Monday, 24 November 2014

Oncological Care: What does the IOM Report reveal?

Ten years after the first report, the Institute of Medicine has published a new study on the quality of cancer care in the United States, forced, according to experts, because the situation is far from improving. To better understand this work, we have to contextualize it in the United States, where they have serious problems of access to cancer care, coordination between professionals and exaggerated costs of clinical processes.

On the other hand, cancer care in our country is, obviously, more accessible and more coordinated than the United States, but nevertheless you will agree with me that we lack, by contrast, the evaluation and analytical capacity of Americans, and for this reason I believe that the findings presented in this report should teach us something with the intention of overcoming our own inefficiencies, because we do have them.

The IOM expert committee concluded that the model of cancer care in America is in crisis, mainly due to three factors: a) the clinical process too often does not focus on the patients’ preferences, b) many patients only receive palliative care at the end of life, and c) clinical decisions too often are not based on evidence.
The recommendations of the IOM experts are more along the lines of modelling than in the lines of concretions. And from the proposed models, I have extracted a couple that I think are interesting. The first chosen proposal is displayed in a self-explanatory graph, because you will see in it, the concept of gradual introduction of palliative care during the clinical process that is the most convenient and not only towards the end of life. 

The second chosen proposal corresponds to the complete conceptual model, in line with the already known care for chronic patients (Wagner et al.) Look at the chart and notice that if the patient is at the centre of the model, then the interactions between patients and clinicians should be framed by the coordination that involves teamwork (workforce), which has to operate in a world sustained both by the evidence as well as the shared clinical information (thanks to current technological possibilities). And to close the model: good accessibility (input), excellent quality indicators (output) and a welfare payment that promotes efficiency.

Next and to end this discussion, I attached a video presentation of the IOM report, from which I want to highlight the words of Dr. Neil Wenger, family physician, Department of Medicine, UCLA: "The cancer care will be unsustainable if we do not focus on offering only the treatment that patients need and want."

Recall that in the post "Waste, oncologists say" I have already referred to the report "Delivering affordable cancer care in high income countries" published by the Lancet Oncology Commission and the article "Bending the cost curve in cancer care" published in the New England Journal of Medicine. Therefore, this new IOM document reinforces the professional initiatives to put a little more common sense in oncology practice.

Jordi Varela

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