Breast Cancer Quality Of Care

Developing or existing breast cancer centres strive to provide the highest quality care possible within their current financial and personnel resources. Although the basics in diagnosis and treatment of breast cancer are well known, providing, monitoring, and assessing the care offered can be challenging for most sites. Based on the work of the International Congress of Breast Disease Centres, this book provides a comprehensive overview of how to start or improve a breast unit wherever you live. Written by a multidisciplinary team of over 100 experts from 25 countries, it provides a practical guide for how to optimally organise high quality integrated breast cancer care, whilst taking into account the local economics and resources available to different countries. Each component of the care pathway, including imaging, surgery, systemic treatment, nursing, and genetic assessment, is discussed from a theoretical and practical aspect. The authors define targets to strive for, methods to assess care, and key recommendations for how to improve within existing limitations. Finally, the book looks beyond the breast care unit to consider accreditation and certification, emerging technologies, media, and the role of governments. This guide will be valuable for anyone working in the field of integrated breast cancer care, including established breast care experts, those new to the field, and policy makers interested in the social, financial, and political aspects of improving breast care quality.

Cancer care today often provides state-of-the-science biomedical treatment, but fails to address the psychological and social (psychosocial) problems associated with the illness. This failure can compromise the effectiveness of health care and thereby adversely affect the health of cancer patients. Psychological and social problems created or exacerbated by cancer-including depression and other emotional problems; lack of information or skills needed to manage the illness; lack of transportation or other resources; and disruptions in work, school, and family life-cause additional suffering, weaken adherence to prescribed treatments, and threaten patients' return to health. Today, it is not possible to deliver high-quality cancer care without using existing approaches, tools, and resources to address patients' psychosocial health needs. All patients with cancer and their families should expect and receive cancer care that ensures the provision of appropriate psychosocial health services. Cancer Care for the Whole Patient recommends actions that oncology providers, health policy makers, educators, health insurers, health planners, researchers and research sponsors, and consumer advocates should undertake to ensure that this standard is met.

Despite significant advances that have been made in breast cancer diagnosis and treatment, a disproportionate burden of the disease continues to fall on women from minority groups. Studies suggest that differentials in the quality of breast cancer care in the treatment stage influence breast cancer disparities. Because treatment is defined by medical intervention, the health system plays a critical role in understanding breast cancer disparities and needs to be further examined. Moreover, studies examining such differentials have focused on aggregated racial data, which may be masking smaller ethnic groups that may be at higher risk. This dissertation attempts to clarify the health system contribution to breast cancer quality of care disparities and highlights the need to examine breast cancer quality of care disparities using disaggregated racial/ethnic data in order to help inform the design of more targeted quality improvement efforts. Paper #1 examines the relationship between designated specialty cancer centers and breast cancer quality of care. In cancer care delivery, there has been an emerging trend for cancer centers to obtain special designations from one or more of the following institutions: the National Cancer Institute (NCI), the National Comprehensive Cancer Network (NCCN), and the American College of Surgeon’ Commission on Cancer. These designations are markers for high quality cancer care, yet little is known about the actual effectiveness of the care they provide or the communities that they tend to serve. Paper #2 examines breast cancer quality of care differences between Asian women (aggregated and disaggregated) and non-Hispanic White women. Cancer disparities research often focus on examining communities in aggregate. Recently, more scholars are utilizing disaggregated ethnic data when assessing cancer disparities in order to acknowledge the diversity of these large communities. Little is known about breast cancer quality of care disparities among Asian American ethnic groups. Paper #3 examines the relative contribution of within hospital and between hospital effects on racial/ethnic disparities on the quality of breast cancer treatment. Existing literature posits that there are two mechanisms at the health systems level that contribute to disparities in the quality of care received by minority groups. Some studies suggest that disparities are due to minorities receiving differential treatment within the same institution as White patients, while others propose that minorities tend to receive care from lower quality health care settings. Studies to date have not examined the ways in which the health system may be contributing to breast cancer quality of care disparities. Data from the California Cancer Registry (CCR) was used for the analyses. The study population consisted of women ages 20 years or older and who have had a first invasive primary breast cancer diagnosis between 2011-2014. This dissertation contributes to the existing literature on breast cancer disparities by clarifying the mechanism of the health system contribution to breast cancer disparities and uncovering disparities in disaggregated ethnic groups. Findings from this dissertation will provide important information for the development of quality improvement efforts in cancer care delivery.

Developing or existing breast cancer centres strive to provide the highest quality care possible within their current financial and personnel resources. Although the basics in diagnosis and treatment of breast cancer are well known, providing, monitoring, and assessing the care offered can be challenging for most sites. Based on the work of the International Congress of Breast Disease Centres, this book provides a comprehensive overview of how to start or improve a breast unit wherever you live. Written by a multidisciplinary team of over 100 experts from 25 countries, it provides a practical guide for how to optimally organise high quality integrated breast cancer care, whilst taking into account the local economics and resources available to different countries. Each component of the care pathway, including imaging, surgery, systemic treatment, nursing, and genetic assessment, is discussed from a theoretical and practical aspect. The authors define targets to strive for, methods to assess care, and key recommendations for how to improve within existing limitations. Finally, the book looks beyond the breast care unit to consider accreditation and certification, emerging technologies, media, and the role of governments. This guide will be valuable for anyone working in the field of integrated breast cancer care, including established breast care experts, those new to the field, and policy makers interested in the social, financial, and political aspects of improving breast care quality.

In the United States, approximately 14 million people have had cancer and more than 1.6 million new cases are diagnosed each year. However, more than a decade after the Institute of Medicine (IOM) first studied the quality of cancer care, the barriers to achieving excellent care for all cancer patients remain daunting. Care often is not patient-centered, many patients do not receive palliative care to manage their symptoms and side effects from treatment, and decisions about care often are not based on the latest scientific evidence. The cost of cancer care also is rising faster than many sectors of medicine--having increased to $125 billion in 2010 from $72 billion in 2004--and is projected to reach $173 billion by 2020. Rising costs are making cancer care less affordable for patients and their families and are creating disparities in patients' access to high-quality cancer care. There also are growing shortages of health professionals skilled in providing cancer care, and the number of adults age 65 and older--the group most susceptible to cancer--is expected to double by 2030, contributing to a 45 percent increase in the number of people developing cancer. The current care delivery system is poorly prepared to address the care needs of this population, which are complex due to altered physiology, functional and cognitive impairment, multiple coexisting diseases, increased side effects from treatment, and greater need for social support. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis presents a conceptual framework for improving the quality of cancer care. This study proposes improvements to six interconnected components of care: (1) engaged patients; (2) an adequately staffed, trained, and coordinated workforce; (3) evidence-based care; (4) learning health care information technology (IT); (5) translation of evidence into clinical practice, quality measurement and performance improvement; and (6) accessible and affordable care. This report recommends changes across the board in these areas to improve the quality of care. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis provides information for cancer care teams, patients and their families, researchers, quality metrics developers, and payers, as well as HHS, other federal agencies, and industry to reevaluate their current roles and responsibilities in cancer care and work together to develop a higher quality care delivery system. By working toward this shared goal, the cancer care community can improve the quality of life and outcomes for people facing a cancer diagnosis.

We know more about cancer prevention, detection, and treatment than ever beforeâ€"yet not all segments of the U.S. population have benefited to the fullest extent possible from these advances. Some ethnic minorities experience more cancer than the majority population, and poor peopleâ€"no matter what their ethnicityâ€"often lack access to adequate cancer care. This book provides an authoritative view of cancer as it is experienced by ethnic minorities and the medically underserved. It offers conclusions and recommendations in these areas: Defining and understanding special populations, and improving the collection of cancer-related data. Setting appropriate priorities for and increasing the effectiveness of specific National Institutes of Health (NIH) research programs, to ensure that special populations are represented in clinical trials. Disseminating research results to health professionals serving these populations, with sensitivity to the issues of cancer survivorship. The book provides background data on the nation's struggle against cancer, activities and expenditures of the NIH, and other relevant topics.

This book discusses the impact on women of the diagnosis and treatment of early breast cancer. Readers will learn about the risks of breast cancer recurrence and interventions to reduce these, such as endocrine therapy and bisphosphonate therapy, as well as the role of lifestyle factors such as diet and exercise. The long-term effects of treatment on fertility, the heart and other systems are discussed, as well the psychological burden for women who are increasingly likely to be cured from their cancer. Each chapter provides background and a practical guide in the management of women after the initial phase of diagnosis and treatment. Authored by a multidisciplinary team this book provides all the relevant expertise as well as different perspectives, providing a holistic picture of early breast cancer consequences. From oncologists to general practitioners as well as specialist nurses, gynaecologists, psychologists and other healthcare professionals involved in the long-term care of women with breast cancer, this book provides a timely and indispensable guide to practitioners caring for early breast cancer survivors.

We all want to believe that when people get cancer, they will receive medical care of the highest quality. Even as new scientific breakthroughs are announced, though, many cancer patients may be getting the wrong care, too little care, or too much care, in the form of unnecessary procedures. How close is American medicine to the ideal of quality cancer care for every person with cancer? Ensuring Quality Cancer Care provides a comprehensive picture of how cancer care is delivered in our nation, from early detection to end-of-life issues. The National Cancer Policy Board defines quality care and recommends how to monitor, measure, and extend quality care to all people with cancer. Approaches to accountability in health care are reviewed. What keeps people from getting care? The book explains how lack of medical coverage, social and economic status, patient beliefs, physician decision-making, and other factors can stand between the patient and the best possible care. The board explores how cancer care is shaped by the current focus on evidence-based medicine, the widespread adoption of managed care, where services are provided, and who provides care. Specific shortfalls in the care of breast and prostate cancer are identified. A status report on health services research is included. Ensuring Quality Cancer Care offers wide-ranging data and information in clear context. As the baby boomers approach the years when most cancer occurs, this timely volume will be of special interest to health policy makers, public and private healthcare purchasers, medical professionals, patient advocates, researchers, and people with cancer.

This open access book provides a valuable resource for hospitals, institutions, and health authorities worldwide in their plans to set up and develop comprehensive cancer care centers. The development and implementation of a comprehensive cancer program allows for a systematic approach to evidence-based strategies of prevention, early detection, diagnosis, treatment, and palliation. Comprehensive cancer programs also provide a nexus for the running of clinical trials and implementation of novel cancer therapies with the overall aim of optimizing comprehensive and holistic care of cancer patients and providing them with the best opportunity to improve quality of life and overall survival. This book's self-contained chapter format aims to reinforce the critical importance of comprehensive cancer care centers while providing a practical guide for the essential components needed to achieve them, such as operational considerations, guidelines for best clinical inpatient and outpatient care, and research and quality management structures. Intended to be wide-ranging and applicable at a global level for both high and low income countries, this book is also instructive for regions with limited resources. The Comprehensive Cancer Center: Development, Integration, and Implementation is an essential resource for oncology physicians including hematologists, medical oncologists, radiation oncologists, surgical oncologists, and oncology nurses as well as hospitals, health departments, university authorities, governments and legislators.