Cancer treatment is improving—saving lives and extending survival for people with cancers at many sites, including the breast and colon, and for people with leukemias, lymphomas, and pediatric cancers.

Clinical trials are the major avenue for discovering, developing, and evaluating new therapies. However, only about 2 percent of all adult cancer patients participate in clinical trials. It is important to increase physician and patient awareness of, and participation in, clinical trials if we are to test new treatments more rapidly, find more effective treatments, and broaden the options available to patients.

For treatments already in use, the United States currently lacks a national data system for comprehensively tracking patterns that reflect the best quality of care. Therefore, for most cancers, we cannot yet illustrate with national data the extent to which cancer patients and their doctors are using the best treatments. However, trends in patterns of care have been documented for a number of important cancer treatments, including those for breast, colorectal, and prostate cancers, through the NCI Patterns of Care/Quality of Care and Surveillance, Epidemiology, and End-Results (SEER)-Medicare projects. Current efforts are underway to document patterns of treatment for ovarian cancer.

NCI is working with many Federal and private partners to further develop methods and data systems for tracking the quality of cancer care. Developing such methods and systems requires a consensus among major interested parties on the best measures of cancer outcomes (such as survival and quality of life) and of quality of care (such as timely receipt of effective treatment).

The research to generate such measures is underway. For prostate cancer, a major study on quality-of-life outcomes among 3,500 men following diagnosis has provided important new information that will help men and their families and physicians to make more informed decisions about treatment. Research results on breast cancer treatment have shown that the use of breast-conserving surgery and radiation for older women increased markedly beginning in 1990 and that the use of recommended adjuvant chemo- and hormonal therapy increased substantially between 1987 and 1995. Similarly, the receipt of adjuvant chemotherapy for stage III colon cancer increased markedly following the publication in 1989 of clinical recommendations for this treatment.

The studies also show that older individuals and members of racial-ethnic minority groups are less likely to receive these treatments. More investigation is required to determine if these differences in treatments received constitute disparities in quality of care that need to be addressed through policy or organizational interventions.

An ongoing NCI initiative, the Cancer Care Outcomes Research and Surveillance Consortium, will provide more detailed information on how to link quality-of-care measures to outcomes important to patients. Other, similar initiatives are being supported by major professional organizations, as well as by NCI.

These and other ongoing studies will provide much new information on treatment. Future editions of the Cancer Progress Report will include treatment trends for cancer sites for which there are definitive treatment guidelines based on rigorous evidence of benefit to patients.

Page last modified: 2/4/2004