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August 2014, Volume 18, Number 4




Deborah K. Mayer, PhD, RN, AOCN®, FAAN—Editor


How Can We Deliver High-Quality Cancer Care in a Healthcare System in Crisis?


This provocative question was addressed in a report from the Institute of Medicine ([IOM], 2013), Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. An interdisciplinary committee synthesized many of the changes that are occurring in our society and health care that will challenge our existing cancer care system. These changes are familiar to many of us: an aging population along with the resulting increase in the number of cancer survivors, an inadequate number of and increased demand for trained healthcare providers, and rising healthcare costs. The IOM report recommended a framework of six interconnected components for improving the quality of cancer care (see Figures 1 and 2). Each of these components is worthy of an editorial and more. I would like to focus, however, on one of them: an adequately staffed, trained, and coordinated workforce. And, for good reason, as I want to retire someday and know that others will be taking my place in caring for cancer survivors across the care continuum. So let’s explore this one component in more detail.


Adequately Staffed and Trained


An estimated 1.6 million people in the United States will be diagnosed with cancer this year, and 14.5 million Americans are cancer survivors (American Cancer Society, 2014; National Cancer Institute, 2014). The Oncology Nursing Society ([ONS], 2014) has about 35,000 members, but we know that other nurses also are caring for people with cancer; however, these figures give you a sense of the ratio of oncology nurses to people with cancer. And the number who are diagnosed is expected to grow to 2.3 million each year by 2030, with more than 19 million survivors (Smith, Smith, Hurrian, Hortobagyi, & Bucholz, 2009). How many of us will be needed to care for them? What do we need to do to make sure there will be enough nurses who will want to provide cancer care?


One concern I have is that, because oncology is a specialty, others may not think they need to learn much about it. Gerontology is similar in that some nurses specialize and develop greater depth of knowledge in this specialty; however, we all need to learn how to care for older adults. Similarly, we will need to educate healthcare professionals, in general, about cancer. If we explored the curriculum in nursing schools, I wonder how much cancer-related content would be included in general sessions? My guess is not enough. And if we looked at how many cancer-specific programs we have, my guess is that there aren’t enough of them either.


Therefore, we will need to be creative in how we educate both generalists and specialists about cancer care and oncology nursing. One example is the online program developed by ONS for advanced practice providers new to oncology (http://www2.ons.org/CourseDetail.aspx?course_id=115). This program will be helpful in providing foundational knowledge to those entering the specialty without formal oncology education. I would like to see this provided during orientation for all of these advanced practice providers. ONS also offers an online OCN® review course and a number of other offerings intended for the oncology nurse. But cancer survivors are cared for by others as well. How will they learn about cancer care? What is our role as a specialty organization in reaching out and educating others about the needs of this population? I hope that we share our expertise with others, whether they are homecare nurses or primary care nurse practitioners. We also may want to develop programs for others providing care to people with cancer, such as caregivers and lay navigators. In this way, we will extend and enhance our ability to share our expertise to improve cancer care.


Coordinated Workforce


This is the other part of the IOM component. Coordinated is defined as “effectively organized so that all the parts work well together” (Cambridge Online Dictionary, 2014). Now, this is where I think the IOM report was on target about a system in crisis. Cancer care is delivered by members of interdisciplinary teams but may not be as coordinated as we would like. We need to be educated in effective communication and collaboration and learn how to deliver cancer care with others. We need to begin learning this in our formative education as healthcare providers. We also need systems that help facilitate communication and care coordination, such as electronic health records (EHRs). The current rollout (stage 2) for meaningful use of EHRs calls for the ability to have electronic transmission of patient care summaries across multiple settings by 2014 and to be able to have access to comprehensive patient data through patient-centered EHRs by 2016 (HealthIT.gov, 2014). That will help facilitate the care we want to deliver, but we will still need to improve how we communicate and collaborate in cancer care delivery. We need more research and demonstration projects on how to do this well.


The IOM (2013) report states that “the central goal of its conceptual framework is to deliver patient-centered, evidence-based, high-quality cancer care that is accessible and affordable to the entire U.S. population regardless of the setting where cancer care is provided” (p. 34). This is a lofty goal and one that I hope we can achieve with an adequately staffed, trained, and coordinated workforce.




American Cancer Society. (2014).  Cancer facts and figures 2014. Atlanta, GA: Author.


Cambridge Online Dictionary. (2014). Coordinated. Retrieved from http://dictionary.cambridge.org/dictionary/british/coordinated_1


HealthIT.gov. (2014). EHR incentives and certification. Retrieved from http://www.healthit.gov/providers-professionals/how-attain-meaningful-use


Institute of Medicine. (2013). Delivering high-quality cancer care: Charting a new course for a system in crisis. Washington, DC: National Academies Press.


National Cancer Institute. (2014). Office of Cancer Survivorship: Statistics. Retrieved from http://cancercontrol.cancer.gov/ocs/statistics/statistics.html


Oncology Nursing Society. (2014). About us. Retrieved from https://www.ons.org/about-ons


Smith, B.D., Smith, G.L., Hurrian, A., Hortobagyi, G., & Bucholz, T. (2009). Future of cancer incidence in the United States: Burdens upon an aging, changing nation. Journal of Clinical Oncology, 27, 2758–2765. http://dx.doi.org/10.1200/JCO.2008.20.8983


Deborah K. Mayer, PhD, RN, AOCN®, FAAN, is an associate professor in the School of Nursing at the University of North Carolina–Chapel Hill. The author takes full responsibility for the content of the article. No financial relationships relevant to the content of this article have been disclosed by the editorial staff. Mayer can be reached at CJONEditor@ons.org.


Key words: quality; cancer care; workforce