Oncology care is complex. This relates directly to the heterogeneity of cancer diagnoses (many different types of cancer, eg, lung, breast, colon, lymphoma); the stage of disease and tumor subtype; the patient characteristics, including comorbid conditions; the patient's social support, financial, and/or insurance resources; and the setting of care. Layered on this is need for multiple oncology specialists to be involved in the delivery of high-quality care, from diverse disciplines including surgery, pathology, radiology, medical oncology, and radiation oncology. Coordination of care among these members of the team is often challenging, even when care occurs within the same institution. Finally, the treatments themselves are frequently toxic, complicated to administer, and require ongoing support in the patient's home and community after receipt in the physician's office. Patient and caregiver support are critical, especially as we consider the aging of the population and the frequency of cancer among individuals older than 65 years. All of these issues are magnified among the underserved, who often present with more advanced cancer and greater frequency of comorbid conditions, along with more limited personal resources.Facing these challenges, how can we work to deliver highquality and affordable cancer care? What strategies should be considered to improve communication and coordination of care, while reducing adverse effects on patients and minimizing waste? The abstracts in the first session of the ASCO Quality Care Symposium provided examples of efforts underway to study these aspects of care. Each presentation examined needed efforts along the continuum of cancer care, from diagnosis through end-of-life care, and are reviewed in this context.
Tools and Strategies at DiagnosisTwo of the abstracts from this session addressed issues related to navigating the health system and delivery of evidenced-based care at the time of diagnosis. Ko et al 1 performed a secondary analysis of data from the National Patient Navigation Research Program, a consortium of federally funded research programs that provided patient navigation to patients newly diagnosed with breast cancer, mostly in underserved populations (13% uninsured and 38% insured by Medicaid). Three National Comprehensive Cancer Network quality indicators measuring the quality of early stage breast cancer treatment were examined in this database: use of endocrine adjuvant therapy in women with hormone receptor-positive disease; use of radiation therapy postlumpectomy; and use of adjuvant chemotherapy for patients with hormone negative disease, tumor more than 1 cm, and younger than 70 years. These quality indicators were chosen because adherence to them can influence mortality. Examination of the available data supported the benefit of patient navigation in improving adherence to endocrine therapy (adjusted odds ratio 1.78, P ϭ .002); however, patient navigation did not significantly affect adherence to the remaining quality indicators, and in fact, chemothera...