Defining Safety & Quality in Cancer Care

ANN MEREDITH U. GARCIA, MD, FPCP, DPSMO, MCMMO
Internal Medicine – Medical Oncology
Deﬁning safety & quality
in
CANCER CARE

Cancer patients
deserve the best care possible,
yet many obstacles
render timely, efﬁcient, safe,
and affordable cancer care
an elusive goal…

The Institute of Medicine’s
SIX DIMENSIONS of QUALITY

The KEY FOUNDATION of systems-based
healthcare quality improvement
Commi%ee on Quality of Health Care in America, Ins8tute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century.
Washington, DC: The Na8onal Academies Press; 2001.

A HIGH-QUALITY
cancer care delivery system
cian interactions (including health care
ch inform development of performance
and implementation of new payment
eration to patient preferences regarding care, and, in parti
the patient-reported outcomes associated with particula
ment plans. Clinical and psychosocial factors inﬂuence
delivery system. This ﬁgure represents the Committee's conceptual framework for improving the quality of cancer care. Quality is
measurement, improvement, and integration into the system. The system should be accessible and affordable to all patients with
IOM (Ins8tute of Medicine). Delivering High-Quality Cancer Care: Char8ng a New Course for a System in Crisis. Washington, DC: The Na8onal
Academies Press; 2013.

Principle 1
People with cancer have the right to a system of
universal health care. This access should not be
precluded because of preexisting conditions,
genetic or other risk factors, or employment status.
National Coalition for Cancer Survivorship:
Imperatives for Quality Cancer Care
Principle 2
Quality cancer care should be available in a health
care system whose standards and guidelines are
developed in consideration of treating the whole
person with cancer. Health care plans must regard
the cancer patient as an autonomous individual
who has the right to be involved in decisions about
his or her care.
Hewi% M, Simone JV, editors. Ensuring Quality Cancer Care. Washington, DC: The Na8onal Academy Press; 1999.

Principle 3
Standards of cancer care should be driven by the
quality of care, not only by the cost of care, and
should include participation in clinical trials and
quality-of-life considerations.
Principle 4
All people diagnosed with cancer should have
access to and coverage for services provided by a
multidisciplinary team of care providers across the
full continuum of care. Health care plans should be
held accountable for timely referral to appropriate
specialists when symptoms of cancer or its
recurrence may be present.

Principle 5
People with cancer should be provided a range of
beneﬁts by all health care plans that include
primary and secondary prevention; early detection;
initial treatment; supportive therapies to manage
pain, nausea, fatigue, and infections; long-term
follow-up; psychosocial services; palliative care;
hospice care; and bereavement counseling.
Principle 6
People with histories of cancer have the right to
continued medical follow-up with basic standards of
care that include the speciﬁc needs of long-term
survivors.

Principle 7
Long-term survivors should have access to
specialized follow-up clinics that focus on health
promotion, disease prevention, rehabilitation, and
identiﬁcation of physiologic and psychosocial
problems. Communication with the primary care
physician must be maintained.
Principle 8
Systematic long-term follow-up should generate
data that contribute to improvements in cancer
therapies and decreases in morbidity.

Principle 9
The responsibility for appropriate long-term medical
care must be shared by cancer survivors, their
families, the oncology team, and primary care
providers.
Principle 10
The provision of psychosocial services must be
safeguarded and promoted. Persons diagnosed
with cancer should receive psychosocial
assessments at critical junctures along the
continuum of cancer care to determine the
availability of needed support and their ability to
seek information and advocate on their own behalf.

Principle 11
Psychosocial research is integral to comprehensive
cancer care, and as such, psychosocial outcome
measures should be included in all future clinical
trials. The importance of this research and its
application and transfer to oncology care plans
should be recognized and encouraged.
Principle 12
Cancer survivors, health care providers, and other key
constituency groups must work together to
increase public awareness; educate consumers,
professionals, and public policy makers; develop
guidelines and disseminate information; advocate
for increased research funding; and articulate for
and promote survivors' rights.

THREE CENTRAL QUESTIONS
What problems are evident in the quality of cancer
care and what steps can be taken to improve care?
How can we improve what we know about the
quality of cancer care?
What steps can be taken to overcome barriers of
access to quality cancer care?

Spinks T, et al. Ensuring Quality Cancer Care: A Follow-Up Review of the Ins8tute of Medicine’s 10 Recommenda8ons for Improving the Quality
of Cancer Care in America. Cancer. 2012;118:2571-82.
Recommendation 1
Ensure that patients undergoing procedures that are
technically difﬁcult to perform and have been
associated with higher mortality in lower volume
settings receive care at facilities with extensive
experience.

Recommendation 2
Use systematically developed guidelines based on
the best available evidence for prevention,
diagnosis, treatment, and palliative care.

Recommendation 3
Measure and monitor the quality of care using a
core set of quality measures.

Recommendation 4
Ensure the following elements of quality care for
each individual with cancer:
1)  that recommendations about initial cancer management
are made by experienced professionals;
2)  an agreed-upon care plan that outlines goals of care;
3)  access to the full complement of resources necessary to
implement the care plan;
4)  access to high-quality clinical trials;
5)  policies to ensure full disclosure of information about
appropriate treatment options;
6)  a mechanism to coordinate services; and
7) psychosocial support services and compassionate care.

Recommendation 5
Ensure quality of care at the end of life, in
particular, the management of cancer-related pain
and timely referral to palliative and hospice care.

Recommendation 6
Public and private research sponsors, and various
health plans should invest in clinical trials to
address questions about cancer care management.

Recommendation 7
A cancer data system is needed that can provide
quality benchmarks for use by systems of care
(such as hospitals, provider groups, and managed
care systems).

Recommendation 8
Public and private sponsors of cancer care research
should support national studies of recently
diagnosed individuals with cancer, using information
sources with sufﬁcient detail to assess patterns of
cancer care and factors associated with the receipt
of good care. Research sponsors should also
support training for cancer care providers interested
in health services research.

Recommendation 9
Services for the un- and underinsured should be
enhanced to ensure entry to, and equitable
treatment within, the cancer care system.

Recommendation 10
Studies are needed to ﬁnd out why speciﬁc
segments of the population (e.g., members of
certain racial or ethnic groups, older patients) do not
receive appropriate cancer care. These studies
should measure provider and individual knowledge,
attitudes, and beliefs, as well as other potential
barriers to access to care.

Defining Safety & Quality in Cancer Care

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