New Study Will Investigate Quality of Breast Cancer Care (dateline May 22, 2000)
Nancy Brinker, founding chairman of the Susan G. Komen Breast Cancer Foundation, announced at the annual meeting of the American Society of Clinical Oncology (ASCO) that her organization will help fund the first large scale study to investigate the quality of cancer care in the United States. The 18-month study will include an analysis of breast cancer and colon cancer patient records and interviews with cancer patients and survivors to determine their perception of cancer care in the United States.
Among other factors, the study aims to determine:
- types of treatment patients receive (surgery, chemotherapy, radiation, etc.)
- whether patients are prescribed the full recommended doses of therapies
- whether patients are given the option of participating in clinical trials
- how many physicians and health care professionals are involved in patient diagnoses and treatment ( cancer treatment team )
- the amount of time it takes for patients to be referred to specialists
- general physician accessibility
- whether treatment is covered by health insurance companies
The ASCO/Komen study will begin in three large U.S. cities: Houston, Texas; Los Angeles, California; and Cleveland, Ohio. The researchers plan to develop a “monitoring system” to determine the best quality of cancer care. Information from the study will benefit both physicians and patients, according to the researchers.
The study is a direct result of an April 1999 report by the Institute of Medicine’s (IOM) National Cancer Policy Board. The report is entitled “Ensuring Quality Care,” and finds significant differences in the quality of breast cancer care across the United States. For example, the technical quality of screening x-ray mammograms and the way in which mammogram reports are interpreted varies greatly, which can lead to missed diagnoses or unnecessary breast biopsies .
The IOM report also finds that many breast cancer patients are not properly informed about their treatment options and that two standard breast cancer treatments, chemotherapy and radiation therapy, are often under-used. It is estimated that up to 40% of women who have breast-conserving surgery ( lumpectomy) do not receive radiation therapy after surgery. Radiation therapy helps destroy any remaining cancer cells after surgery and reduces the likelihood that the cancer will return.
Participation in cancer clinical trials is also low despite the increase in the number of trials available. According to the Komen Foundation, less than 5% of adult cancer patients in the United States participate in clinical trials designed to test the effectiveness of new cancer treatments. The ASCO/Komen study will investigate the reasons for these and other variations in breast cancer diagnosis and treatment.
Cancer Patient Education Has Improved
According to Brinker, when her sister Susan Komen was diagnosed with breast cancer in 1980, there was a profound fear and lack of knowledge about the disease. Komen was not informed about her treatment options, and like the majority of breast cancer patients, she did what her physician told her to do. Her physician was knowledgeable, but he was not a cancer specialist. While Brinker believes her sister’s cancer treatment was standard for the early 1980s, the quality of care needed to be improved.
In her address at the ASCO meeting, Brinker said that patients have become more informed about breast cancer over the years. With the Internet, television programs, and 1-800 numbers, breast cancer has now become a topic for public discussion. In fact, AIDS activists base many of their efforts on strategies breast cancer advocates have used to create awareness.
In 1984, Brinker was also diagnosed with breast cancer, but physicians were already closely monitoring her because they were aware of her family history. She had a cancerous lump removed from her breast and remains disease-free a decade and a half later. She says being informed about the disease and treatment options was a tremendous benefit to her.
- The Susan G. Komen Foundation provides information on the ASCO/Komen study at http://www.breastcancerinfo.com/news/html/quality_of_care.asp and http://www.breastcancerinfo.com/news/html/081699.asp
- The Institute of Medicine’s April 1999 report, “Ensuring Quality Cancer Care,” is available to order at http://www.nap.edu/catalog/6467.asp
- The May 20, 2000 Reuters report by Maggie Fox, “Study to Probe Quality of Cancer Care in U.S.,” is available at http://dailynews.yahoo.com/h/nm/20000520/sc/cancer_care_1.asp