Recommendations to Improve Care of the Cancer Patient

Workshop Summary

ARTHUR I. HOLLEB, MD

EFORE THE WORKSHOP adjourned the attendees had B generated a wealth of information and timely rec- ommendations for quality assurance in cancer care. The following was the consensus of workshop participants:

It is incumbent on the recognized experts in the cancer field to promptly assume leadership in seeking a systematic approach to quality assurance and clinical indicators in the care of the cancer patient.

Quality assurance is feasible in prevention, early de- tection, diagnosis, pretreatment staging and evaluation, treatment, rehabilitation, and continuing care; all settings are appropriate, including the physician’s office, the hos- pital, inpatient and outpatient clinics, community health centers, free-standing treatment centers, hospices, nursing homes, rehabilitation centers, and the home.

Challenges exist in the area of quality assurance; among them are the need to develop more effective methods for defining, evaluating, and ensuring quality care; locate greater resources; understand cultural issues involved in relationships among patients, health care professionals, and facilities; develop evaluation systems for nonhospital settings; and improve and expand existing data bases.

Recognition be given to groups such as the American College of Radiology, the College of American Patholo- gists, the Commission on Cancer ofthe American College of Surgeons, and the National Cancer Institute for their “patterns of care” studies and other retrospective infor- mation on cancer therapy. Health care professionals need and are responsive to growing data bases related to de- tection and diagnosis, as well as data-driven change ini- tiated and reviewed by peers that results in improved management.

There is a need for improved communication between health care professionals and third-party payors about the prevention and detection of cancer. Payors need to be informed about scientifically valid medical procedures to

identify cancer in early stages, thereby reducing high treatment costs later on.

Staging constitutes an essential and measurable element of quality assurance.

Multidisciplinary consultations, as well as tumor boards and treatment planning protocols are effective mecha- nisms for quality assurance in both treatment and overall planning for care of the cancer patient.

The nursing profession has established standards for oncology nursing practices and recognizes the need for developing and testing clinical indicators.

A data base that includes information vital to oncology social workers and others concerned with psychosocial aspects of care and rehabilitation should be compiled and monitored so as to incorporate it into clinical manage- ment.

Patient satisfaction with care rendered is a major ele- ment of quality assurance, and should be thoroughly in- vestigated and measured.

Preliminary models of clinical indicators suggest that a more comprehensive definition and refinement are needed to ensure appropriate monitoring. Broadly based experts and organizations should help develop bases for clinical indicators to guarantee the best possible medical care. Existing elements of cancer programs presently in place in most hospitals should be evaluated in the devel- opment of clinical indicators (such as cancer committees, tumor boards, and tumor registry data bases). It must be understood that a clinical indicator is a flag for investi- gation, and does not necessarily represent an end point in the assessment of quality.

The Agenda for Change of the Joint Commission on Accreditation of Healthcare Organizations endorses re- source deployment to assess quality; proposes greater at- tention to evaluating data and analyzing clinical and or-

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ganizational factors; and emphasizes the importance of commitment by all health professionals to substantive peer review.

Local peer review is an effective instrument in modi- fying inappropriate practice patterns and enhancing ad- herence to recommended risk management practices.

Mechanisms must be devised to promote culturally targeted education about cancer prevention and detection to socioeconomically disadvantaged people. Access to high-quality diagnostic and treatment services must be provided, along with assured coverage of necessary costs. An expanded data base regarding socioeconomic status,

ethnicity, and quality of life of cancer survivors is needed to effectively measure outcome rather than mere survival.

There is a great need for earlier detection of the major cancers occurring in the elderly population not only to reduce mortality rates, but also to decrease morbidity. Studies should be undertaken on how elderly individuals approach the symptoms of illness and how providers ren- der care to the elderly under the conditions imposed by both normal and pathologic processes of aging.

An ongoing program of the American Cancer Society and the American College of Surgeons is needed to devise an acceptable strategy for monitoring cancer care.