Cancer care planning and quality improvement: 2 for the price of 1?

The last decade has brought increased promotion of patient-centered cancer care. In response to the growing number of cancer survivors, the Institute of Medicine (IOM), American Society of Clinical Oncology (ASCO), and other leading organizations have endorsed the provision of treatment summaries and survivorship care plans (SCPs) at the end of cancer treatment. More recently, the IOM’s National Cancer Policy Forum has emphasized the importance of implementing treatment plans (TPs) from the time of diagnosis through the end of active treatment. Both TPs and SCPs are charged with multiple missions: to foster coordinated, patient-centered, quality care across the cancer treatment continuum while promoting patients’ health self-management and parsimonious use of services in a future that includes a projected shortage of oncologists. However, care planning has yet to be broadly adopted because of various barriers, with the most frequently cited reason being the burden on oncology clinicians. Concurrently, because of the 1999 IOM report concluding that many patients with cancer were not receiving the standard of care, there has been an increased emphasis on quality monitoring. There have been growing efforts focused on the development of quality measures along with programs for physician reporting of adherence to specific quality measures in their practice (eg, Centers for Medicare and Medicaid Services Physician Quality Reporting System). Financial incentives are often associated with these programs, and their goal is to improve the quality of care received by patients. To avoid the administrative burden of reporting on individual patients within a practice, some reporting programs allow prospective participation in registries from which quality measures can be derived. To this end, ASCO conducted a pilot study to evaluate the feasibility of a breast cancer registry (BCR) that could serve multiple purposes, including quality reporting as well as the development of TPs and SCPs. The initial results from the BCR pilot study have been reported in Cancer. The article by Partridge et al presented the operationalization of data collection within 20 oncology practices that volunteered to participate in the BCR pilot study and discussed the challenges of implementation within the workflow of a busy clinical setting. The BCR pilot study capitalized on existing breast cancer TP and treatment summary templates that were developed by ASCO and adapted for electronic data capture. Fortuitously, these data could also be shared directly with patients: first as part of treatment planning at the initiation of therapy and later as part of a posttreatment SCP effort at the end of treatment. Although the main focus of the BCR was to evaluate the quality of care, Blinder et al, in a companion article, reported on the opportunistic capture of data from patients who received these TPs and summaries as a byproduct of the registry effort. The ASCO BCR pilot program demonstrates various ways in which TPs and SCPs can be implemented so as to maximize their usefulness to patients and clinicians. Involving more than 2000 patients, the program was able to prospectively collect data used both for quality assessment purposes and to create individualized TPs and SCPs in a way that was feasible and acceptable to both clinicians and patients. Blinder et al found that a majority of patients with breast cancer believed that the TPs and SCPs were useful communication aids that also bolstered their personal peace of mind. Partridge et al found that a majority of clinical practices viewed the BCR positively, favoring it as a source of quality improvement data, and believed the TPs and SCPs improved communication with patients. However, greater than one-half of the