IOM Cancer Report Highlights Harmful Care
Ganz has other examples. "Many older folks, if they had gall bladder surgery done by a surgeon, that's who they [would] go to for their colon cancer surgery years later. And they shouldn't, unless that person has enough volume and experience to take care of colon cancer with the state of the art today.
"Do they know they need to remove [a minimum of] 12 nodes? Does the pathologist assure they've examined 12 nodes? Do they know they need to give radiation and chemotherapy before removing a rectal cancer? They may or they may not."
The Commission on Cancer, a program operated by the American College of Surgeons, accredits about 1,500 hospitals where acute cancer care is delivered, but it doesn't go far enough, to outpatient settings where most cancer treatments after surgery take place, Ganz and Sledge say.
"They're not actually looking to see how often did a woman who was presenting with diffuse abdominal symptoms get operated on by a gynecologist who doesn't know anything about ovarian cancer, instead of by an oncologic gynecologist?" Ganz says.
If health systems used [better] metrics and were transparent, Ganz notes, you could actually learn how many times women at one hospital had to be re-operated on, compared to the hospital across the street. "Patients would probably want to go to the hospital that's doing it right more often."
Another example Ganz gives of wasteful care is the practice by too many doctors of prescribing the expensive and potentially toxic drug Herceptin without first confirming through genetic testing that the patient's cancer has the genetic mutation that's susceptible to that drug. Now at least one insurance company, United Healthcare, is trying to put a stop to that by demanding that doctors fax the tumor's genetic test results before it will pay for the drug, she says, and more should do likewise.
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