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IOM: Cancer Care System in Crisis

Cheryl Clark, for HealthLeaders Media, September 11, 2013

Questioning Providers
The 315-page report, which differs greatly from one the IOM issued in 1999, also lists 40 questions it says patients should ask, and demand answers for, before going ahead with treatments for their cancer. For example, it urges patients to ask their clinicians:

  • If I cannot be cured, will I live longer with treatment?
  • How much longer?
  • How does this treatment compare with other treatment options?
  • Are there any side effects?

"If you have a physician or a team member that does not want to answer these questions, you need to find another set of providers," Ganz said.

The report is sponsored by The American Cancer Society; the American Society for Radiation Oncology; LIVESTRONG; The American College of Surgeons, Commission on Cancer; and the National Cancer Institute – National Institutes of Health, among other groups.

As an example of how the system doesn't work well, she said that for an advanced lung cancer patient, "we may have evidence for the first, second, or even the third line of chemotherapy, but there's no evidence for the fourth or fifth.

And most of the data available was not tested in that population, so adding additional morbidity and toxicity to somebody who is on a trajectory toward end-of life does not make sense. It's also very costly… and patients will end up in the hospital when they would rather be spending this time at home."

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