Every year my colleagues at the American Cancer Society along with the National Cancer Institute, the Centers for Disease Control and Prevention and the North American Association of Center Cancer Registries publish the “Annual Report to the Nation on the Status of Cancer.” This year’s report, covering the years 1975-2002, discusses trends in cancer treatment along with some observations regarding the quality of care for patients with cancer.
This is a very detailed report, with complex information that takes a measure of expertise and patience to understand and digest. But there are some key highlights that are of interest, and will likely get considerable attention from the press.
For example, cancer incidence rates among men were stable from 1995 through 2002. For women, however, the incidence rates increased about 0.3% per year from 1987 through 2002. The better news is that for men and women, death rates decreased 1.1% each year from 1993 through 2002. That means that although the incidence of cancer is either stable or rising, fewer patients are dying. Earlier diagnosis and better treatment are the likely explanations for those observations.
For lung cancer, among women it appears that the numbers of lung cancers diagnosed each year have stabilized recently, whereas they had been rising in the past. Death rates of lung cancer in women continue to increase. What this information suggests is that women are starting to see the benefit of decreasing their rates of smoking, but it takes time to see those actions result in decreasing rates of disease from smoking. Hopefully, death rates from lung cancer in women will decrease in the near future.
The report also highlights some of the good news about cancer treatment, and some of the problems that face us as a nation. We are seeing more people treated in accordance with recommended guidelines. But there are significant gaps that appear to relate to where a patient lives, their race, their access to care, and whether or not they have seen an oncologist. It appears that consultation with an oncologist, whether surgical or medical depending on the disease evaluated, improves outcome (for example, outcomes appear to be better for women with ovarian cancer treated by a surgical oncologist as opposed to a gynecologist or general surgeon. Women with breast cancer do better if seen by a medical oncologist).
Age also appears to be a barrier to cancer treatment. Of course, common sense suggests that the very elderly, or those who are otherwise impaired either by serious medical or other problems may not be candidates for chemotherapy or other treatments for their cancer. But there are many older people who could safely receive current, state-of-the-art, guideline directed cancer treatment.
What this report highlights, aside from the information about the incidence and death rates from cancer, are some of the issues we face as a country in delivering high quality, consistent cancer care. How do we make certain that people diagnosed or being treated for cancer have access to the best available care, dictated by guidelines developed in collaboration with the experts who are most familiar with the best way to treat the particular disease?
We are on the cusp of a revolution in the delivery of health care in this country. There has been considerable discussion about the need for electronic health records, and the anticipated benefits those records will bring to patients, physicians, and those interested in making certain patients received quality medical care. There is a real focus by many national organizations representing patients, doctors, insurers, the government and others on developing standards for quality medical care. After many years of “talk”, there is actually a “walk” (more like a stampede) towards implementing measures of quality medical care. Cancer care must be part of this discussion, as well as screening, prevention and early detection for cancer in people without symptoms.
But changing the patterns of care by increasing awareness of physicians, patients and others is a huge task. The current report outlines what we know about the right way to treat certain cancers. It also benchmarks how we are actually doing. And, as I mentioned earlier, we are doing better—but that is not good enough. We still have a ways to go to be certain that women with breast cancer have the option of lumpectomy and radiation therapy vs. mastectomy; that men of color have the option of getting the proper treatment for their localized prostate cancer; that women with ovarian cancer can receive their surgery from a gynecologic oncologist.
We can do all the research in the world, all the clinical trials, and all the analysis of what treatment works best in a particular cancer. But if we can’t translate that information into education for doctors, patients, families, insurers, hospitals and anyone else and help guide the treatment of patients with cancer in our current health care system we will have not accomplished our goal of doing everything we can to reduce the burden of cancer, and the suffering from these diseases.
So, as the annual report suggests, we are making progress. But we cannot rest on our laurels. We need to take information and turn it into action. That is the only way we will see continued improvement in future reports to the nation.