Print“For many Americans with cancer, there is a wide gulf between what could be construed as the ideal and the reality of their experience with cancer care.”
A group of doctors in white coats are gathered in a hallway. They are in deep thought and impassioned discussion. In the middle of the group stands a doctor holding a patient record that’s mostly a photograph of a smiling middle-aged man with a few vital statistics. Suddenly, the doctor interrupts a voiceover to summon his colleagues. “Listen up. His daughter’s getting married soon,” he says. “Let’s make sure he’s ready.” The voiceover returns. “University of Maryland Medical Center: Medicine on a Mission.” Linda, in Essentia Health’s “Here with you” commercial, declares she’s “cancer free” as she looking lovingly at her man on his motorcycle. Tallahassee Memorial Cancer Center’s Commercial features a radiologist doing his Tom Cruise Minority Report number moving data on a transparent screen with the mere movement of his hands. “One Team. One Focus. One Powerful Place to Fight Cancer.”
I drag my ass home on a bus each night and cook dinner for the family. My daughter gives me one word answers about her day – “good.” My wife offers me two word answers to my questions about work, kids, and financial matters—“not good.” And the dogs don’t say much, but sometimes leave me presents that require me to say “bad!” So when I see commercials for cancer care centers I admit a desire to have a team of people who’ve got my back, a loving family that’s playful and laughing, and a chance to ride a Harley on a winding road against an explosion of autumn colors. Fear cancer? Hell no. It sounds pretty good to me.
But alas, it turns out cancer is not all it’s cracked up to be. In fact, a report from the Institute of Medicine warns cancer care in the United States is facing a crisis. That’s because of a conspiracy of factors including demand for care that’s growing, an oncology workforce that’s shrinking, costs that are rising, and the complexity of the disease and its treatment.
“For many Americans with cancer, there is a wide gulf between what could be construed as the ideal and the reality of their experience with cancer care,” the report says.
As the proportion of the population over the age of 65 increases, the matter is expected to get worse. The elderly account for most cases of cancer. Today, more than 1.2 million new cases of cancer are diagnosed in the United States each year. That’s expected to grow to 2.3 million by 2030, a 45 percent increase. The oncology workforce may be getting too small to meet demand and the report warns that training programs lack the ability to rapidly expand.
The advances in understanding cancer haven’t made things easier. Instead, they’ve added to the complexity. As the use of targeted therapeutics that treat subpopulations of certain cancers based on the profile of tumors increases, the report finds clinicians, patients, and patients' families can find it difficult to formulate care plans with the necessary speed, precision, and quality. “Clinicians have agreed upon standard ways to treat some types of cancer, but for others, no evidence-based consensus exists,” the report says.
And then there’s the issue of costs. Treating cancer is expensive and the costs are rising faster in this area than in other areas of healthcare. The report says at the current rate of increase, the costs of cancer care will grow to $173 billion a year by 2020 from $125 billion in 2010.
Other problems include the underuse of diagnostics for early detection, the lack of adherence to standards for diagnosis, and the fact that some individuals with cancer simply don’t receive care that’s known to be effective for their condition.
The report makes a series of 10 recommendations to improve cancer care, half of which are focused on changes to the healthcare system. These include having difficult procedures performed at facilities with extensive experience doing them; use of evidence-based guidelines; measuring and monitoring the quality of care; having experienced professionals recommend initial cancer management with agreed upon goals, the resources necessary to implement them, and full disclosure about treatment options; and ensuring the management of pain and timely referral to palliative and hospice care.
To improve the quality of care, the report recommends investment in clinical trials to answer questions about cancer care management; the establishment of a cancer data system to provide quality benchmarks; and support for research and training for good care.
Last, the report says to overcome barriers of access to quality care steps should be taken to provide equitable treatment within the cancer care system for people who are uninsured and underinsured; and studies should be conducted to determine why certain segments of the population do not get adequate cancer care.
As I read the report and thought about the problems, they had a familiar ring. Use evidence-based care. Engage patients. Coordinate care. Train more professionals and do a better job. Institute quality measures. Improve accessibility to affordable care. The problem isn’t cancer care in the United States. The problem is healthcare. Cancer care happens to be a notable example of that.
“Cancer is really just the extreme of both the complexity and severity of illness and the cost of care,” says Patricia Ganz, chair of the IOM committee that wrote the report and a professor at the School of Medicine and School of Public Health, University of California, Los Angeles. “You could take somebody with multiple sclerosis or Parkinson’s disease, or any chronic illness. All of the things we’re talking about in there are key things that the Institute of Medicine has been talking about generally in the healthcare system.”
The good news, says Ganz is that some of the recommendations are already being echoed in changes in the healthcare system. She says bringing about some of the changes may not be a daunting as it seems.
The report offers a stark look at the reality of cancer care in the United States. There may be places out there that provide ideal care, but there’s a gulf between ideal and real today. Reading the report convinced me getting cancer’s not such a good idea. In fact, getting sick at all looks like a pretty bad idea.
September 13, 2013
http://www.burrillreport.com/article-why_i_decided_not_to_get_cancer.html
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