Doctor Shortage, Rising Costs, Makes Quality Cancer Care Difficult

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A shortage of oncologists and rising costs of chemotherapy and radiation therapies and imaging tests, are making delivering quality cancer care increasingly difficult, according to a new review by researchers at RTI Health Solutions and Eli Lilly and Company.

The study, published in the March 1 issue of Cancer, found that the definition of quality cancer care differed among patients and physicians.

"High-quality cancer care cannot be achieved without an understanding of the perceptions of quality," said Ann Colosia, Ph.D., a senior associate in market access and outcomes strategy at RTI Health Solutions, a business unit of RTI and the paper's lead author. "The quality of cancer care is under pressure in part because of the rising number of cancer patients in the United States."

The researchers reviewed 25 sources that described interviews or surveys with patients, providers or professionals in managed care settings. They found that patients defined quality cancer care as being treated well by providers, having multiple treatment options, and being part of the decision-making process.

Patients report poor quality of care when information is difficult to obtain, trust is limited or care is not well coordinated.

Providers, on the other hand, perceive quality cancer care as making decisions based on the risks-benefits of specific chemotherapy regimens and patients' health status rather than costs.

The study found that payers must control the costs of cancer care but do not want an adversarial relationship with providers or patients. They found that payers' methods of managing cancer more efficiently involved working with providers to develop assessment and decision-assist tools.

"Health care reform must reflect these various needs to maintain and improve quality care, while controlling costs," Colosia said.

The American Society of Clinical Oncologists estimates that by 2020 the shortage of oncologists in the United States will be between 2,350 and 3,800, which represents a capacity of between 9.5 million and 15 million office visits.

The RTI report suggests that to compensate for physician shortages, nurse practitioners and physician assistants likely will be used increasingly in the future.

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