Ensuring quality cancer care

254 Pages·1999·0.795 MB·English

by  Maria Elizabeth Hewitt, Joseph V Simone, National Cancer Policy Board (U.S.)

Ensuring Quality Cancer Care
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ENICIDEM FO ETUTITSNI
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DRAOB YCILOP RECNAC LANOITAN
YEL WROEHTEP ( riahC ), George ,ygoloht aftPonemtrap e,Dnamria hd Cnraossefo rnPaybaF
looh clSacid edMravraH
HPESOJ ENOMIS ( ri aehcCiV ,etutit sdnnnoIaitadn uroeFc nnaaCmst n,urHotce rliaDci d,e)M
ha t fUyotisrevinU
JOHN BAILAR, ogaci h fCyotisrevi n,Useidu thStla e fHtonemtrap e,Dnamria hC
NAMRON ,SLEINAD ytisrevi nsUtf u,Tyhposoli h fProosseforP
,HEPIEVSAODJ ,hcraes eftRonedise rePc iV sttesuhcas s,aeMgdirb m,a.C c,nnIegoiB
ROBERT DAY, htla ecHilb u fPnooisiv i,Drebm edM n,arotcer idD ntanedise rsPutiremE
,retn ehCcraes erRecn anCosnihct udHe r,FsecneicS notgnih s,aeWlttaeS
N,EYEELLHOTFAK -nao llSairom e,Mygoloru e fNtonemtrap e,Decivr enSi a,Pfei hC
y tk irw,CoerYNet nreeCc nganCiretteK
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oi h,OsubmuloC
,ZTI RNGELLE nosred n.AD .,Msecnei clSaroivah eftBonemtrap e,Dria hd CnraosseforP
recnaC ,retneC ,notsuoHsaxeT
,T RHATHEBAZILE sax e,Tsall a,Dlanoitanret ntIr a,Hrecif feOvituce xfEei hdC ntanediserP
THOMAS KELLY, d nyagolo irBalucel oftMonemtrap e,Dnamria hd Cnraossefo ryPruoB
enicid e fMloooh cyStisrevi nsUnikp osHnh o,JsciteneG
,O LNZHSOAJL aigr o,eaGtnaltA
MAILLIW McGUIRE, ,noitaropr oeCraChtla edHeti n,Urecif feOvituce xfEeihC ,aknotenniM
atosenniM
,ITTI TAENPAID res i,anKoitaul a dvhnEcarae s,erRotceriD nre he ttfunooeSnamreP
anedas a,PainrofilaC
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enicideM
,NI RNFHFOEJS aigro e,Gatnal t,Ayteic orSecn anCacire m,Arecif feOvituce xfEeihC
JANE E. SISK, namli a .MhLpes o,Jtnemegan adM nyacil ohPtla e fHnooisiv i,DrosseforP
yt ikCr owY e,Nytisrevi naUibmul o,Chtla ecHilb u fPlooohcS
,LLA VNOETLSLE revl i,Spihsrovivr urSecn ar Confoitila olCanoit a,Nrotcer ieDvitucexE
dnalyr a,MgnirpS
S,EOCCNSAIRVF . C,.nDotgnih s,anWoitil aroeCc ntasCa elraBnoi t,atNnediserP
ROBERT YOUNG, aihpledali h,Pretn erCecn aeCsa hxC o,FtnediserP
FFATS
A,ITRTAIMWEH Study Director,
ROBERT COOK-DEEGAN, dr ayocBi lroePc nlaaCnoi t,arNotceriD
, DNNEALBLLEEHG recif fmOargo rrPoineS
N E,LNLOESNHOJ tnatsiss AevitartsinimdA
ANNIKA OLSSON, tnatsis shAcraeseR
,HDTDEIBKAZILE nretnI
ADNAMA ,ENEERG nretnI
iii
STNATLUSNOC
ECURB ,.REENLLIH htlaewnommo Cainigri V,supma Cainigri Vf oegello ClacideM
evinU r ytis
ENNAEJ .S,TTALBLEDNAM retn elCacid eyMtisrevi nnUwotegro eG
MARK A. SCHUSTER, acin oaMtn a,SDN AdR nsaeleg nsA o tLaainrofil a fCyotisrevinU
THOMAS J. SMITH, htlaewnommo Cainigri V,supma Cainigri Vf oegello ClacideM
ytisrevinU
iv
INDEPENDENTR EPORTR EVIEWERS
sihT troper sah neeb deweiver ni tfard mrof yb slaudiv indensiohc rof rieht esrevidep r -
sevitceps dna lacinhcet ,esitrepxe ni ecnadrocca htiw serudecorp devorppa yb eht lanoitaNR e -
ed i wv seooiir tvptenrednepe ds enifsihootp re.uhepTettim mwoeCi vterRo pse’Rlicn uhocCraes
deee nt hsg i ut tst nncft slraine iiioieilhlehlk dthsitbmtaadestswumcm iMnapoiddIctnniaarcc e -
trop sa dnuos sa elbissop dna ot erusne taht eht troper steem lanoitutitsn isdradnats rofitcejbo v -
sse noe t v t ,.is peeesty i hc gnnddrwtn e,droeunceethynapmtasidfTtahsmsuviaiceonevrrcaredm
lait nt oecy ntdet.i itisaeeforsmh v nrgeetfieopec roth ctodaTsn rrreiepaehhobstB iiolwtekdnaht
:trop esri h ftwoeiv eer h ntnioitapicitr arpie hrt osflaudivid nginiwoll oefht
UL NNA,YADA htla ecHilb u fPloooh csSax e fTyotisrevi n,Urossefo rP
NEELH,TLAEKGNA sttesuhcass a,Myawd iM
,ISE RLBUAALPAC ytisrevi nnUwo r,Bsutire mnEamria hdC neanicid e fMroossefo rP
enicid e fMlooohcS
MAILLIW .H,HTROFNAD ytisrevi nnUotgnihs a,Wseetsu r fTdora o,Bnamria hC
DLORAH .P,NAMEERF rfoossef od,rnrPaet nleaCtip smoeHl r,ayHre g rrfouotSce riD
snoegru Sdn asnaicisyh Pf oegello Cytisrevin Uaibmulo C,yregru SlacinilC
, Z AN.IAACGIRTAP fyotisrevi n,Uhtla ecHilb udP neanicid e fMsolooh c,Srossefo rP
lortn odC nnaoitneve rrPecn a fCnooisiv i,Drotcer idD n,aseleg nsA o tLaainrofilaC
taainrofil a fCyotisrevi n,Uretn erCecn aeCvisneherpm onCossn o,JhcraeseR
seleg nsAoL
DONALD R. MATTISON, ,snia lePti h,Wnoitadnu osFtcef ehDtr isBem i fDhocr aM
New York
HTUR McCORKLE, d near asCsenl lcIinor hneCicnellec xr Eorfetn e,Crotcer id Dnraossefo rP
gnisr uflNoooh cyStisrevi neUl a,Ymargo rlParotc o,DriahC
DI V,.ALPDLAR ,secnei chStla elHatnemnoriv nfeEotutits nlIanoit ae Nhfrtootcer irDemr oF
anilor ahCtr o,Nkr aePlgnai rhTcraeseR
ROSEMARY ROSSO, ,pu oyrcGaco vrdeAc ntasCa enroBtgnihsaW-eromit lraeBta erG
. C,.nDotgnihsaW
e ls ildha eWu etdehsivtitvo l cibdeudaevrndatiihsvnoorcp e vsitne,msm nodocniatseggus
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.enici defetoMutit s e ndhdIntra agonBirohtua
v
vi
Contents
SUMMARY ................................ ................................ ................................ ............................... 1
1 NOITCUDORTNI ................................ ................................ ................................ ....... 13
4,1dra oyBcil orPecn alCanoit ae NhfetoloR
Framework of the Report, 15
2 ER”HE MTCEENRTAASCCYS“ ................................ ................................ ............ 18
,8t1ro fef rEraeCc nlaaCre d eesfhFtotnemelE
0,2er arCecn afsCotnemelE
ece RslaudividnI 0,2er arCecn agCnivi
, er2yre 2racfoCnotacCejarT
, e6rr2 eas cCrfneoadCivorP
,0e 3rrae Cc snfeaotCiS
,4h3crae sde enrrRaae Cc nnfoaoiCtcesre tenhIT
5,3er arCecn a fCsots olCaicnaniF
,er arCecn anmCoets yeSr ahCtla egHnign a fhtaoCcapmI 36
, ed7re3agCanaM
1,4sna lePcnarus nhItla edHednuF-fleS
1 4,sgnidni FyeK
3 S RSE GEERONCCATINCCRAAUCSNE ................................ .............................. 46
7,4smelbo rsPsec c fAeocnedivE
7 4?tsix Esecnereffi Deseh To DyhW
8,4er arCecn aosCtsec cosAtreirr alBaicnaniF
t ieL h ftwoeiveR ,e, ese0fyrar5obahuCPtare
,0n5oitce tye l Der:sa1aEhP
6,5stlus egRnineer clSamron b fAnooitaula v :Ee2sahP
,t8n5emt areee src:aTn3haPC
vii
viii ENSURING QUALITY CANCER CARE
e:s4ahP ,3e 6reacCnerru cdeencRanalliev rtunSemtaerttsoP
,3e6 reafCiL-fo- de:ns5EahP
sgnidni FyeK , 66
4 S GEDNSNISANAIFED ERREA CCYNTAIC LGANUIQS ................................ .. 79
9 7,era Cf oytilau QgninifeD
0?8er arCecn a fCyotila ueQrusa eyMhW
0?8derusa eyMtila uswQIoH
,0y8til aluaQrutcurtS
,1y8til asusQecorP
,semoctuO48
8,8er ansCinoitairaV
ytila u sQwIoH 8?8detcell onCoitamrof neIraC-fo-
0,9smelbo ryPtila ueQr arCecn a fCeocnedivE
t s,areercBnaC19
Prostate Cancer, 103
80 1,sgnidni FyeK
5 E RRAE CC YNFTAOICL ADYUNRQAEVI LE ERHDATCLAEH ................... 116
sRecivr ehStla emHo refcnedi v fEhotgner teS hgtnitaulavE e ,h7c1r1aes
8 1,1snaicisy hlPaudivid n rIsolatips orH oefmul oeVsaC
9 1,1yregr urSecn akCsiR-hgiH
Prostate Cancer, 125
,y r 6ret2egs1cranueaSrCB
6 2,1seirtnu orCeh tmOo rpfihsnoital eeRmoctuO–emul oe VhnetocnedivE
8 2,1noitazilaicepS
aicepS 82 1,seitilica Ff onoitazil
03 1,snaicisyh Pf onoitazilaicepS
3,3e 1reacCivreS-rof- eseuFs re erdVaeCganaM
73 1,sgnidni FyeK
6 TIL AE URRQAECCNAC E CYNARUSSA ................................ ............................ 144
5 4,1evitcepsr erPemusn olCaudivid n nI:Aecnarus syAtilauQ
,5s4r1er ugsnniIsoohC
hC 6 4,1slatips odH nsanaicisy hgPnisoo
,8s4n1o ittnpeOmt agenriTsoohC
8 4,1sremusn o yCnboitamrof nyItila u fQeosU
0 5,1hcaorp ptAek r :aAeMcnarus syAtilauQ
1 5,1hcaorp prAotceS-cilb ue Ph:Tecnarus syAtilauQ
2 5,1noitartsinim dgAnicnan ieFr ahCtlaeH
4 5,1gnirotin ohMtla ecHilbuP
4 5,1hcraes edR nyacil oePr ahCtla erH oyfcnegA
5 5,1hcaorp plAanoissefo rePr ahCtla ee Hh:Tecnarus syAtilauQ
5 5,1snoitazinag reOrachtla efnHooitatiderc cnnAooissimm otCnioJ
cnarus syAtila urQ oefettimm olCanoitaN e, 156
YRAMMUS xi
8 5,1CARU/.c n,Inoissimm oeCr ahCtla enHoitatiderc cnAaciremA
8 5,1ytilibatnuoc cr AonfoitadnuoF
8 5,1recn a nCnooissimm o’Csnoegr u fSeogell onCaciremA
0 6,1sretn erCecn ayCtinumm o fCnooitaicossA
g reOr ahCtla enHiht itWnemevorp myItilauQ 3 6,1snoitazina
4 6,1seniledi ueGcitcarP
47 1,sgnidni FyeK
7 SEECRI VHRTELSAEH ERHRE CACNRCNIAAECS ................................ ..... 180
0 8?1hcraes esRecivr ehStla estHIahW
1,8h1crae sseeRciv rhetSl adeeHtaleR-re c snfuaotCatS
Research Support, 184
aes edRerosno pySllaredeF ,hcr481
4 8,1secivr enSam ud Hnhatla eftHonemtrapeD
9,9e1sne ftfenoDemtrapeD
2 0,2sriaf fsAnaret eftVonemtrapeD
3 0,2hcraes egRnidn usFnoitazinag reOtavirP
3 0,2yteic orSecn anCaciremA
7,0n2oitarobal leonCarh ceohCT
70 2,sgnidni FyeK
8 F SGSNNIODINT IADDNNAEMMOCER ................................ ............................. 211
t asehIhWt 4?1”2mets yeS r“raeCc n eeafhtCotatS
5?1d2erus aws tdeoIeInMH raraeCc nyatCil atsuaIQhW
spe ttSa hdW near arCecn a fCyotila ueQ h nttinedi veE rsAmelbo rtPahW
?6 e1er2v aonnC reaoepkCtBmaIT
How Ca 1 2?2er arCecn afyCotila ue Qhttuo bwAo netKWa heWvorp menIW
3?2e2 rraeCc nyatCil asoustQe csfcroAeir reamBocr enovetO k neasaBTpC ettaShW
YRASSOLG ................................ ................................ ................................ .......................... 226
ACRONYMS ................................ ................................ ................................ ......................... 231
XEDNI ................................ ................................ ................................ ................................ ... 235
1
Introduction
eW lla tnaw ot eveileb taht nehw elpoep teg gnidulcni—r escenvalcesruo dna ruoler a -
yeht—sevit lliw teg htlaeh erac fo eht tsehgi h.ytilauq sihT troper si tuoba woh ylesolc ewuc r -
yltner hcaorppa siht laedi ni eht detinU .setatS snrecnoC tuoba a gniworg kcal fo cilbupfnoc i-
ecned ni eht s’noitan metsys fo erac detpmorp eht lanoitaN recnaC yciloP draoB ot ekatrednua
evisneh ewrepimvoecr fo eht ecnedive no eshstenevitcef ffeo recna csecivres dna yreviledys s -
,smet eht ycauqeda fo ytilauq ecnaru s,ssamsinahcem dna sreirrab taht edepmi ssecca otrecnac
.erac sihT troper si eht tluser fo taht ;weiver ti sezirammus eht etats fo egdelwonk tuobaytilauq
.etvior p womtotiuh osbnaoitadnemmo cseer k daenm raraeccnac
ehT sekats era .hgih nI ,9991 erom naht 8 ,nsonialcliirm ermoA 3 tnecrep fo ehtlupop a -
,noit lliw eriuqer emos mrof fo erac esuaceb fo a sisongaid fo :recnac 2.1 noillim fo esehtdni i-
slaudiv lliw eb ylwen desongaid siht raey dna etaitini ;tnemtaert ,emos desongaid nisuoiverp
d e d t ynra elaeeovlgrnaunvth foe,sl s s o ree;hnevctwehacnethuebosm teaue n r,iltstlrniaowecy i-
ecned f, orpe u cle-;nlrweaiiorcwula qlcdeonrfa r0 e0ev0lo,p 0ol0el5piw eid m.orrefcnneavcE
;9 9,9S 1CrAe(c nrdaoecfnee rn cee sevl balshiewt adteS t sientnh ilU tsufrdoeab mruengral seiR
et al., 1997) .
sA gniticx ewcei nfsietcnneaivcd saera gnikam eht ,swen ereht er asnrecn otcaht tahwsi
ydaerl anwonk ot eb evitceff ersolfaudiv ihdtniiw recnac si ton gnihca eersoht ohw nac.tifeneb
sihT nrecnoc si ton ;wen ti saw tnenimorp gnoma eht snosaer rof eht 1791 lanoitaN recnaCtcA
) 8. d1Lnd e2.inys- Paals2 s(gte9sa anrawsep acx4ee9r9 1ni taro prfleeoar cnenohaiAtCtaN d -
, ,)ydB4rrA9oaC9soN1iB(v recna Ctasd aaorssorC . tA ye the,entmeriame asihs tttihrteocbnu
t usosbean eeevh vitsfitnotcoaeil ftetyfnraneehavtmr eetrnai gnie bdesu dna a gninwgoorcger i-
noit t ahhct rsatersoefr fdeeen ot e bdednapx eo t ysfdirtandendai tfso erac ,MO I.()499l1pmoC i-
gnitac eht erutcip si eht dipar noitulove fo wen htlaeh erac yreviled ,smetsys esohw tcapmino
.raelc nsuniam esremoct ueor arcecnac
es ve ehgratd rt nphae nalfitteicaoc Sihen nnthadoUnniiatfa zsi t n nfraeiioghhjrtsaoM e -
ee rrn uaoe,mvdeerusn iesnrnuaaci r refemob Amgun ni.w eoAcrngedi f s nnidois eciatractipic n -
,derusn idrnead ynam ohw era derevoc ni htlae hsnalp era deirro wtaht eht metsys rgonfireviled
13