Maximizing Use of Health Systems Vital in Improving Cancer Outcomes

Despite substantial progress made in cancer treatment and prevention, patients and the nation overall will not benefit from these new developments if they are not optimized, a new report details.

Cancer mortality significantly decreased between 1991 and 2015 thanks to strides made in prevention, screening, treatment, and survivorship care, the authors wrote—but outcomes vary greatly based on a patient’s race/ethnicity, socioeconomic status, health insurance coverage, and geographic location. And while cancer spending continues to grow, preventable deaths continue to occur. Patients who died from their disease may have had a different outcome had they received optimal care.

The report is part of the Cancer Control Blueprint series and appears in CA: A Cancer Journal for Clinicians.

Delivering Health Care Across the Cancer Control Continuum

In their report, the researchers outline the different aspects of the cancer control continuum and the importance of access to care for each one. Health care across the cancer control continuum includes risk assessment and prevention, screening and detection, diagnosis, treatment, survivorship, and end-of-life care.

While medical advances have made this type of care possible, certain barriers keep it inaccessible for some patients, the study authors explained. Some of these roadblocks include:

  • Risk assessment and prevention: Lack of risk assessment and behavior counseling
  • Screening and detection: Lack of screening recommendation
  • Diagnosis: Lack of follow-up [for] abnormal findings
  • Treatment: Underuse, overuse, and misuse of effective treatment(s), and lack of early inclusion of palliative care
  • Survivorship: Lack of coordinated survivorship care
  • End-of-life care: Lack of coordinated palliative care

Access issues are multi-faceted. For instance, geography makes a difference in access: patients who live in rural areas may have to travel far to receive optimal care. Care access also varies by state, as do Medicaid features. Other variables include patient factors such as minority race/ethnicity, poverty, limited education, or unfamiliarity with the health care system. And for low-income patients, they simply may not be able to afford health care.

Facets of a High-performing Health Care System

Health care costs continue to climb, according to the researchers, and as the baby boomer generation gets older, costs will continue to rise.

“Despite these high costs, the health of the population and, for purposes of this article, the health of the population in relation to cancer control is suboptimal, and disparities are pronounced,” the study authors wrote. “Health care in the United States is not optimally effective, timely, efficient, or equitable.”

In order to optimize cancer control across the country, the study authors outlined several goals for a high-performing health system:

  • Encourage adoption of healthy lifestyles
  • Provide access to a regular source of primary care
  • Facilitate timely access to evidence-based care
  • Promote patient-centeredness, including effective patient-provider communication
  • Enhance coordination and communication between providers
  • Ensure affordability for patients, payers, and society

While the goals are clear, the road toward them is a challenge, and the complexities associated with each patient achieving them surpasses the scope of the report. But one thing is clear, the authors state: no one should develop or die from cancer because they do not have access to appropriate care.

“Health care should be accessible, affordable, administratively simple, and based on evidence, and payment must be linked to the right incentives, as measured by the achievement of optimal outcomes with appropriate resource utilization,” the researchers wrote. “Ensuring that all individuals can access high‐quality care is critical, a vital attribute to judge the effectiveness of a delivery and payment system.”

Source: CA: A Cancer Journal for Clinicians