The US cancer care delivery system is in crisis and changes across the board are urgently needed to improve the quality of cancer care, concludes the Institute of Medicine (IOM) of the National Academies in its new report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis.

Sponsored by the National Cancer Institute (NCI), the Centers for Disease Control and Prevention (CDC), the American Cancer Society (ACS), and several other organizations, the IOM report committee sets forth a conceptual framework for improving the quality of cancer care based on the main problems being faced by the system. For example, the report puts the projected costs of cancer care at $173 billion by 2020; coupled with a growing elderly population that is vulnerable to cancer and a shortage of oncology health professionals, the current care delivery system is poorly prepared to address cancer care needs, the authors contend.

The IOM report presents six components of high-quality cancer care that need to be addressed, in order of priority level. Detailed explanations of each are available in the report as well as in the report brief:

Engaged patients Cancer care teams should provide comprehensible information to these patients and their families on such matters as cancer prognosis, treatment benefits and harms, and palliative care.


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An adequately staffed, trained, and coordinated work force The cancer care work force must include enough clinicians with essential core competencies for treating patients with cancer. The cancer care team should work with primary care/geriatrics and specialist teams to implement patient care plans and deliver comprehensive, efficient, and patient-centered care.

Evidence-based care Clinical research should gather evidence of the benefits and harms of various treatment options and of the impact that treatment regimens have on symptoms, quality of life, and patients’ overall experience with the cancer.

A learning health care information technology (IT) Cancer care requires an IT system that can “learn” by enabling real-time analysis of patient data in various settings to improve knowledge and inform medical decisions.

Translation of evidence into clinical practice, quality measurement, and performance improvement Clinicians should be given tools that allow them to incorporate new medical knowledge into routine care quickly.

• Accessible and affordable care HHS should develop a national strategy that leverages existing community interventions to provide accessible and affordable cancer care, as major disparities currently exist in access to such care. Professional societies should publicize evidence-based information about cancer care practices that are unnecessary or that carry more harms than benefits. If specific payment models demonstrate increased quality and affordability, payers should quickly adopt those models.

The report calls upon all participants and stakeholders in cancer care to reevaluate their current roles and responsibilities and to work together to improve the cancer care delivery system. These parties include cancer care teams, patients and their families, researchers, developers of quality metrics, payers, HHS and other federal agencies, and industry. ONA