IOM Report: Solving Cancer Care Crisis Starts With Improving Patient Engagement, Team-Based Care

Delivering patient-centered care and engaging in shared decision-making should be top priorities for oncologists responding to the current crisis in the quality of cancer care delivery, according to a recent Institution of Medicine (IOM) report.

“This report serves as a template at the local level as to what kinds of things we can be doing better, particularly patient engagement,” said Mary S. McCabe, RN, MN, director of the Survivorship Program at Memorial Sloan-Kettering Cancer Center in New York City, and a member of the committee that wrote the IOM report. “Do we have useful information for patients that is written at the right grade level and understandable for them to make good decisions? Are we really doing the best job we can?”

The nation’s cancer care delivery system is in crisis due to several converging factors, according to the report, including increased demand for services from a growing older population; rising costs of care; and increasingly complex treatment plans based on new therapies that are challenging for oncologists to incorporate into clinical care.

“Given the disease’s complexity, clinicians, patients, and patients’ families can find it difficult to formulate care plans with the necessary speed, precision, and quality,” said an IOM news release. “As a result, decisions about cancer care are often not sufficiently evidence-based.”

In addition, oncologists must develop survivorship care plans that address patients’ needs following the treatment phase, said McCabe.

“Over the past five years, there has been greater attention given to what happens right after treatment and what guidance we need to be giving patients,” she said. “In addition to communicating about follow-up appointments and tests and patient self-care strategies, oncologists also must coordinate and communicate with other providers involved with the patient’s care.

“We’re going to see an increase in the number of elderly survivors with comorbidities, so it’s important that there is a collaboration among providers,” said McCabe. “And patients, who are at the center of all this, should have a clear understanding of what’s going to happen and what they can do actively themselves.”

The report divides high-quality cancer care into six categories (ordered by priority) and recommends strategies for improvement in each area:

Engaged patients. Cancer care teams should provide patients and their families with understandable information about the cancer prognosis and the benefits, harms, and costs of treatments. They also need to discuss patients’ options, such as revisiting and implementing advance care plans.

An adequately staffed, trained, and coordinated work force. Professional organizations should define the essential core competencies needed for high-quality care, and organizations that deliver cancer care should ensure their clinicians have those skills.

Evidence-based cancer care. Clinical research should gather the evidence of the benefits and harms of various treatment options to aid care teams in making informed decisions. Research is also needed on the impact of treatment regimens on quality of life, symptoms, and patients’ overall experience with the disease; and on interventions for older adults and those with multiple chronic diseases.

A learning health care information technology system for cancer care. A system is needed that can “learn” by enabling real-time analysis of data from cancer patients in a variety of care settings. Professional organizations and the Department of Health and Human Services (HHS) should develop and implement the learning health care system, and payers should create incentives for clinicians to participate as it develops.

Translation of evidence into practice, quality measurement, and performance improvement. Tools and initiatives should be delivered to help clinicians quickly incorporate new medical knowledge into routine care and quality measures are needed to provide a standardized way to assess the quality of care.

Accessible and affordable cancer care. HHS should develop a national strategy to provide accessible and affordable cancer care, the report says. Professional societies should disseminate evidence-based information about cancer care practices that are unnecessary or where the harm may outweigh the benefits. The Centers for Medicare and Medicaid Services and other payers should design and evaluate new payment models that incentivize cancer care teams to provide evidence-based care that aligns with patients’ needs.