From the Department of Internal Medicine, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond.
What can physicians do today about the cancer burden? The managed care
industry has principally focused on early detection of breast, cervical, and
colorectal cancers. Cancer professional organizations have pushed to expand
access to research trials and experimental therapy. The role of genetic screening
is also hotly debated.
However, relatively little attention has been given to the actual care
provided to patients with cancer. In other words, does it matter where patients
live, what type of insurance coverage they have, what their physician's specialty
is, and at what type of medical center they are being treated or what its
volume of cases is for a specific cancer? With the prominent exception of
factors associated with breast-conserving surgery and local radiation compared
with mastectomy for early stage breast cancer, the answer is the US health
care system does not know and has not even tried to look (B.E.H. and T. J.S.,
unpublished data, 1998).
Hillner BE, Smith TJ. Hospital Volume and Patient Outcomes in Major Cancer SurgeryA Catalyst for Quality Assessment and Concentration of Cancer Services. JAMA. 1998;280(20):1783-1785. doi:10.1001/jama.280.20.1783