'We Need to Think Differently' to Improve US Cancer Care

Pam Harrison

July 02, 2019

WASHINGTON — A national strategy for cancer control is urgently needed in the United States so as to be able to deliver cancer care more equitably and efficiently across the country and to rein in costs that are threatening to bankrupt the nation, according to the authors of a new report, "Guiding Cancer Control: A Path to Transformation."

"The system of cancer control in the US — indeed, the whole system of healthcare in the US — was never designed, it just emerged from various players being motivated to pursue various goals," William Rouse, PhD, Stevens Institute of Technology, Hoboken, New Jersey, explained at a press briefing here.

"The complex, adaptive model we are proposing implies that we need much greater coordination and much greater information sharing if we are going to make a major impact on cancer control," committee chair Michael Johns, MD, chancellor emeritus, Emory University, Atlanta, Georgia, added.

We need to think differently yet still play together. Dr Joseph Lipscomb

"Essentially, we are arguing that we need to think differently yet still play together," quipped Joseph Lipscomb, MD, also from Emory University.

The press briefing was held at the National Academies of Sciences, Engineering, and Medicine here in Washington, DC, on June 27. Other committee members who attended the briefing included Ashleigh Guadagnolo, MD, University of Texas MD Anderson Cancer Center in Houston, and Mary McCabe, Columbia University School of Nursing in New York City.

Spectrum of Care

To help ensure integration and coordination of the cancer control system, the authors of the report called for an improvement in the availability of interventions across the entire spectrum of cancer care, from cancer prevention to palliative care.

The report also calls for integration of multiple forms of information, including social media, to create new data sources.

Committee members foresee the need to rely on cloud computing, machine learning, and artificial intelligence to facilitate continuous analytics and more rapid reporting of trends and patterns in healthcare behavior.

They also envision the medical community making sincere efforts to minimize waste and harm that may arise from disparate clinical practices and to reduce the use of interventions for which there is little evidence to support their use. These aims echo those of the Choosing Wisely campaigns initiated by the American Board of Internal Medicine Foundation.

Discourage DTC Advertising

The report authors discourage direct-to-consumer marketing and other forms of advertising of products and services that companies and organizations can now offer because such services are currently tax deductible.

In cooperation with other federal participants, the National Academies of Sciences, Engineering, and Medicine members also feel that any national cancer control strategy should be orchestrated and run by the Department of Health and Human Services and that relevant government agencies should periodically review the plan to ensure its goals are being met.

"Our overarching conclusion is that the nation's cancer control system needs to become more effective, more efficient, and more accountable than it is today if we are to ever successfully address the approaching wave of cancer we are going to see in our aging society," committee members emphasized.

"What's being envisioned here is to think about cancer as a complex adaptive system that learns over time, continues over time, and which is going to get better over time — one that moves people, institutions, and resources out of their silos," they added.

In a statement, Howard Burris, MD, president of the American Society of Clinical Oncology, reaffirmed that stakeholders in the cancer community must work together to drive innovation and solve systemic problems that currently hamper access to high-quality care.

"ASCO [the American Society of Clinical Oncology] commends the National Academies of Sciences, Engineering, and Medicine for this important report," Burris noted.

"We will continue to work across the cancer community to reduce the global burden of cancer through research, education, and the promotion of high-quality patient care," he added.

The committee members have disclosed no relevant financial relationships.

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