Reward Doctors for Whole Patient Care – Not Just Treatments and Surgery

Panel members discussing cancer care promote need for cancer care planning, coordination and better doctor-patient communication

Speaking at a roundtable moderated by ABC News veteran Sam Donaldson this morning, National Coalition for Cancer Survivorship Acting President Ellen Stovall emphasized the need for drastic changes in how physicians are reimbursed for care.  The panel discussion, titled "Cancer as a Chronic Disease: What Should be Done to Serve Cancer Survivors in 2009 and Beyond?," opened the 14th annual conference of the National Comprehensive Cancer Network and included several cancer experts as well as cancer survivor Elizabeth Edwards and New York Times writer Jane Brody.

"Doctors are rewarded for mechanical acts – administering chemotherapy and radiation, performing surgery," Stovall said.  "We need to reward physicians for treatment of the whole patient, not just treatment of the disease."

Panel members agreed on the need for care planning and coordination that begins at the time of cancer treatment and continues post-treatment and throughout survivorship.  A small number of oncologists and cancer centers are beginning to employ this practice, and Rep. Lois Capps (D-CA) will reintroduce legislation in this congressional session that would provide Medicare reimbursement for the development of written treatment plans and summaries, and the discussion of those plans between doctors and patients. 

"We need to reinstate true respect for doctor-patient communication and reward the real bond that exists in that relationship, not just to cure their cancer but to heal people in a more encompassing way than looking only at the disease," Stovall said.

People with cancer face a range of issues in addition to needing treatment for the medical aspects of their illness.  A structured process for the planning of treatments – beginning with a thorough discussion between the doctor and patient – gives patients an opportunity to understand the goals of treatment, the pros and cons of various treatment options, how side effects will be managed, whether they have emotional or psychosocial needs to address, and whether they should consider participating in a clinical trial.  By having their care plans laid out in writing and reviewed in person with the doctor, patients are in a better position to understand the process ahead, advocate for themselves, monitor their health, and participate in decisions about their care – not just their cancer treatment and its side effects, but also their social and emotional needs. 

Furthermore, increasing numbers of people are surviving cancer and living with follow-up healthcare needs, making their experience more like having a chronic illness than a fatal disease.  An effective cancer care planning process continues beyond treatment and throughout the survivor's life.  These plans can also help coordinate care by making essential information readily available to other professionals who might also be caring for the survivor (e.g., cardiologist, primary care physician, internist, gynecologists and other specialists).

Many cancer experts agree that survivorship care planning is essential to providing quality cancer care.  Some of the most recent evidence can be found in the Institute of Medicine (IOM) report, From Cancer Patient to Cancer Survivor: Lost in Transition.  Additional evidence can be found in earlier IOM reports, such as Ensuring Quality Cancer Care.