The United States continues to be challenged in its delivery of cancer care to all who need it.
The national model is a distributive one but this delivery system of care offered at varied locations is far from uniform in distribution of services, is getting increasingly expensive and also raises issues around quality of care.
The ideal system from the viewpoint of the cancer patient is one in which the patient does not have to travel long distances for treatment while maintaining high levels of quality and safety and avoiding treatment that is not fractionalized among institutions.
Getting a diagnosis of cancer is stressful enough. Any recommended therapy needs to be reasonably easily accessible as does any needed care in the event of a complication or toxicity issue. And all must be delivered with the best evidence available, and with limited variability. These issues are particularly acute in rural communities.
However, no matter where a patient with a cancer diagnosis lives, the question for treatment providers is how do we create very efficient care processes and deliver them to such patients in a way that is both relevant and without inefficiencies.
This means asking tough questions. For example, should every hospital have a cancer treatment program today or should cancer care be concentrated in facilities where you can actually generate expertise across specialties and diseases and manage both cost and quality in an effective way?
Hospitals, too, need to determine what their cancer specialties and offerings will be so the best results will be achieved and with cases involving rarer conditions referred elsewhere.
Long term, there is a need for an expanded clinical care workforce to provide for the health needs of the growing number of cancer survivors as well as to address the question of how do we efficiently deliver quality of care to terminal cancer patients who do not need to be in the hospital.
Studies are underway at the National Cancer Institute as well as the Centers for Medicare and Medicaid Services to best determine how affordable cancer care can be delivered in the future to patients with that care based on value to the patient and centered on the needs of the patient and their family.
The movement toward quality cancer care today means being able to determine the right treatment for the right patient at the right time at a time when options and possibilities are on the increase.
This involves a broad re-thinking of clinical studies — something the NCI is also doing — so a patient’s time is not wasted on studies that will not move that patient’s care forward.
There is always going to be cancer, but today more than ever we can better address this by asking how can we deliver and manage the cancer care available for the most success in treatment outcomes and patient satisfaction. While the cancer scourge will not be eliminated, we can take steps to ensure that the best care is delivered without errors to all patients who need them.
Dr. Wilson C. Mertens is vice president, medical director of cancer services at Baystate Regional Cancer Program based in Springfield.