Strengthening the Evidence Base for Quality Cancer Care

One of the most significant challenges in cancer research is connecting the discovery and development of proven cancer therapies with their optimal dissemination and implementation in general clinical practice. Research on cancer care delivery in the community, and the impact of that care on both patients' quality of life and survival, is a critical complement to randomized clinical trials. Evidence concerning delivery can tell us whether clinical trial findings are being applied appropriately in everyday practice and whether cancer patients are receiving the highest possible quality of care - from initial diagnosis through the end of life.

In order to strengthen the evidence base for what constitutes high-quality cancer care, the National Cancer Institute (NCI) launched the 5-year, $34 million Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) project. With an expected enrollment of 11,000 patients with newly diagnosed lung or colorectal cancer, CanCORS is structured to collect data that reflect the entire span of care from diagnosis through end-of-life care, capturing data from patients, their physicians (surveys and medical records from specialists and nonspecialists), and their informal caregivers who provide care during their treatment. Our aim is to determine the factors that influence the interventions that cancer patients actually receive, and then to evaluate the effects of that care on patients' survival, quality of life, and satisfaction with care.

CanCORS includes eight research teams, and a geographically and demographically diverse patient population. Data are being collected from intensive patient interviews, medical records, physician surveys, caregiver surveys, linkages to Medicare claims, and other sources. Although this is an NCI initiative, led by the Applied Research Program in the Division of Cancer Control and Population Sciences, we have many important partners, including the Department of Veterans Affairs and the Centers for Disease Control and Prevention. An external expert panel also has provided valuable advice to the funders and investigators.

CanCORS' power lies in its large sample size, diverse population-based patient sample, and ability to triangulate a rich set of relevant information from multiple sources, such as biological characteristics, treatment details, comorbidities, patient and physician preferences and attitudes, sociodemographic characteristics, and many other potential explanatory factors. This wealth of information provides a unique opportunity to test numerous hypotheses regarding treatment decisions and patient outcomes.

Looking beyond CanCORS, we are developing ideas for moving our knowledge about cancer care quality into promising new areas. For example, future projects could track recently developed therapies, including the integration of molecular studies with quality-of-care studies to predict and assess outcomes. Such efforts would address a high-priority goal at NCI: the integration of molecular biology and population science.

Another critical objective of CanCORS is to uncover the reasons for disparities in cancer care delivery, such as those associated with age and race/ethnicity. Better evidence concerning the reasons for disparities is urgently needed to inform policies and programs designed to reduce them.

We believe CanCORS has the potential to improve the delivery of cancer care by identifying, in a scientifically rigorous manner, the key factors in usual clinical practice associated with high-quality care. For more information about this initiative, visit http://healthservices.cancer.gov/cancors/.