Delivering High-Quality Cancer Care: A Decade Later

Academic Background

In 2012, the National Academies of Sciences, Engineering, and Medicine (NASEM) convened a committee to address the quality of cancer care in the United States and provide recommendations to policymakers and the cancer care community on strategies to improve cancer care delivery from diagnosis through end-of-life care. In 2013, the committee released a report titled Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, which presented a conceptual framework consisting of six interconnected components of care and corresponding recommendations. However, over the past decade, delivering high-quality cancer care has become more complex and demanding on the workforce. This article reviews the goals and recommendations made in the 2013 report, describes the progress made to date, and offers insights into the dedicated efforts and new strategies needed to achieve high-quality cancer care in the future.

Source of the Paper

This article was co-authored by Larissa Nekhlyudov (Brigham and Women’s Hospital, Harvard Medical School), Laura A. Levit (American Society of Clinical Oncology), and Patricia A. Ganz (University of California, Los Angeles). It was published on October 2, 2024, in the Journal of Clinical Oncology.

Main Content

1. Engaged Patients

High-quality cancer care requires placing patients at the center of care and supporting them in making informed medical decisions that align with their needs, values, and preferences. The 2013 NASEM report emphasized that the cancer care team should provide patients and their families with understandable information on cancer prognosis, treatment benefits and harms, palliative care, psychosocial support, and estimates of the total and out-of-pocket costs of cancer care. Although these recommendations were partially adopted in the Oncology Care Model (OCM) implemented from 2016 to 2022, the model showed only modest improvements in cost and healthcare utilization. Nevertheless, the experiences of both patients and healthcare professionals were positive, and CMS (Centers for Medicare and Medicaid Services) is now launching a new experimental payment model, the Enhancing Oncology Model (EOM), based on lessons learned from OCM.

2. Adequately Staffed, Trained, and Coordinated Workforce

The 2013 NASEM report highlighted the need to develop a healthcare system that provides competent, trusted, interprofessional cancer care teams aligned with patients’ needs, values, and preferences, and coordinated with patients’ non-cancer care teams and caregivers. Although some organizations have developed communication training programs, their reach and implementation remain limited. Additionally, the Oncology Nursing Society recently endorsed the Palliative Care and Hospice Education and Training Act, which aims to provide government funding for palliative care and hospice education centers to improve the training of healthcare professionals. However, this act has not yet been passed by Congress.

3. Evidence-Based Cancer Care

The 2013 NASEM report identified persistent gaps in the evidence base for treating cancer patients, particularly in data collection for older adults and individuals with multiple comorbidities. Although the FDA, ASCO, NCI, and other organizations have taken steps to improve the inclusion of older adults in clinical trials, their representation remains insufficient. Furthermore, the Food and Drug Omnibus Reform Act of 2022 (FDORA) mandates that sponsors of phase three studies submit diversity action plans to the FDA to increase data collection on representative patient populations.

4. Learning Health Care Information Technology System

The NASEM committee recognized that healthcare systems themselves could serve as laboratories for real-time data analysis and rapid application. Although progress has been made in electronic health records (EHRs) and cancer data repositories, the full vision of a learning health care system has not yet been realized. Future efforts may require investments from commercial entities, and artificial intelligence and machine learning are expected to play a prominent role in clinical care and research.

5. Translating Evidence into Clinical Practice, Quality Measurement, and Performance Improvement

Although the 2013 NASEM committee recommended the creation and implementation of a formal long-term strategy for publicly reporting quality measures for cancer care, this goal has not been achieved. ASCO recently launched the ASCO Certified program, which provides a set of standards for practices to measure the quality of their care and encourages ongoing assessments and quality improvement projects. However, the program is still in its early stages of implementation and requires further evaluation to determine its effectiveness.

6. Accessible and Affordable Cancer Care

The Affordable Care Act (ACA) led to critical improvements in access and affordability for cancer patients, but challenges remain. The NASEM committee emphasized the need to continue efforts to reduce disparities in access to cancer care for vulnerable and underserved populations. The recent passage of the CMS 2024 Medicare Physician Fee Schedule Final Rule, under the Moonshot Initiative, allows for the billing and reimbursement of patient navigation services, which has the potential to reduce disparities in care.

Conclusion

The 2013 NASEM report was forward-looking and aspirational, envisioning a patient-centered cancer care delivery system that could meet the challenges of an aging population and an increasingly fragmented healthcare system. Over the past decade, national organizations and champion initiatives have made incremental progress in improving aspects of the healthcare delivery system as recommended in the report, such as the development and testing of innovative payment models, efforts to increase the administration of palliative and end-of-life care, and the expansion of research priorities to include diverse patient populations. However, most of these efforts have been incremental and have not led to significant improvements in cancer care. Moving forward, continued dedication and new strategies will be essential to ensure that all cancer patients have access to high-quality care.

Highlights

This article reviews the goals and recommendations made in the 2013 NASEM report, describes the progress made to date, and offers insights into the dedicated efforts and new strategies needed to achieve high-quality cancer care in the future. It emphasizes the importance of patient engagement, workforce training, evidence-based care, learning health care information technology systems, quality measurement, and accessible and affordable cancer care. Although some progress has been made over the past decade, further efforts are needed to achieve high-quality cancer care for all patients.