The Nation's Investment in Cancer Research
A Plan and Budget Proposal for Fiscal Year 2008
Prepared by the Director, National Cancer Institute as mandated by The National Cancer Act (P.L. 92-218)
Improving the Quality of Cancer Care
We will support the development and dissemination of quality improvement interventions and measure their success in improving health-related outcomes across the cancer continuum.
Today's Research
For cancer, high quality care means delivering the full range of evidence-based interventions that are safe, patient-centered, effective, timely, efficient, and equitable. Such care must be provided with technical competence and cultural sensitivity and must foster patient choice based on informed decision making. Examples of NCI research include:
- Refining process and outcome measures
- Researching patterns of care
- Improving and disseminating quality of care research resources
- Understanding behavioral and sociocultural factors that influence the quality of cancer care
- Developing interventions that target patients and their families
- Improving symptom management and palliative care
- Improving the training of specialized care providers
- Evaluating patient psychological and social distress, the quality of supportive care for advanced cancer patients, and the impact of aging on quality of care
Tomorrow's Strategies
NCI will foster the development and dissemination of research resources for quality of care studies and will help make quality of care interventions available to the people who need them. We will support research to:
- Foster the use of research evidence about patterns of care and care outcomes, to develop quality improvement interventions.
- Begin using advanced information systems and interoperable electronic health records to inform future research and guide clinical practice.
- Turn symptom management and palliative care research findings into interventions to improve care for patients and survivors throughout their cancer experience, and particularly at the end of life.
- Ensure that the best scientific evidence about quality measures and assessment informs Federal, state, and private sector decision making about cancer care.
- Ensure that new information about cancer prevention, treatment, and follow-up reaches the people who need it.
- Strengthen the methods used to evaluate quality improvement efforts.
Moving Research Forward
…with Improved Access to Quality Cancer Care
NCI supports research to provide the scientific evidence needed for public and private decision making related to care delivery, insurance coverage, purchasing, regulation, and standard setting. This research gives cancer patients, survivors, and caregivers the information they need to enhance the efficiency and quality of cancer care services. For example, some NCI research findings provide guidance to the cancer community on how to improve cancer patients' and survivors' access to the full range of evidence-based interventions that may benefit them.
…and Progress in Pursuit of our Goal
- Health Insurance and Quality of Cancer Treatment. Researchers recently studied the association between treatment received and insurance status (private insurance, Medicaid or Medicare only, or no insurance) for 10 common cancers with established evidence-based treatment guidelines. The study was based on a sample of more than 7,000 patients identified through NCI's Surveillance, Epidemiology, and End Results (SEER) program. Patients who depended on Medicare or Medicaid alone for insurance, especially non-Hispanic Black patients with Medicaid only, were least likely to receive guidelines-based treatment. In a follow-up study, the investigators will examine how insurance status affects survival after cancer diagnosis.
- Factors Affecting Completion of Colon Cancer Treatment. A recent study showed that colon cancer patients who were female, widowed, elderly, or hospitalized during treatment were less likely to complete adjuvant (post-surgical) chemotherapy, even though stopping meant increasing their risk of dying from the disease. The strongest predictor of an incomplete treatment course was a hospital stay after surgery and after beginning chemotherapy, perhaps because of complications from treatment. The investigators suggest that improving social and physical support during treatment may be needed to increase the number of patients who complete treatment.
