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U.S. Lacks Cancer Program

Many Americans with cancer are not getting the best care, largely because there's no way for them to know where to turn for the best treatment, said a report Tuesday.

"There is no national cancer care program or system of care in the United States," the report, put together by cancer experts from across the country, said.

Survival rates immediately after complicated cancer surgery or chemotherapy are two to three times higher when performed by more experienced medical staff, according to several studies reviewed in the report.

"We were all shocked at how little information is available on [cancer care]," said Dr. Joseph Simone of the University of Utah, co-author of the National Cancer Policy Board report.

Why the difficulty? Cancer consists of 100 diseases requiring different treatments depending on their stage of development. Programs that count cancer incidence and deaths often don't record the patient's disease stage or type of treatment.

Until a systematic way can be developed to assess quality care, the report offered patients some advice:

  • There are no data on whether most cancer patients should go to a high-volume cancer center instead of a smaller hospital near home. But for complicated and high-risk surgeries, such as for pancreatic cancer or the removal of the esophagus or pelvic organs, and for complicated chemotherapy regimens, patients should seek out hospitals that perform the highest numbers of such procedures.
  • All patients should find oncologists experienced in their particular form and stage of cancer. A woman with Stage III breast cancer, for instance, should specifically ask how many Stage III breast cancer patients the doctor has treated.
  • Patients should be given all treatment options before planning a clear approach to therapy. A single doctor should then coordinate and interpret the care patients will need from multiple physicians. It's typical to get radiation at one site, tests at another, for example.

The National Cancer Policy Board was created by the Institute of Medicine and the National Research Council, independent organizations that advise the government. Tuesday's report lays out the problem. The board will meet later this year to plan solutions with agencies like the National Cancer Institute.

"This is a complex and probably formidable task, but we intend to pursue this with vigor," said Simone.

About 8 million Americans were treated for cancer last year, and about 1.2 million new cases were diagnosed. Cancer is the second-biggest killer in industrialized countries, after heart disease.

"So if a patient has a bad outcome, is it just bad luck or is it because they got inappropriate care?" Simone asked.

There is no way to ensure that doctors follow the latest cancer guidelines. Physicians sometimes even order too few cancer screening tests, the report said.

Take breast cancer, where early detection and treatment iwell-known to be lifesaving. More is known about the quality of breast cancer care than any other cancer, the report said, yet studies show some doctors don't push patients to get regular mammograms, perform inadequate biopsies and underuse radiation or chemotherapy after surgery.

Part of the problem may be financial: 7 percent of newly diagnosed cancer patients lack insurance, the report said.

Another problem is poor pain treatment, especially in terminal patients. Doctors need to be better educated in pain management, Simone said. "The vast majority of patients need not suffer."

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