Good treatment available, but system is complex, and quality varies greatly
- From: J <nexsw@nvalid,anon>
- Date: Sun, 29 Jul 2007 06:33:43 -0400
July 28, 2007, 11:53PM
Battling cancer can become fight for care
Good treatment available, but system is complex, and quality varies
greatly
By DENISE GRADY
New York Times
Does initiative promise too much?
The first doctor gave her six months to live. The second and third said
chemotherapy would buy more time, but surgery would not. A fourth offered
to operate.
Karen Pasqualetto had just given birth to her first child last July when
doctors discovered she had colon cancer. She was only 35, and the disease
had already spread to her liver.
For the past year, she and her relatives have felt lost, fending for
themselves in a daunting medical landscape in which they struggle to make
sense of conflicting advice as they race against time.
"It's patchwork, and frustrating that there's not one person taking care
of me who I can look to as my champion," Pasqualetto said recently in an
interview from her home near Seattle. "I don't feel I have a doctor who is
looking out for my care. My oncologist is terrific, but he's an
oncologist. The surgeon seems terrific, but I found him through my own
diligence. I have no confidence in the system."
It was a sudden immersion in the scalding realities of life with cancer.
This year, there will be more than 1.4 million new cases of cancer in the
United States and 559,650 deaths. Only heart disease kills more people.
Cancer, more than almost any disease, can be overwhelmingly complicated to
treat.
Patients are often stunned to learn that they will need not just one
doctor, but at least three: a surgeon and specialists in radiation and
chemotherapy.
Doctors do not always agree, and patients may find that they also have to
seek second opinions on biopsies and therapy, fight with insurers and sort
out complex treatment options.
The decisions can be agonizing, in part because the quality of cancer care
varies among doctors and hospitals, and it is difficult for even the most
educated patients to be sure they are receiving the best treatment.
"Let the buyer beware" is harsh advice to give a cancer patient, but it
often applies.
It's about access
Excellent care is out there, but people are often on their own to find it.
Patients are told to be their own advocates, but few know where to begin.
"Here it is, a country with such a great health system, with so many
different breakthroughs in treatment, but even though we know things that
work, not everybody who could benefit gets them," said Dr. Nina Bickell,
an associate professor of health policy and medicine at the Mount Sinai
medical school in Manhattan.
Death rates from cancer have been dropping for about 15 years in the
United States, but experts say far too many patients receive inferior
care, and mistakes in care can be fatal.
"It's quite surprising, but the quality of cancer care in America varies
dramatically," said Dr. Stephen Edge, chairman of surgery at the Roswell
Park Cancer Institute in Buffalo, N.Y. "It's scary how much variation
there is."
Government and medical groups acknowledge that the quality of care is
uneven.
In 1999, a report by the Institute of Medicine in Washington said, "For
many Americans with cancer, there is a wide gulf between what could be
construed as the ideal and the reality of their experience with cancer
care."
The institute noted that there was no national system to provide
consistent quality.
In March, cancer organizations tried to address the problem by issuing the
first set of quality measures to judge whether hospitals are giving
patients up-to-date care for breast and colon tumors, two of the most
common cancers.
The list of measures calls for treatments that seem so basic even to a
layperson that it is shocking to think any hospital would skip them. For
instance, it says women under 70 who have lumpectomies for breast cancer
also should have radiation, and doctors should consider chemotherapy for
people with colon cancer that has spread to the lymph nodes.
Edge, who worked on the measures, said, "While they're fairly simple and
straightforward, and they seem very basic, it's quite surprising how many
people do not get the care that's recommended."
Treatment guidelines approved by experts already exist for 70 to 80 types
of cancer (www.nccn.org), but the new measures are the first to be
formally endorsed by cancer organizations to assess whether hospitals are
performing up to par. The measures were developed by the American College
of Surgeons Commission on Cancer, the American Society of Clinical
Oncology and the National Comprehensive Cancer Network, and are available
online at www.facs.org/cancer/qualitymeasures.html.
Eventually, the measures may be used by regulators and payers, including
Medicare, Edge said.
.
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