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Spring 2014 Vol. 13 Number 2

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A Crisis in Cancer Care

The treatment of cancer has always been a profound medical challenge, and it is about to become an even greater one. By 2030, cancer incidence in the U.S. is expected to rise to 2.3 million new diagnoses a year -- an almost 45 percent increase over the current annual rate of 1.6 million. This increase will be driven largely by the aging of the U.S. population: The number of adults older than 65 is growing rapidly, and this slice of the population accounts for the majority of cancer diagnoses and deaths, as well as the majority of cancer survivors. In addition, the oncology workforce is not expanding to accommodate this influx of patients, so the future number of patients is likely to exceed the system's capacity to care for them.

Meanwhile, the cost of cancer care is rising faster than many other sectors of medicine. Cancer treatment in the U.S. cost $125 billion in 2010 and is expected to reach $173 billion per year by 2020. Still another challenge is the complexity of cancer and its treatment. New knowledge and therapies are rapidly emerging -- a positive development, except that it can be difficult for clinicians to assimilate this vast quantity of new knowledge effectively into the care they provide.

All of these developments are driving a crisis in cancer care, says a recent report from the Institute of Medicine, which recommends various steps to help the U.S. health care system rise to the challenge. Research shows that many patients need more accurate information than they are getting now. Patients with advanced cancer have additional communication and decision-making needs, including discussions with clinicians about implementing advance care plans when they approach the end of life. Currently these discussions do not happen as often as they should. Cancer care teams should provide patients and their families with understandable information about the cancer prognosis and the benefits, harms, and costs of treatments. The federal government and other stakeholders should improve the development and dissemination of this information.

More information should be gathered on the benefits and harms of different therapies, especially for older patients who often have multiple chronic health conditions and are usually excluded from clinical studies. An information technology system should be created to collect this information and help clinicians quickly incorporate new medical knowledge into routine care. And using new models of team-based care could help meet workforce shortages and ensure that care is coordinated.

-- Sara Frueh & Jennifer Walsh

Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population, Board on Health Care Services, Institute of Medicine (2013, 412 pp.; ISBN 978-0-309-28660-2; available from National Academies Press, tel. 1-800-624-6242; $65.95 plus $5.00 shipping for single copies).

The committee was chaired by Patricia Ganz, Distinguished University Professor in the Schools of Medicine and Public Health, University of California, Los Angeles, and director of cancer prevention and control research at the Jonsson Comprehensive Cancer Center, Los Angeles. The study was funded by the National Cancer Institute; Centers for Disease Control and Prevention; AARP; American Cancer Society; American College of Surgeons, Commission on Cancer; American Society of Clinical Oncology; American Society of Hematology; American Society for Radiation Oncology; California HealthCare Foundation; LIVESTRONG; National Coalition for Cancer Survivorship; Oncology Nursing Society; and Susan G. Komen for the Cure.

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