then the document explains what went right in each case study when
proactive and evidence-based steps were taken by various stakeholders,
including health care providers, insurers/payers, policy makers,
patients, and families.
Each case study is an amalgamation of events that
have been known to take place in a variety of care settings. Common
mistakes such as delays in detection and misdiagnoses, missed opportunities
to receive expert input, and shortcomings such as lax protocols
and a lack of counseling, are juxtaposed against real solutions
to those deficiencies. Then a discussion reviews the results of
each scenario.
Designed as a teaching tool for a broad audience,
the blueprint is written in clear language with tables for each
case that outline what went right and what went wrong as well as
steps to optimal care. The Cancer Quality Alliance hopes that the
blueprint will encourage stakeholders to explore options, mine resources,
and think of possibilities for improving the care people with cancer
receive.
As part of an academic setting, you are potentially
in a key role to lead the way. The multidisciplinary environment
you're a part of gives you the opportunity to learn about and implement
the methods needed to achieve optimal care. At your fingertips lies
access to knowledge and the resources to enable you to become pioneers
in a model for developing and delivering integrative, coordinated
cancer care that is truly patient-centered.
We in the cancer community want to play a role in
our own destiny by keeping pace with science, pressing for the most
advantageous outcomes, and changing paradigms when appropriate.
Initiatives like the blueprint provide a valuable mechanism to educate
and inspire.
Editor's Note: The opinions expressed by the authors
do not necessarily reflect the opinions of the AAMC or its members.
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