With most illnesses in teens and children, parents can rely on their own knowledge and skills, or those of the child's doctor, for an accurate diagnosis and treatment. But cancer requires the help of a team of specialists trained to deal with different types of cancer and many types of treatment. Treatment may include surgery, radiation therapy, chemotherapy, bone marrow or stem cell transplant, and immunotherapy. Treating childhood cancer often means consulting with more medical specialists if any problems come up. Other specialists can also help patients and family members with the social, emotional, educational, and spiritual issues that are part of childhood cancer. Comprehensive care is an approach that cares for the whole patient and all his or her needs, not just the medical and physical ones.
Comprehensive care – using the services of many professionals working together – is the standard approach at all major medical centers that treat young people with cancer. The key aspects of well-designed comprehensive care are:
"..A cancer diagnosis is one of the most feared events. Rarely diagnosed before the late 20th century, cancer now competes with cardiovascular disease as the leading cause of death in North America. With people living longer, the continued use of tobacco products, infectious diseases that transmit cancer-causing viruses and other pathogens, and an obesity epidemic, the cancer burden is projected to increase substantially in the United States over the coming decades.
Almost 14 million people, more than 4 percent of the U.S. population, are cancer survivors; by 2012 this will grow to 18 million cancer survivors. Survivors have complex journeys, and even after completing cancer treatment, must engage in medical follow-up care to help manage the long-term and late effects of their treatments, and monitor the possibility of cancer recurrence or development of new secondary cancers.
For the 1.6 million people in the United States who join the ranks of newly diagnosed cancer patients each year, the cancer care system can be overwhelming. The complexity of the cancer care system is driven by the biology of cancer itself, the multiple specialists involved in the delivery of cancer care, as well as a health care system that is fragmented and often ill prepared to meet the individual needs, preferences, and values of patients who are anxious, symptomatic, and uncertain about where to obtain the correct diagnosis, prognosis, and treatment recommendations.
Moreover, older individuals comprise the majority of people with cancer. Addressing the unique needs of an aging population of patients diagnosed with cancer, who are already experiencing comorbid conditions and loss of independence, is a critical challenge. We are not prepared to take care of this growing cancer patient population, as few of our standard treatment Preface approaches have been evaluated in this setting. Instead, we extrapolate from trial results and toxicities that emerge from treating younger and healthier patients with the same diagnoses.
On top of this, the quality of cancer care varies tremendously. As someone who has been an oncology practitioner for almost 40 years, I have seen dramatic changes in the treatment of cancer that have benefited my patients—greater precision in diagnosis, surgical treatments that are less radical and disfiguring, diagnoses of earlier stage disease as a result of screening, and more long-term disease-free survivors. However, the human and economic costs of these advances are enormous. Cancer patients often endure protracted periods of primary and adjuvant therapies, multimodal treatments with substantial toxicities and comorbidities, which may take years of physical and psychological recovery, with great financial hardship and social disruption. Palliative care and hospice services are underutilized and usually employed much later in the course of a patient's cancer journey than recommended.
Patients and their families often play the role of principal communicator as they visit one cancer treatment specialist after another, conveying the recommendations to subsequent consultants in a serial fashion. Coordination of complex cancer care, using a common electronic health record, with treating specialists who jointly discuss the patient's case and then confer with the patient about their recommendations, is the exception and not the rule. Receipt of psychosocial support at the time of diagnosis and during treatment is also rare, as these "high-touch" services are seldom compensated through health insurance and are usually supported through ad hoc philanthropic funding rather than institutional or clinical practice resources.
We all want the best care for our family members and friends, but our current cancer care delivery system falls short in terms of consistency in the delivery of care that is patient centered, evidence based, and coordinated. We are at an inflection point in terms of repairing the cancer care delivery system. If we ignore the signs of crisis around us, we will be forced to deal with an increasingly chaotic and costly care system, with exacerbation of existing disparities in the quality of cancer care... In many ways, oncology care is an extreme example of the best and worst in the health care system today—highly innovative targeted diagnostics and therapeutics alongside escalating costs that do not consistently relate to the clinical value of treatments, tremendous waste and inefficiencies due to poor coordination of care, and lack of adherence to evidence-based guidelines with frequent use of ineffective or inappropriate treatments."