The Institute of Medicine’s newly-released report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis,updates its recommendations on the looming “crisis” in cancer care. Adults over age 65 comprise the majority of cancer patients and the majority of cancer deaths. Their care needs are complex, yet the nation is faced with a shrinking health care workforce, providing fragmented care, at the time when the population of older adults is set to double in less than two decades.
Additionally, care and treatment costs are rising faster than many other areas of medicine — from $72 billion in 2004 to $125 billion in 2010. It’s projected to climb another $50 billion by the start of the next decade. This places an extraordinary burden on Medicare, as the primary insurer, on patients, and on families. The IOM also points out growing disparities in care – in access to care, affordable treatment options and in finding knowledgeable providers, particularly among those caring for seniors. The report also describes the complexity of caring for older adults with cancer, who may have multiple chronic conditions, decrease in cognition, require assistance with ADLs or IADLs, depend on family or friends for caregiving help, and who may be more vulnerable to side effects.
The existing health system is poorly equipped to handle these multiple needs or to adequately provide long-term care, address palliative care needs or offer support systems for family caregivers. The IOM makes six key recommendations to address the need for higher-quality care for all cancer patients across the care continuum:
Put patient-centered care and decision making at the forefront of any care plan. Communicate all available options and support all patients in making the right care decisions for their particular needs.
Ensure staff and health care workforce are adequately trained, who can provide care compatible with patients’ needs and preferences, and who practice an inter-disciplinary, coordinated approach to care.
Use clinical research and evidence-based care parameters as the basis for informed medical decisions.
Leverage health IT to improve cancer treatment, research, training, outcomes, and system performance.
Incorporate new medical evidence into clinical practice guidelines, quality and performance measures, and progress on care delivery.
Make the system affordable and available to all patients; align reimbursement to reward care teams who deliver high-quality, evidence-based care, and eliminate waste.
While these are lofty goals, the IOM report says that achieving them is absolutely necessary to meet the impending care crisis, and to improve outcomes and quality of life for every patient diagnosed with cancer.
Resources
- American Cancer Society Facts and Figures 2013
- Centers for Disease Control Cancer Stats
- CMS Hospital Mortality and Readmission data breaks down spending by claim, geography and other parameters. An easy-to-use versionis available on the AHCJ site.
- The Insight Blog on Special Needs of Older Cancer Patients, from the Dana-Farber Cancer Institute
- Medscape article by Elizabeth McGann, D.N.Sc., R.N., on unique needs of older adults with cancer
- Cancer Net, the American Society of Clinical Oncologist’s consumer site, has videos, downloadable booklets, and a variety of comprehensive information designed for older patients and families.
