Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis

323 Pages·2014·10.54 MB·English

by  Laura Levit

Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis

Delivering High-Quality Cancer Care:
Charting a New Course
for a System in Crisis

Committee on Improving the Quality of Cancer Care:
Addressing the Challenges of an Aging Population

Board on Health Care Services

Laura Levit, Erin Balogh, Sharyl Nass, and Patricia A. Ganz, Editors

Copyright © National Academy of Sciences. All rights reserved.
Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the
National Research Council, whose members are drawn from the councils of the National Academy
of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of
the committee responsible for the report were chosen for their special competences and with regard
for appropriate balance.

This study was supported by Contract Nos. HHSN261200900003C and 200-2011-38807, TO #13
between the National Academy of Sciences and the National Cancer Institute and the Centers for
Disease Control and Prevention. This study was also supported by AARP; the American Cancer
Society; the American College of Surgeons, Commission on Cancer; the American Society for
Radiation Oncology; the American Society of Clinical Oncology; the American Society of
Hematology; the California HealthCare Foundation; LIVESTRONG; the National Coalition for
Cancer Survivorship; the Oncology Nursing Society; and Susan G. Komen for the Cure. Any
opinions, findings, conclusions, or recommendations expressed in this publication are those of the
author(s) and do not necessarily reflect the view of the organizations or agencies that provided
support for this project.

ISBN 978-0-309-28660-2

Additional copies of this report are available from the National Academies Press, 500 Fifth Street,
NW, Keck 360, Washington, DC 20001; [phone] or [phone]; http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2013 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and
religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute
of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Cover credit: Original oil painting, “Day 15 Hope,” reproduced by permission from Sally
Loughridge, Rad Art: A Journey Through Radiation Treatment (Atlanta: American Cancer Society,
2012), 31.

Suggested citation: IOM (Institute of Medicine). 2013. Delivering high-quality cancer care:
Charting a new course for a system in crisis. Washington, DC: The National Academies Press.

Copyright © National Academy of Sciences. All rights reserved.
Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis

Copyright © National Academy of Sciences. All rights reserved.
Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in
scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general
welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to
advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of
Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a
parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing
with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of
Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and
recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent
members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts
under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal
government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is
president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community
of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government.
Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating
agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the
government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies
and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the
National Research Council.

www.national-academies.org

Copyright © National Academy of Sciences. All rights reserved.
Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis

COMMITTEE ON IMPROVING THE QUALITY OF CANCER CARE:
ADDRESSING THE CHALLENGES OF AN AGING POPULATION

PATRICIA A. GANZ, (Chair), Distinguished University Professor, University of California, Los
Angeles Schools of Medicine & Public Health, and Director, Cancer Prevention & Control
Research, Jonsson Comprehensive Cancer Center
HARVEY JAY COHEN, Walter Kempner Professor of Medicine, and Director, Center for the Study of
Aging and Human Development, Duke University Medical Center
TIMOTHY J. EBERLEIN, Bixby Professor and Chair, Department of Surgery, Washington University
School of Medicine; Spencer T. and Ann W. Olin Distinguished Professor; and Director, Siteman
Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine
THOMAS W. FEELEY, Helen Shafer Fly Distinguished Professor of Anesthesiology, Head, Institute
for Cancer Care Innovation, and Head, Division of Anesthesiology and Critical Care, The University
of Texas MD Anderson Cancer Center
BETTY R. FERRELL, Professor and Research Scientist, City of Hope National Medical Center
JAMES A. HAYMAN, Professor, Department of Radiation Oncology, University of Michigan
KATIE B. HORTON, Research Professor, George Washington University, School of Public Health and
Health Services
ARTI HURRIA, Associate Professor, and Director, the Cancer and Aging Research Program, City of
Hope
MARY S. MCCABE, Director, Survivorship Program, and Lecturer, Division of Medical Ethics, Weill
Medical College, Memorial Sloan-Kettering Cancer Center
MARY D. NAYLOR, Marian S. Ware Professor in Gerontology, and Director, New Courtland Center
for Transitions and Health, University of Pennsylvania, School of Nursing
LARISSA NEKHLYUDOV, Associate Professor, Department of Population Medicine, Harvard Medical
School, and Internist, Department of Medicine, Harvard Vanguard Medical Associates
MICHAEL N. NEUSS, Chief Medical Officer, and Professor, Department of Medicine, Vanderbilt-
Ingram Cancer Center, Vanderbilt University Medical Center
NOMA L. ROBERSON, Cancer Research Scientist, Roswell Park Cancer Institute (Retired)
YA-CHEN TINA SHIH, Associate Professor, Section of Hospital Medicine, and Director, Program in
the Economics of Cancer, Department of Medicine, The University of Chicago
GEORGE W. SLEDGE, JR., Chief of Oncology, Department of Medicine, Stanford University
THOMAS J. SMITH, Director and Harry J. Duffey Family Professor of Palliative Medicine and
Professor of Oncology, Johns Hopkins School of Medicine
NEIL S. WENGER, Professor, University of California, Los Angeles, School of Medicine

Study Staff

LAURA LEVIT, Study Director
ERIN BALOGH, Associate Program Officer
PAMELA LIGHTER, Research Assistant
MICHAEL PARK, Senior Program Assistant
PATRICK BURKE, Financial Associate
SHARYL NASS, Director, National Cancer Policy Forum
ROGER HERDMAN, Director, Board on Health Care Services

Consultants

DANIEL MASYS, Affiliate Professor, Biomedical and Health Informatics, University of Washington
TRACY SPINKS, Project Director, The University of Texas MD Anderson Cancer Center
v

Copyright © National Academy of Sciences. All rights reserved.
Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis

VICKIE WILLIAMS, Project Coordinator, Young Breast Cancer Survivorship Program,
UCLA-LIVESTRONG Survivorship Center of Excellence, Jonsson Comprehensive Cancer Center
vi

Copyright © National Academy of Sciences. All rights reserved.
Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis

REVIEWERS
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and
technical expertise, in accordance with procedures approved by the National Research Council's Report
Review Committee. The purpose of this independent review is to provide candid and critical comments
that will assist the institution in making its published report as sound as possible and to ensure that the
report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The
review comments and draft manuscript remain confidential to protect the integrity of the deliberative
process. We wish to thank the following individuals for their review of this report:

ROBERT M. ARNOLD, UPMC Palliative and Supportive Institute
EDWARD J. BENZ, JR., Harvard Medical School and Dana-Farber Cancer Institute
AMY BERMAN, John A. Hartford Foundation
CATHY BRADLEY, Virginia Commonwealth University
DEBORAH BRUNER, Emory University
KAREN S. COOK, Stanford University
DEBRA GORDON, University of Washington School of Medicine
DEBRA J. HOLDEN, RTI International
J. RUSSELL HOVERMAN, The U.S. Oncology Network and Texas Oncology, P.A.
CARLOS ROBERTO JAÉN, University of Texas Health Science Center at San Antonio School of
Medicine
KENNETH W. KIZER, University of California, Davis
RUTH McCORKLE, Yale University School of Nursing
DIANE E. MEIER, Mount Sinai School of Medicine
LEE NEWCOMER, UnitedHealthcare
DAVID B. REUBEN, University of California, Los Angeles
LAWRENCE N. SHULMAN, Dana-Farber Cancer Institute
EDWARD H. WAGNER, Group Health Research Institute

Although the reviewers listed above have provided many constructive comments and suggestions,
they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the
report before its release. The review of this report was overseen by HAROLD C. SOX, Dartmouth
Institute for Health Policy and Clinical Practice, and PATRICIA FLATLEY BRENNAN, University of
Wisconsin–Madison. Appointed by the National Research Council and Institute of Medicine, they were
responsible for making certain that an independent examination of this report was carried out in
accordance with institutional procedures and that all review comments were carefully considered.
Responsibility for the final content of this report rests entirely with the authoring committee and the
institution.
vii

Copyright © National Academy of Sciences. All rights reserved.
Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis

Copyright © National Academy of Sciences. All rights reserved.
Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis

ACKNOWLEDGMENTS

The committee and staff are indebted to a number of individuals and organizations for their
contributions to this report. The following individuals conducted background research for the committee:

Lindsay Forbes, Intern, Institute of Medicine (Summer 2011)
Randy Gale, Fellow, Institute of Medicine (2010-2011)
Ana Hincapie, Mirzayan Science and Technology Fellow, Institute of Medicine (Winter 2012)
Adam Schickedanz, Intern, Institute of Medicine (Summer 2012)

We extend thanks to Eric Slade and Eric Slade Productions for working with the committee to produce
the dissemination video for this report. We also extend special thanks to the following individuals who
were essential sources of information, generously giving their time and knowledge to further the
committee’s efforts.

Peter Bach, Attending Physician, Memorial Sloan-Kettering Cancer Center
Dikla Benzeevi, 11-year Metastatic Breast Cancer Survivor, Breast Cancer Patient Advocate
Amy Berman, Senior Program Officer, Hartford Foundation
Helen Burstin, Senior Vice President for Performance Measures, National Quality Forum
Eric Fennel, Senior Advisor of Policy and Programs, Center for Medicare and Medicaid
Innovation
John Frenzel, Chief Medical Information Officer, MD Anderson Cancer Center
Kristen McNiff, Director, Quality and Performance Measurement, American Society of
Clinical Oncology
Mark Miller, Executive Director, MedPAC
Stephen Palmer, Director, Office of e-Health Coordination, Texas Health and Human
Services Commission
Maddie Peterson, Cancer Survivor
Willie C. Roberson, Clergyman/Pastor, Saint's Home Church of God in Christ
Joesph V. Simone, President, Simone Consulting
Ron Walters, Associate Vice President of Medical Operations and Informatics, The
University of Texas MD Anderson Cancer Center
Peter Yu, Chair, Health Information Technology Work Group, American Society of Clinical
Oncology

In addition, we thank the individuals who spoke at the October 2012 National Cancer Policy Forum
workshop, Delivering Affordable Cancer Care in the 21st Century. Workshop presentations and
discussions informed committee deliberations. Speakers included

Denise R. Aberle, Professor of Radiology and Bioengineering, David Geffen School of
Medicine, University of California, Los Angeles
Amy P. Abernethy, Associate Professor, Duke University School of Medicine
Peter B. Bach, Attending Physician, Memorial Sloan-Kettering Cancer Center
Justin E. Bekelman, Assistant Professor of Radiation Oncology, Member, Abramson Cancer
Center
Otis W. Brawley, Chief Medical Officer, American Cancer Society
Renzo Canetta, Vice President, Oncology Global Clinical Research, Bristol-Myers Squibb
Company
Susan Dentzer, Editor-in-Chief, Health Affairs
ix

Copyright © National Academy of Sciences. All rights reserved.