CA current issue

[NEWS & VIEWS] SCREENING MESSAGES NOT REACHING CRITICAL AUDIENCE, STUDY FINDS

2008-09-03

[NEWS & VIEWS] STUDY SEES LINK BETWEEN VITAMIN D, BREAST CANCER PROGNOSIS

2008-09-03

[ARTICLES] Cancer Quality Alliance: Blueprint for a Better Cancer Care System

Rose, C., Stovall, E., Ganz, P. A., Desch, C., Hewitt, M. — 2008-09-03

The Cancer Quality Alliance (CQA), a national alliance advocating for improvements in the quality of cancer care in America, presents a set of 5 case studies that depict a vision of quality cancer care and a "Blueprint" for actions to realize this vision. The CQA Blueprint case studies feature patients with soft tissue sarcoma, breast cancer, rectal cancer, and Hodgkin disease and focus on key phases in the cancer care trajectory: detection, diagnosis, treatment, post-treatment/survivorship, and end of life. Each case study begins with a patient summary, follows with a worst- and a best-case scenario, and concludes with a discussion section identifying "what went right" in the best case and "what went wrong" in the worst case. Steps to be taken by key stakeholders, for example, health care providers, insurers/payers, policy makers, and patients and families, are then outlined. By juxtaposing a worst- and best-case scenario, the cancer care case studies elucidate the origins of complex health care problems and clarify the actions needed to overcome them. The CQA will make the case studies available for use as teaching tools to give health care providers and patients themselves descriptions of how the health care system should work to achieve the ultimate benefit for an individual living with, through, and beyond a diagnosis of cancer. The CQA adopted the definition of quality health care of the Institute of Medicine, and the analysis of care provided in the discussion section of each case study is framed using 6 quality improvement aims identified in the Institute of Medicine's report, Crossing the Quality Chasm: A New Health System for the 21st Century. Health care quality may be judged according to its safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.

[ARTICLES] Decision Making in Oncology: A Review of Patient Decision Aids to Support Patient Participation

Stacey, D., Samant, R., Bennett, C. — 2008-09-03

Although cancer management is becoming more structured with disease- specific guidelines and clinical pathways, many decisions remain complex. Contributing to this complexity is the need to make value tradeoffs between benefits and harms across cancer treatment and/or screening options. Since there is no "best" option for everyone, decisions are defined as being of higher quality when informed with the latest scientific evidence and based on patients' informed values associated with outcomes of options. However, clinicians are not good judges of patients' values, and patients often have inadequate knowledge, unrealistic expectations, and decisional conflict that interfere with their involvement in decision making. Effective approaches to support patient involvement into clinical decisions include clinicians trained in shared decision making, question prompt sheets, patient decision aids, and decision coaching by nurses and other allied health professionals. Based on systematic review of 23 randomized trials of cancer patient decision aids, patients exposed to decision aids are more likely to participate in decision making and achieve higher-quality decisions. This review highlights key historical changes leading to patient involvement in decision making, summarizes evidence on effective interventions to support shared decision making, explores strategies to implement these interventions in oncology practices, and identifies future directions.

[ARTICLES] Aiming at a Curative Strategy for Follicular Lymphoma

Bendandi, M. — 2008-09-03

Follicular lymphoma is often managed as an incurable disease. However, a substantial and growing fraction of patients are achieving long-term disease-free survival from aggressive treatment approaches. The application of novel therapeutic tools, including monoclonal antibodies, radioimmunotherapy, and vaccines, as well as new and more active chemotherapeutic agents, is producing complete responses in the majority of treated patients, with a 2-fold increase in disease- and progression-free survival in randomized trials. For some of these treatment approaches, follow up has not yet been long enough to determine a median response duration, but it certainly exceeds the "2 to 3 years" that is routinely stated as dogma to patients with this illness. Furthermore, some patients remain in complete remission beyond a decade from their initial treatment, implying that the assumption of inevitable relapse also must be challenged. One clear fact is that no patients will ever be cured by adopting a palliative treatment approach. The assumption that patients with follicular lymphoma are incurable is certain to be a self-fulfilling prophecy. Here the author summarizes the large and growing body of knowledge that suggests an expectant approach to management is not appropriate for all patients.