| NEW YORK, Sept 10
NEW YORK, Sept 10 Cancer treatment has grown so
complex, many U.S. doctors can't keep up with new information
and are offering incorrect treatment, failing to explain options
and leaving patients to coordinate their own care, according to
a report released on Tuesday by the Institute of Medicine, part
of the National Academy of Sciences.
The 315-page report, "Delivering High-Quality Cancer Care:
Charting a New Course for a System in Crisis," identifies a long
list of reasons for the crisis, including a growing demand for
cancer care as more people receive a diagnosis and a shrinking
"Probably on average the quality of care is not bad, but we
know there are people who are not getting the (highest) standard
of care," said Dr Patricia Ganz, who chaired the institute's
panel that wrote the report and is a professor at the Schools of
Medicine and Public Health, University of California, Los
Angeles. "Patients need to be asking, Is my doctor giving me
Treating the disease, which can require precisely matching a
tumor's molecular characteristics to a drug, has become so
complicated that many physicians lack "core competencies in
caring for patients with cancer," the report concludes.
Groups such as the American Society of Clinical Oncology
(ASCO) have developed scores of treatment guidelines for
virtually every stage of nearly every kind of cancer. But
clinicians' adoption of the guidelines is not widespread, finds
the IOM. Some physicians believe their own experience trumps
scientific evidence, others suspect their patients are different
from the norm, and still others are simply unaware of treatment
"When cancer patients understand that their local doctor in
their community hospital doesn't have half the new knowledge
about their particular subtype of cancer, well, 'gobsmacked'
would pretty well describe it," said Clifton Leaf, a cancer
survivor and journalist whose new book "The Truth in Small
Doses: Why We're Losing the War on Cancer - and How to Win It"
is critical of the cancer establishment.
PALLIATIVE CARE, GOALS UNADDRESSED
Doctors are also falling short when it comes to simpler
challenges. Too few oncologists know how to provide palliative
care to keep patients comfortable when treatment has failed, or
even how to make referrals to palliative-care consultants, the
Patients can't even assume their doctors will communicate
adequately. Many are failing to explain the pros and cons of
treatment options, let alone asking patients about their
preferences. Nor are they spelling out the goals of treatment or
even what treatment patients have received and how it might
affect their future health. Some chemo, for instance, raises the
risk of heart disease.
Most physicians also seem unwilling to deliver hard truths:
Up to 80 percent of cancer patients with poor prognoses
incorrectly believed their treatment could result in a cure, the
Responding to the criticisms, ASCO President Dr Clifford
Hudis said, "I have no reason to doubt the accuracy of the IOM
report," adding that "every person with cancer should receive
state-of-the-art, high-quality and compassionate care.
"A large minority of oncology practices" have signed on to
ASCO's program to improve the quality of care, he said. The
initiative includes sending anonymized patient charts to ASCO
experts, who tell the physician if they performed the correct
tests - such as probing a lung cancer for a particular gene
mutation - and offered the appropriate therapy. If they did not,
that is flagged.
Studies show this quality-control program is working. "But
there are still barriers to oncologists staying up to date" with
the complexity of cancer care, said Hudis, a breast cancer
specialist at Memorial Sloan-Kettering Cancer Center in New
York, including finding time to travel to medical meetings and
read scientific journals.
Many cancer patients know all too well that cancer care "is
often fragmented and poorly coordinated," the report finds.
Jessie Gruman, a four-time cancer survivor who in 1992
founded the nonprofit, Washington, D.C.-based Center for
Advancing Health, was recently diagnosed with stomach cancer. In
one single year eight physicians, starting with her oncologist
and surgeon, cared for her, and only once did two of them
communicate directly with each other.
"Otherwise, I have been the sole arbiter of who gets what
information and which test results from the others," Gruman
wrote in an essay in "Health Affairs" earlier this year.
Just over 1.6 million new cancer cases are diagnosed each
year in the United States; by 2030, 2.3 million will be as the
population ages. That will present even more challenges,
starting with too few oncologists and facilities to care for the
rising number of patients: A report commissioned by ASCO
concluded that the nation will be short 2,500 to 4,080 medical
oncologists by 2020.
Most of the new cancer patients are elderly and suffering
other illnesses, which means they tend to be weaker and thus
less able to tolerate punishing therapy. Age also complicates
treatment because few new chemotherapy drugs or other treatments
have been tested in older patients; drug companies that sponsor
these clinical trials prefer younger patients who don't have
Sadly, said Ganz, little progress has been made since 1999,
the last time the IOM examined the issue, in the quality of care
cancer patients receive. That report's recommendations for
implementing evidence-based care and making other changes, she
said, "have had limited uptake."
(Reporting by Sharon Begley; Editing by Michele Gershberg and