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    Tuesday, November 08, 2005

    Special Needs: Do cancer survivors get inferior care? According to the National Academy of Sciences they do:

    The number of cancer survivors is growing rapidly, but their care is often haphazard and disjointed, so no one notices a recurrence of cancer or side effects that can occur months or years after treatment, the academy said in a new report.

    ...More than 6o percent of cancer survivors are 65 or older, so Medicare is "the primary payer of care for cancer survivors" in the United States, said the panel, established by the Institute of Medicine, an arm of the academy. It said government programs like Medicare, as well as insurance companies, should pay cancer specialists to prepare a comprehensive plan describing the follow-up care that ought to be provided to each person treated for cancer.

    Cancer specialists should routinely provide such plans to internists and other primary care doctors, the panel said. At present, said Dr. Greenfield, a professor at the University of California, Irvine, "there is no organized system to link oncology care to primary care."

    Sure there is, it's called the consult letter, and it should be an integral part of every specialist's encounter with a referred patient. There's no reason to pay oncologists more money to write a letter to the patient's primary care doctor - it's part of their job. Unfortunately, it's a part of their job they often fail to do - at least around here.

    Some specialists are very good about this. In my experience surgeons, cardiologists, gastroenterologists, and orthopedists are among the best. They'll send operative reports, biopsy results, and letters summarizing their recommendations and plans for future follow-up. But for some reason oncologists are abysmal at communicating with other doctors.

    It wouldn't take much to write a letter at the end of a patient's treatment to say "I'm releasing him from my care and returning him to you for routine follow-up. He should have a bone scan, chest x-ray, etc. etc. once a year for the rest of his life ( or whatever the current recommendation is.) " One senses that the goal of this "study" is to provide another argument for an interconnected national electronic medical record database. Either that, or to increase payments to oncologists to get them to write letters.

    The real problem may be that we don't have a good handle on what exactly needs to be done routinely after successful treatment of some cancers. How often and for how long do they need bone scans to look for mets, or chest x-rays? Five years? Ten years? What if they've gone twenty years without cancer? What's the likelihood of a recurrence that far down the road? When and how often do they need cystoscopies? These are questions we may not know the answer to in many cases, given that cancer survival has only recently begun to improve.

    posted by Sydney on 11/08/2005 08:36:00 AM 0 comments


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