WASHINGTON -- Delivery of cancer care in the U.S. is facing a crisis stemming from a combination of factors -- a growing demand for such care, a shrinking oncology work force, rising costs of cancer care, and the complexity of the disease and its treatment, says a new report from the Institute of Medicine. The report recommends ways to respond to these challenges and improve cancer care delivery, including by strengthening clinicians' core competencies in caring for patients with cancer, shifting to team-based models of care, and communicating more effectively with patients.
Most clinicians caring for cancer patients are trying to provide optimal care, but they're finding it increasingly difficult because of a range of barriers, said Patricia Ganz, chair of the committee that wrote the report and a professor at the School of Medicine and School of Public Health, University of California, Los Angeles. As a nation we need to chart a new course for cancer care. Changes are needed across the board, from how we communicate with patients, to how we translate research into practice, to how we coordinate care and measure its quality.
Changing demographics will place new demands on the nation's cancer care delivery system, as the number of adults older than 65 -- the segment of the population that accounts for most cancer diagnoses -- rapidly increases, the report says. In the United States, more than 1.6 million new cases are diagnosed each year; by 2030, cancer incidence is expected to rise by 45 percent to 2.3 million new diagnoses per year. The oncology work force may soon be too small to care for the rising number of people diagnosed with cancer, and training programs lack the ability to rapidly expand, the report says.
Adding to stresses on the system is the complexity of cancer and its treatment, which has grown in recent years with the development of new therapies targeting specific abnormalities often present only in subsets of patients. Incorporating this new information into clinical care is challenging, the report says. Given the disease's complexity, clinicians, patients, and patients' families can find it difficult to formulate care plans with the necessary speed, precision, and quality; as a result, decisions about cancer care are often not sufficiently evidence-based.
Another challenge is the cost of cancer care, which is rising faster than other sectors of medicine, having increased from $72 billion in 2004 to $125 billion in 2010, says the report. At the current rate, it will increase another 39 percent to $173 billion by 2020. And the single largest insurer for those over 65, the Centers for Medicare and Medicaid Services (CMS), is struggling financially.
The report recommends strategies for improving the care of cancer patients, grounded in six components of high-quality cancer care. The components are ordered based on the priority level with which they should be addressed.