Here at NCI's Division of Cancer Control and Population Sciences, we're pleased to announce
the launch of our new Healthcare Delivery Research Program. Health care settings vary
tremendously, we want to solicit the best ideas about how to understand the variation
and the quality of cancer care around the country and then develop effective strategies
to improve the quality of care that's delivered. These are the kinds of scientific questions
that providers need us to help answer in order for them to improve their cancer care. We
have made some headway into some of the health care delivery problems and improved some outcomes,
but we have not done enough. And so it is time to start looking at provider-level, and
system-level, and community-level factors that we may need to intervene on in order
to further improve outcomes. We draw on expertise from multiple perspectives. So epidemiology,
public health, psychology, behavioral medicine, Pulling all of those perspectives together
enhances the work we do, but it’s also a challenge. So for communication I think it’s
looking at the system level. We've noticed that when you get an electronic health record
into a full health system and then you get the organizations and the expectations in
policy surrounding that that we now can increase rates of adherence in ways that we never have
before. We find that with screening, for example. We can reduce these losses to follow-up if
we get the system level to pick up on these breaks that we had before. The creation of
this new program is a great opportunity to get a better understanding of how cancer survivors’
work lives, their financial status, their caregiving responsibilities, and all of the
other important things that they're doing affect treatment decisions, treatment planning,
and treatment adherence. Our research has already taught us that being told that you're
free of cancer does not mean you're free of the cancer experience. Many individuals report
problems with psychological well-being, social function, economic status, physical outcomes,
et cetera. what happens to those individuals after treatments end? Health services research
really gives us an opportunity to look at treatment effects within the context of health
care systems and particular patterns and structures for health care delivery. Patients and their
caregivers may not be able to work after a cancer diagnosis, or they may be limited in
the type of work they can do. We’re going to be encouraging research related to understanding
the economic burden of cancer and that means things like greater medical debt, higher out-of-pocket
expenditures compared to their income, and greater risk of bankruptcy, compared to similar
people who don't have cancer or don't have a cancer history. We know that most people
in their lifetime will serve as an informal caregiver to a family member or loved one.
These people are incredibly important to the patients that they take care of, and yet,
we know so little about their health and well-being across the cancer care continuum. We're going
to be more actively listening and seeking opinions from investigators and from clinicians
as well as people who are affected by cancer, to better understand how care is delivered
and what issues they're facing. we want to enhance the completeness of our treatment
information and so a lot of the treatment data that we want to capture comes from claims
data. We will be having complementary data sources and infrastructure that we’d like
to develop that we could use for surveillance and that would simultaneously support extramural
investigators for health services research activities. I see a number of key opportunities
for the grantee community in precision medicine. That includes tracking the use of molecular
targeted therapies. Are patients adhering to these therapies? What are the determinants
of their use? What are the outcomes of their use? We need to make sure that the efforts
that NCI focuses are of special relevance to cancer patients and also we want to work
closely with other research funders, within and outside the federal government, to make
sure that our efforts are coordinated, and we want to ensure that the best ideas are
coming to the table about how to prioritize research in this area, and how to collaborate
and coordinate effectively with other funders, and the many organizations that have a strong
stake in this topic area.