About 14 million living Americans have had cancer and 1.6 million cases occur each year. Some are not life-threatening but many are and cancer is perhaps the illness which creates the greatest anxiety about care among its sufferers. An Institute of Medicine report examines the state of cancer care in the US, with recommendations for improvement. (IOM Report) Cancer care cost about $125 billion in 2010 and the costs are rising rapidly, largely due to better survival times and more expensive specialty drugs. Much of the cost of this care is placed on patients through deductibles and copays and even drug coinsurance. This raises questions about access to needed care. The IOM expressed concern about the extent of patient involvement in care decisions, through shared decision-making and other methods, particularly for patients who are likely terminal. Palliative care is not always used, which may create unnecessary discomfort from the effects of drugs, radiation and other treatment. And although many guidelines for various cancers exist, care is still not often provided in accordance with these guidelines, which may lower outcomes and increase costs. Another significant problem is the adequacy of the work force, given trends in cancer frequency. To address these issues, the IOM recommended six key components to a cancer care system: engaged patients; a trained and coordinated cancer care workforce; consistent use of evidence-based care; better IT specifically for cancer treatment; quality improvement systems and ensuring access, including affordability. The report provides a good roadmap, but in a fragmented system, we will see what the chances of implementation are.
