Unlike many other areas in health care, the practice of oncology
presents unique challenges that make assessing and improving value
especially complex.
First, patients and professionals feel a
well-justified sense of urgency to treat for cure, and if cure is not
possible, to extend life and reduce the burden of disease.
Second,
treatments are often both life sparing and highly toxic.
Third,
distinctive payment structures for cancer medicines are intertwined
with practice.
Fourth, providers often face tremendous pressure to
apply the newest technologies to patients who fail to respond to
established treatments, even when the evidence supporting those
technologies is incomplete or uncertain, and providers may be reluctant
to stop toxic treatments and move to palliation, even at the end of
life.
Finally, the newest and most novel treatments in oncology are among the most costly in medicine.
"Assessing and Improving Value in Cancer Care: Workshop Summary" summarizes the
results of a workshop that addressed these issues from multiple
perspectives, including those of patients and patient advocates,
providers, insurers, health care researchers, federal agencies, and
industry. Its broad goal was to describe value in oncology in a
complete and nuanced way, to better inform decisions regarding
developing, evaluating, prescribing, and paying for cancer therapeutics.
National Academies Press makes the "Cancer Care" book available for reading online, or for purchase.