Improving the Quality of Cancer Care
NCI leads the Nation's efforts to develop new and better methods for cancer prevention, treatment, and symptom
management. The Institute also strives to improve the quality and delivery of cancer care throughout the world by
sharing best practices with the doctors, nurses, and other health care providers who interact directly with cancer
patients and their families.
A diagnosis of cancer presents a challenge to patients and their families - a challenge that is best met with highquality
care from a team of health care providers who have access to the latest tools and techniques of cancer care.
Should their cancer progress despite the best available care, patients will need help to reduce their pain and
suffering and to understand and face the challenges associated with the end of life. The need to improve end-of-life
care is especially urgent in developing nations, where cancer patients are often diagnosed with more advanced,
less curable disease.
The international projects described in this section highlight some of the efforts that NCI has made to improve the
quality of cancer care around the world.
Most new cancer interventions and new ways of caring for cancer patients are generated
in the industrialized world, while many of the world's cancer patients live in developing
nations. Oncologists and other health care providers in these countries have limited
opportunities to learn about the latest tools and techniques in the treatment and palliation
(symptom relief) of cancer. As a step toward addressing this dissemination problem, NCI
has cosponsored, in collaboration with the International Network for Cancer Treatment
and Research (INCTR), a set of workshops for health care providers in the Middle East
and China.
In 2003, NCI sponsored a 3-day symposium on lymphomas in Cairo, Egypt, featuring
both local and international lecturers. Concurrent with this meeting, NCI helped support
a 3-day training course for Egyptian and Palestinian oncology nurses on new developments
in cancer nursing.
Also under the framework of INCTR, NCI sponsored two pediatric oncology workshops,
one in the United Arab Emirates and one in Chongqing, China. These workshops, both
held in 2003, featured presentations on the treatment, management, and palliative care
of common childhood cancers. In addition, NCI held a workshop in Amman, Jordan for
Iraqi pediatric oncologists in 2004 to help them devise solutions for treating and caring
for pediatric patients in Iraq.
More information about INCTR can be found in Improving Cancer Communications.
NCI sponsored the first TCM Oncology Research Meeting in 2006. The conference
provided an opportunity to educate NCI staff about the application of various TCM
methods (e.g., herbs and other plant remedies, acupuncture) to prevent and treat cancer,
as well as manage symptoms. Conference organizers created a collegial environment to
engage Chinese clinical investigators and other practitioners of TCM and to facilitate
discussion about the role that NCI should take in furthering research in this area.
Presenters from China included investigators from Guang An Men Hospital of the China
Academy of TCM in Beijing, Guangzhou University of TCM in Guangzhou, and Xiyuan
Hospital of the China Academy of TCM in Beijing. Other presenters from China were
identified from a review of the relevant literature and recommendations of experts in the
field, including NCI grantees working in TCM. Invited guests included grantees in the
field of complementary and alternative medicine, NCI extramural program staff, interested
NCI intramural investigators, other National Institutes of Health program staff working
on related topics (for example, the Office of Dietary Supplements), and other TCM
investigators working in the field of oncology in the United States and elsewhere.
The Ireland-Northern Ireland-NCI Cancer Consortium has instituted numerous collaborative
programs to enhance patient outcomes in Ireland (see
Building the Capacity and Infrastructure for Cancer Research and Care for more information
about this consortium). One notable achievement of the consortium has been the
ongoing implementation of the TELESYNERGY® system. This integrated telecommunications
system of computers, microscopes, cameras, and other equipment can transmit
X-rays and other medical images or a live examination of a patient to distant sites, where
clinicians can discuss the case as if they were in the same room.
To date, five TELESYNERGY® suites have been installed on the island of Ireland under
the auspices of the All-Ireland Cancer Consortium. These suites are hosted by Belfast City
Hospital in Belfast, Northern Ireland; St. Luke's Hospital and St. James' Hospital in
Dublin, Republic of Ireland; Cork University Hospital in Cork, Republic of Ireland; and
University College Hospital Galway in Galway, Republic of Ireland.
In 2003, NCI commissioned the International Observatory on End of Life Care (IOELC)
in the United Kingdom to conduct a pilot survey of palliative and end-of-life care in the
six geographic regions represented in the Middle East Cancer Consortium (MECC) (More
information about MECC can be found below and in
Building the Capacity and Infrastructure for Cancer Research and Care). These regions include
Cyprus, Egypt, Israel, Jordan, Turkey, and the territory administered by the Palestinian
Authority. The survey's results were presented at a MECC palliative care workshop in
Cyprus in 2004.
Subsequently, NCI provided funding for IOELC to collect more information and to
prepare detailed reports on the palliative and hospice care provided in each MECC
jurisdiction. These reports were completed as part of the observatory's global analysis of
palliative and hospice care, which is intended to provide reports on palliative care services
and issues for countries and territories throughout the world in a common template to
facilitate comparative analysis.
Each IOELC report examines the current provision of palliative care, history and
development, public health context, and ethics of providing palliative care for that
country or territory. The reports for the six MECC jurisdictions are available on the
observatory's Web site at http://www.eolc-observatory.net/global_analysis/mecc.htm.
Health care providers in developing nations, including those in the Middle East, need
access to the latest tools and techniques for palliative cancer care. To help ensure broad
access to quality palliative care, NCI has worked with the Middle East Cancer
Consortium (MECC) to deliver training on palliative care to health care providers in the
Middle East and India. See above and also Building the Capacity and Infrastructure for Cancer Research and Care for more information on MECC.
In November 2005, NCI helped sponsor a second MECC palliative care workshop in
Cyprus. Researchers and clinicians from the United States, Canada, India, Pakistan, Iraq,
and the six MECC jurisdictions participated in the workshop. The topics included pain
control, psychosocial concerns, grief and bereavement, nursing issues in palliative and
home care, practical aspects of managing palliative care, and the current practice of
palliative care.
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