IOM Report on Cancer Care Decoded

TON - May/June 2014 Vol 7 No 3

Cancer care in the United States is reaching crisis proportions, with costs spiraling out of control and some patients getting suboptimal care. The Institute of Medicine (IOM), an independent nonprofit organization that provides unbiased reports to the public and policy makers, convened a committee of experts to address the crisis in cancer care and formulate goals for addressing the broken healthcare system. The full report and an important video are available on the IOM website: http://www.iom.edu/Reports/2013/Delivering-High-Quality-Cancer-Care-Charting-a-New-Course-for-a-System-in-Crisis/Videos.aspx.

Two Oncology Nursing Society (ONS) members—Betty Ferrell, RN, PhD, MA, FAAN, research scientist at the City of Hope National Medical Center in Duarte, California, and Mary McCabe, RN, MA, director of the Cancer Survivorship Center at Memorial Sloan Kettering Cancer Center, New York City—participated on the IOM expert committee. At the recent ONS 39th Annual Congress, they decoded the IOM report and discussed implications for oncology nurses at this critical juncture in history.

“Our culture says the more we do, the better. We need to stop the fast-moving train we are on and consider what high-quality cancer care would look like. A major shake-up is necessary. We are at a critical crossroad. Our current system delivers suboptimal care at too great a cost,” Ferrell stated.

“Cancer care is not as patient centered, accessible, coordinated, or as evidence based as it should be. It is easier said than done to achieve this,” Ferrell noted.

Drivers of the current healthcare crisis include an aging population with several comorbidities, a workforce shortage of oncologists and nurses (about 50% of oncology nurses are reaching retirement age), reliance on family as providers of direct care, the rising and untenable costs of cancer care, and the limitations of current tools to assess quality of care.

“The cost of cancer care is expected to increase by 39% in the year 2020. Unless we [as nurses] participate in those discussions, cuts in cost may occur in the wrong places. We need to think about how to bend the cost curve. What does quality mean? How does cost influence quality? How do we provide quality care at a cost we can afford? Even the co-pays for biologics and targeted therapies are overwhelming, and often these drugs improve survival by weeks or months. We need to think about whether we can afford these drugs,” Ferrell said. In addition, the cost of end-of-life care and overuse of testing also needs to be rethought. Many patients prefer to die at home and not undergo expensive treatments at end of life. Palliative care is often a better option and should be initiated sooner in the course of illness, she said.

Better tools are needed to evaluate current practices and identify those that work and those that are inappropriate, and then to disseminate results of those assessments.

“We propose that patients be informed and that cancer care be focused on patients’ needs, values, and preferences. We also propose that there be an adequately staffed, trained, and coordinated workforce to provide team-based care for patients and incorporate their values and preferences,” McCabe stated.

Other recommendations include evidence-based cancer care, and employing scientific research such as clinical trials and comparative effectiveness research to design better systems. The report also calls for “a learning healthcare information technology (IT) system for cancer” to improve the quality of care delivery, as well as translation of evidence into clinical practice, quality measurement, and performance improvement.

Finally, the report calls for accessible and affordable cancer care, which is one of the greatest hurdles to implementing high-quality care.

“We have a long way to go. We can work with individuals or groups to explain about health exchanges. We need to develop patient-centered high-quality cancer care and improve communication among ourselves and with our patients,” McCabe said. “We want to make this report an actionable tool and a living document.”

Reference
Ferrell B, McCabe M. Deciphering the IOM report “Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis”: the oncology nursing call to action. Presented at: Oncology Nursing Society 39th Annual Congress; May 1-4, 2014; Anaheim, CA.

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