The health care delivery system is poorly organized to meet today’s challenges at hand. The delivery of care is overly complex and uncoordinated, requiring steps and patient handoffs that decrease the quality and safety of care. The cumbersome processes waste resources, lead to loss of information, and fail to build upon the strengths of all health care providers involved to ensure that care is appropriate, timely, and safe.1
Research focus for cancer care delivery:
Understanding the barriers that contribute to delays in care
Using survivorship plans to improve the coordination of care
1 Crossing the Quality Chasm: A New Health System for the 21st Century. Report Brief. IOM. March 2001.
The United States leads the world in cancer care outcomes, but the cost is extremely high—and growing rapidly. There is a broad and growing consensus that the rising cost of health care in the United States will result in crippling economic effects if this trend is not reversed. New proposals for health reform emphasize one clear and immediate need: to control runaway cost. How the cost curve bends, along with how we manage cost while sustaining quality patient care, is a top concern.2
Research focus for cost:
Overuse of drugs, tests and procedures
Cost-Effectiveness of new interventions
2ASCO Task Force on the Cost of Cancer Care. Schnipper, L. July 2009.
The burden of cancer is too often greater for the poor, minorities, and the uninsured than for the general population. Many ethnic minorities develop cancer more frequently than the majority of the US white population.(3)
Numerous studies suggest that members of minority groups not only develop cancer disproportionately, they also do far worse with regard to accessing quality care and surviving the disease. The data also supports the role of poverty, lack of insurance and poor education as being highly predictive for the disproportionate development of cancer and for worse outcomes.3
Research focus for disparities:
Variations by race, ethnicity, region, and socio-economic status
Disparities in treatment quality
3 Disparities in Cancer Care. ASCO Journal of Oncology Practice. September 2006.
Effectiveness and Outcomes
Comparative effectiveness research is being discussed as part of the national health reform debate as a mechanism for improving the quality of health care and for decreasing health care spending. The aim of comparative effectiveness research is to improve health outcomes by developing and disseminating evidence-based information to patients, providers, and health care decision-makers about the effectiveness of treatments relative to other options. Identifying the most effective and efficient interventions has the potential to reduce unnecessary treatments, which in turn, may help lower costs.4
Research focus for effectiveness and outcomes:
Comparative effectiveness of treatment strategies
Association between publically reported hospital satisfaction and quality data and oncologic outcomes
4 Explaining Health Reform: What is Comparative Effectiveness Research? The Henry J. Kaiser Family Foundation. October 2009.
Patterns of Care
Patterns of care provide important information on the receipt of cancer therapies. Data gathered through patterns of care studies are used in a number of ways. The data helps investigators examine disparities in cancer treatment among age, racial/ethnic groups, and urban/rural residents. They also provide information about the dissemination of new therapies into community practice, the relationship between hospital volume and outcomes, and utilization patterns of aggressive end-of-life care.5
Research focus for patterns of care:
Trends in use by treatment type (i.e. surgery, chemotherapy, radiation)
Incorporating the benefits of technology and digital engagement
5 Patterns of Care/Quality of Care Studies. NCI. 2017.
In the United States, approximately 14 million people have had cancer and more than 1.6 million new cases are diagnosed each year. By 2022, it is projected that there will be 18 million cancer survivors and, by 2030, cancer incidence is expected to rise to 2.3 million new diagnoses per year. However, the barriers to achieving excellent care for all cancer patients remain daunting.6
The cancer care delivery system is in crisis due to a growing demand for cancer care, increasing complexity of treatment, a shrinking workforce, and rising costs. Changes across the board are urgently needed to improve the quality of cancer care. All stakeholders need to reevaluate their current roles and responsibilities in cancer care and work together to develop a higher quality cancer care delivery system.6
Research focus for quality:
Adherence to guidelines, quality indicators, medications
Innovative technology and its implications on quality and cost
6 Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Report Brief. 2013.
Maintaining a safe environment reflects a level of compassion and vigilance for patient welfare that is as important as any other aspect of competent health care. The way to improve safety is to learn about causes of error and use this knowledge to design care systems to reduce errors and harms. As a result, researchers, policymakers, and providers have intensified their efforts to understand and change organizational conditions, components, and processes as they relate to patient safety.7
Research focus for safety:
Identifying the occurrence of serious adverse events
Preventing adverse effects and managing risks for complications
7 “Creating a Safe and High-Quality Health Care Environment.” Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Stone, P, Hughes, R, Dailey, M. April 2008.