Unlike many other areas in health care, the practice of oncology presents unique challenges that make assessing and improving value especially complex. First, patients and professionals feel a well-justified sense of urgency to treat for cure, and if cure is not possible, to extend life and reduce the burden of disease. Second, treatments are often both life sparing and highly toxic. Third, distinctive payment structures for cancer medicines are intertwined with practice. Fourth, providers often face tremendous pressure to apply the newest technologies to patients who fail to respond to established treatments, even when the evidence supporting those technologies is incomplete or uncertain, and providers may be reluctant to stop toxic treatments and move to palliation, even at the end of life. Finally, the newest and most novel treatments in oncology are among the most costly in medicine.

This volume summarizes the results of a workshop that addressed these issues from multiple perspectives, including those of patients and patient advocates, providers, insurers, health care researchers, federal agencies, and industry. Its broad goal was to describe value in oncology in a complete and nuanced way, to better inform decisions regarding developing, evaluating, prescribing, and paying for cancer therapeutics.

Contents

• THE NATIONAL ACADEMIES
• PLANNING COMMITTEE ON ASSESSING AND IMPROVING VALUE IN CANCER CARE
• NATIONAL CANCER POLICY FORUM
• Reviewers
• Preface
• 1. Introduction
• 2. Opening Remarks: What Is Value in Cancer Care and Why Is It Important?
• PART I. Challenges to Value in Cancer Care
  • 3. Clinician–Patient Communication and Its Influence on Value
    • INSIDE THE CLINICIAN–PATIENT DISCUSSION IN CANCER CARE
    • THERAPY FOR ADVANCED-STAGE CANCER: WHAT DO PATIENTS WANT AND EXPECT?
    • DISCUSSION
    • REFERENCES
  • 4. Generating Evidence About Effectiveness and Value
    • THE FDA AND EVIDENCE FOR REGULATORY APPROVAL IN CANCER
    • WHAT CONSTITUTES REASONABLE EVIDENCE OF EFFICACY AND EFFECTIVENESS IN CANCER CARE?
    • DISCUSSION
    • REFERENCES
  • 5. Value and the Oncology Market
    • DRUG PRICING AND VALUE IN ONCOLOGY COMPARED TO OTHER AREAS IN MEDICINE
    • INDUSTRY PERSPECTIVE ON PHARMACEUTICAL PRICING IN ONCOLOGY
    • BUILDING THE EVIDENCE BASE FOR VALUE OF NEW TREATMENTS: COST-EFFECTIVENESS ANALYSES ALONGSIDE CANCER CLINICAL TRIALS
    • DISCUSSION
    • REFERENCES
  • 6. Value in Oncology Practice: Oncologist and Health Insurer Perspectives
    • ONCOLOGISTS’ PERCEPTION OF VALUE
    • PAYING FOR NEW CANCER TREATMENTS: RIGHTS AND RESPONSIBILITIES OF HEALTH INSURERS
    • INTERNATIONAL PERSPECTIVES ON ASSESSING VALUE FOR ONCOLOGY PRODUCTS
    • DISCUSSION
    • REFERENCES
  • 7. Ethical Issues and Value in Oncology
    • ETHICAL ISSUES WHEN CONSIDERING INSURANCE COVERAGE BASED ON VALUE IN THE TREATMENT OF CANCER
    • CLINICIAN–PATIENT COMMUNICATION ABOUT CANCER THERAPY: ETHICAL ISSUES
    • DISCUSSION
    • REFERENCES
• PART II. SOLUTIONS FOR VALUE IN CANCER CARE
  • 8. Improving Value in Oncology Practice: Ways Forward
    • VALUE-BASED INSURANCE DESIGN: INITIATIVES OUTSIDE OF ONCOLOGY
    • GENERATING EVIDENCE OF VALUE POST-FDA APPROVAL: IS THERE A ROLE FOR HEALTH INSURERS?
    • COMMUNICATING EFFECTIVELY WITH CANCER PATIENTS ABOUT THE BENEFITS AND RISKS OF CANCER TREATMENTS
    • CONCRETE IDEAS FOR INCREASING VALUE IN ONCOLOGY CARE: A VIEW FROM THE TRENCHES
    • ADVOCATING FOR VALUE IN CANCER CARE
    • DISCUSSION
    • REFERENCES
  • 9. Toward a Shared Understanding of Value
    • WORKSHOP MODERATOR PERSPECTIVES
    • GROUP DISCUSSION OF VALUE IN CANCER CARE
    • ATTRIBUTES AND METRICS OF VALUE IN CANCER CARE
• Acronyms
• Glossary
• Appendix A Workshop Agenda
• Appendix B Speaker and Moderator Biographies

Rapporteur: Adam Schickedanz.

This study was supported by Contract Nos. HHSN261200611002C, 200-2005-13434 TO #1, and 223-01-2460 to #27, between the National Academy of Sciences and the National Cancer Institute, the Centers for Disease Control and Prevention, and the Food and Drug Administration, respectively. This study was also supported by the American Cancer Society, the American Society of Clinical Oncology, the Association of American Cancer Institutes, and C-Change. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Suggested citation:

IOM (Institute of Medicine). 2009. Assessing and improving value in cancer care: Workshop summary. Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.