Experts Say U.S. Faces Crisis in Cancer Care

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Increasing demand for cancer care, fewer cancer doctors, the rising cost of cancer treatment, and the complexity of the disease are all combining to create a crisis in delivering cancer care in the United States, according to a report by cancer experts.

The report was published on Sept. 10, 2013 by the U.S. Institute of Medicine. Read the summary of “Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis.”

The committee of experts who wrote the report said that to avert the crisis, care needs to be better coordinated and more information needs to be collected on cancer outcomes and care quality.

“Most clinicians caring for cancer patients are trying to provide optimal care, but they’re finding it increasingly difficult because of a range of barriers,” said Patricia Ganz, M.D., chairperson of the expert committee and professor at the School of Medicine and School of Public Health, University of California-Los Angeles. Dr. Ganz also serves on the Breastcancer.org Professional Advisory Board. “As a nation, we need to chart a new course for cancer care. Changes are needed across the board, from how we communicate with patients, to how we translate research into practice, to how we coordinate care and measure its quality.”

About 14 million people in the United States -- about 4% of the population -- have been diagnosed with cancer. The number is expected to grow to 18 million by 2030, with about 2.3 million new cancer diagnoses each year. Because of this dramatic increase, the number of doctors trained to treat cancer may soon be too small to care for all the people diagnosed and medical schools can’t expand quickly enough to keep up with the need.

At the same time, the cost of treating cancer is rising faster than the cost of treating other diseases. In 2004, cancer care cost $72 billion; in 2010 the cost rose to $125 billion. Costs are expected to rise another 39% to $173 billion by 2020.

The report also says that in many cases, decisions about cancer care aren’t based on scientific evidence and many people aren’t treated for treatment side effects or symptoms of the disease.

The experts recommend these strategies to improve cancer care in the United States:

  • Doctors should give patients and their families understandable information about cancer prognosis, as well as the risk, benefits, and costs of treatment.
  • Cancer care teams should provide complete information about advanced-stage disease to people who have been diagnosed with it, as well as end-of-life care that meets patients’ needs, preferences, and beliefs.
  • Cancer care teams need to ensure that care is coordinated, comprehensive, and follows the patient’s preferences.
  • Every member of the cancer care team has essential cancer care skills, is trained in appropriate areas, and knows how to provide comprehensive, coordinated care.
  • Treatment should be based on scientific research and the risks and benefits of the treatment should be clearly explained to the patient.
  • More studies should be done on older adults with cancer and on people who have other diseases in addition to cancer.
  • Development of a cancer healthcare information system so doctors can analyze information from cancer patients in real time.
  • Development of a national reporting program to track the quality of cancer care.
  • A national strategy to make sure that everyone has equal access to cancer care.
  • Making cancer care more affordable by working with groups that want to design and test new ways to pay for care, as well as working to reduce waste and inefficiency.

While the Institute of Medicine report is about all cancer care, many of the points the experts make apply to breast cancer care. It’s clear that many of the changes will need to be implemented at a national level, but there are things that you can do to ensure that you receive the best care possible.

No matter which breast cancer treatment options your care team recommends for you, it’s always a good idea to talk to your doctors about:

  • why each treatment is recommended (including any combinations)
  • the timing and sequence of the treatment
  • the expected benefits, risks, and side effects of each treatment
  • the expected cost of each treatment
  • how your care team will coordinate your treatments

Good communication with your doctor can help you stay on track with your treatment. If you feel like you’re bothering your oncologist with too many questions, remember that your family physician or gynecologist -- whom you may have known longer -- can help explain things to you and answer your questions. Many women may lose contact with their primary care doctor because they’re seeing so many other doctors after being diagnosed with breast cancer. Your family doctor can be a tremendous resource.

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