Index

A

Access to care, general, 1, 2, 11, 15, 46-67, 144, 146, 181, 182, 213, 214, 220

coordination of care, 2, 7, 26, 30, 40-41, 46, 133, 175, 214, 215, 220

federal, 2, 19, 41, 145, 175

defined, 46

educational attainment, 11, 47, 53, 61, 134, 148

fee-for-service care, 37, 39, 40, 43, 99, 116, 117, 133-137, 138, 152

financial barriers, general, 7-8, 15-16, 47, 55;

see also Costs

geographic barriers, 11, 46, 224

HEDIS, 157

nonfinancial barriers, 11, 46, 47, 52, 54-59, 64-65, 66, 205, 215, 224;

see also Attitudes and beliefs;

Cultural factors

referral to care, 38, 39, 96, 146, 151, 224

utilization reviews, 38

see also Demographic factors;

Health insurance;

Managed care;

Socioeconomic

status

Accountability, 6, 15, 18, 39-40, 67, 144-145, 154, 158, 175, 212, 218-219

see also Standards

Accreditation/approval, organizations, 6, 30-31, 39, 81, 146-147, 148, 151-152, 155-164, 174, 219

insurers, 6, 39, 151-52, 174, 175, 219

Adjuvant therapy, 22-23, 61, 82, 153

breast cancer, 94-95, 98, 99, 101-102, 108, 109, 153, 171, 173

colorectal cancer, 173

Advisory Board Company, 165

Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 5, 145, 175

African Americans, 20, 191, 192, 194, 200, 202-203

hospitalizations, 33

incidence, 20, 21

screening, 51, 53, 54-55, 58, 62, 189, 198

survival rates, 20, 21, 47

treatment, 59, 62, 63, 205

Age factors, 20, 31, 33, 89

breast cancer, 54, 91, 99-101, 167

clinical trials, 62, 63

cost of care and, 36

insurance coverage, 117

mammography, 54, 91, 167

prostate cancer, 103, 105, 202

treatment, general, 60-61, 62, 99-101, 120

see also Children;

Elderly persons

Agency for Health Care Policy and Research, 8, 19, 153, 154-155, 170, 175, 180, 185, 193-196, 209

Alternative treatments, 24, 204

Ambulatory care, 9, 10, 27-32, 163

American Accreditation Health Care Commission, Inc./URAC, 158

American Association of Health Plans, 154-155



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--> Index A Access to care, general, 1, 2, 11, 15, 46-67, 144, 146, 181, 182, 213, 214, 220 coordination of care, 2, 7, 26, 30, 40-41, 46, 133, 175, 214, 215, 220 federal, 2, 19, 41, 145, 175 defined, 46 educational attainment, 11, 47, 53, 61, 134, 148 fee-for-service care, 37, 39, 40, 43, 99, 116, 117, 133-137, 138, 152 financial barriers, general, 7-8, 15-16, 47, 55; see also Costs geographic barriers, 11, 46, 224 HEDIS, 157 nonfinancial barriers, 11, 46, 47, 52, 54-59, 64-65, 66, 205, 215, 224; see also Attitudes and beliefs; Cultural factors referral to care, 38, 39, 96, 146, 151, 224 utilization reviews, 38 see also Demographic factors; Health insurance; Managed care; Socioeconomic status Accountability, 6, 15, 18, 39-40, 67, 144-145, 154, 158, 175, 212, 218-219 see also Standards Accreditation/approval, organizations, 6, 30-31, 39, 81, 146-147, 148, 151-152, 155-164, 174, 219 insurers, 6, 39, 151-52, 174, 175, 219 Adjuvant therapy, 22-23, 61, 82, 153 breast cancer, 94-95, 98, 99, 101-102, 108, 109, 153, 171, 173 colorectal cancer, 173 Advisory Board Company, 165 Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 5, 145, 175 African Americans, 20, 191, 192, 194, 200, 202-203 hospitalizations, 33 incidence, 20, 21 screening, 51, 53, 54-55, 58, 62, 189, 198 survival rates, 20, 21, 47 treatment, 59, 62, 63, 205 Age factors, 20, 31, 33, 89 breast cancer, 54, 91, 99-101, 167 clinical trials, 62, 63 cost of care and, 36 insurance coverage, 117 mammography, 54, 91, 167 prostate cancer, 103, 105, 202 treatment, general, 60-61, 62, 99-101, 120 see also Children; Elderly persons Agency for Health Care Policy and Research, 8, 19, 153, 154-155, 170, 175, 180, 185, 193-196, 209 Alternative treatments, 24, 204 Ambulatory care, 9, 10, 27-32, 163 American Accreditation Health Care Commission, Inc./URAC, 158 American Association of Health Plans, 154-155

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--> American Board of Internal Medicine, 26 American Board of Obstetrics and Gynecology, 26 American Board of Pediatrics, 26 American Board of Radiology, 26, 90 American Cancer Society, 49, 104, 203-206 consumer information, 148 National Cancer Data Base, 9, 89-90, 109, 124, 160, 222 American College of Radiology, 90, 106-107 American College of Surgeons, 6, 30-31, 147, 155, 158, 160, 174, 203 National Cancer Data Base, 9, 124 American Indians, see Native Americans American Joint Committee on Cancer, 160 American Medical Association, 26 American Pain Society, 153 American Society of Clinical Oncology, 26, 166-167 American Urological Association, 90, 104, 105, 106, 166, 179-171 Approaching Death: Improving Care at the End of Life, 65, 67 Asians, 54, 190, 206 Association of Community Cancer Centers, 160-163 Attitudes and beliefs patient, 2, 11, 13, 14, 23, 46, 47, 62, 64, 65, 79, 85-86, 153, 157, 159 fatalism, 11, 53 physician, 54, 55, 59, 60, 63, 85 public opinion, 1, 2, 13, 14, 150; see also Mass media screening, 53, 54 see also Cultural factors; Public opinion B Beliefs, see Attitudes and beliefs Bing Foundation, 108 Biopsies, 92-93, 156 Bladder cancer, 61, 88 Bone and bone marrow, 23, 59, 60, 127, 190, 203 see also Leukemia Breast cancer, 3, 10, 11, 53, 91-103, 108-109, 151, 156, 159, 187, 189-190, 192, 193, 198, 203, 216 adjuvant therapy, 94-95, 98, 99, 101-102, 108, 109, 153, 171, 173 age factors, 54, 91, 99-101, 167; see also ''elderly persons'' infra chemotherapy, 60, 82, 94-95, 96, 98-99, 109, 129, 167, 171, 173, 174 clinical practice guidelines, 99, 165, 166, 167, 169, 171, 173, 174 cost of, 36 DoD program, 199-200, 201 elderly persons, 14, 42, 51, 54, 99-101, 134-135, 194, 196 mammography, 14, 42, 51, 54, 192, 197 incidence, 20, 91, 157 outcome analysis, 109, 126, 152, 185-186, 194; see also "survivorship" infra radiation therapy, 97, 98, 100, 101, 102, 108, 134, 159, 171, 173, 174 research funding, 8, 10, 185, 186, 187, 199 screening, 3, 14, 22, 42, 50-57 (passim), 83, 87, 91-94, 156, 167, 185-186, 189, 198, 200, 201, 205, 216, 224; see also Mammography SEER, 60, 100, 108-109, 186 specialty care, 128, 129-130 standards, 3, 92, 102, 167, 173 surgery, 14, 59, 88, 94, 95-102, 109, 126, 129, 133-135, 153, 159, 160, 165, 173, 189, 204, 217 survivorship, 46, 88, 94, 126, 128, 129, 133, 134-136, 159 treatment, 3, 14, 23, 27, 28, 30, 31, 42, 46, 58, 59, 60-62, 82, 92, 94-103, 126, 108, 109, 126, 128, 129-130, 132, 133, 134-136, 153, 156, 159, 186, 189, 200, 201; see also "chemotherapy," "clinical practice guidelines," and "radiation therapy" supra Breast Cancer Surveillance Consortium, 185-186 Bronchial cancer incidence, 20 survival rates, 47 treatment, 30 C Canada, 51, 129, 130, 132-133, 171 Cancer at the Crossroads, 13 Cancer Care, 49 Cancer care centers, 18, 19, 34, 90, 146-147, 160-163, 165, 171 National Comprehensive Cancer Network, 90, 165, 166, 167 Cancer registries, 89, 90, 98, 100, 117, 136, 153, 154, 161, 185, 194, 203

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--> see also National Cancer Data Base; Surveillance, Epidemiology, and End Results program Cancer Surveillance Research Program, 185 Centers for Disease Control and Prevention, 11, 18-19, 49, 154, 180 , 185, 197-199, 224 Cervical cancer, 11, 14, 22, 42, 51, 171, 187, 189, 190, 192, 193 Pap smears, 22, 51, 54-55, 56, 57, 190 research funding, 185, 187 Cervical Cancer Early Detection Program, 11 Chemotherapy, 3, 4, 22, 23, 30, 31, 49, 58, 60, 62, 82, 83, 88, 217 breast cancer, 60, 82, 94-95, 96, 98-99, 109, 129, 167, 171, 173, 174 clinical practice guidelines, 166, 169-170, 173, 174 insurance coverage, 50, 59 international perspectives, 171-172 lung cancer, 166-167, 190 prostate cancer, 107 side-effects, 24 specialty care and, 128, 129, 130, 131 standards, 164 see also Drugs Children, 19, 49, 188, 195-196, 206 incidence, 20 treatment, 34, 62 Clinical practice guidelines, 4-5, 7-8, 15, 18, 23, 34, 43, 62, 64 -65, 99, 119, 133, 144, 148, 154-155, 164-174, 175, 195, 212, 220 American Society of Clinical Oncology, 26, 166-167 breast cancer, 99, 165, 166, 167, 169, 171, 173, 174 chemotherapy, 166, 169-170, 173, 174 colorectal cancer, 166, 169, 171, 172, 173, 174 defined, 164-165 lung cancer, 166-167, 169, 172 managed care, 172 ovarian cancer, 171, 172, 174 patient education, 165, 168, 173 proprietary, 166 prostate cancer, 165, 170-171, 172 surgery, 99, 133, 166, 167, 170-171, 172 Clinical trials, 4, 8, 23, 62-63, 117, 129, 146, 181, 182, 187, 191 , 194-195, 200, 213, 217, 220, 221 age factors, 62, 63 breast cancer, 94, 132 evidence criteria, 82, 194 funding, 8, 43, 221 insurance coverage, 43, 63 international perspectives, 34 managed care, 37, 41, 63 minority groups, 34, 62-63 NCI, 34, 62, 99 postoperative survival, 83 private sector, 8, 213 prostate cancer, 103 publication bias, 118, 138 standards, 162 women, 62-63, 94, 132 Cochrane Collaboration, 207, 208-209 Colorectal cancer, 88, 156 adjuvant therapy, 173 chemotherapy, 83, 173 clinical practice guidelines, 166, 169, 171, 172, 173, 174 cost of, 36, 199 elderly persons, 51, 153 incidence, 20 insurance, 42, 136 minorities, 47 screening, 22, 42, 51, 54, 57, 58, 193, 198, 199, 203, 205 treatment, 27, 28, 30, 31, 61, 82, 83, 88, 132-133, 153, 156, 173, 203, 204 Community Clinical Oncology Program, 34, 99 Community Hospital Oncology Program, 168-169 Complementary treatments, 24, 204 Continuous quality improvement programs, 163-164 Cooperative Group Program, 34 Coordination of care, 7, 26, 30, 41, 46, 214, 215, 220 disease management specialists, 40-41, 133 federal, 2, 19, 41, 145, 175 Costs, 20, 35-36, 182, 194, 206 age factors, 36 breast cancer, 36 clinical practice guidelines, 172-173 colorectal cancer, 36, 199 disease management specialists, 40-41, 133 individual patient, 10, 20, 35, 47, 48, 50, 64 insurance premiums, 47, 48, 50, 52 national costs of cancer, general, 20, 35-36, 41 out-of-pocket, 50, 52, 57, 59, 64, 66 screening, 50, 52, 57, 186, 189, 190 treatment, general, 35, 186, 189, 190

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--> Counseling, see Patient education and counseling; Psychosocial impacts and support Cultural factors, 14, 16, 24, 46, 47, 53, 66, 79 see also Language factors D Databases, 8-9, 57, 138-139, 152, 221 CONQUEST, 194 consumer education, 148 HEDIS, 152, 154, 156-158 insurance, 9, 98, 152, 154, 156-158 NLM/HSRProj, 181-183, 184, 192, 197, 206 screening, 57, 157 see also Cancer registries Data collection and surveillance, 88-90, 138-139, 154, 180-209, 213 , 220-223 breast and colorectal cancer, 166 funding, 8, 10, 18 HCFA, 152, 197 national studies, 10 patient records, 3, 88-89, 98, 101, 117, 123-124, 125, 160, 212 posttreatment surveillance, 25, 63, 203 recommendations, 8-9 see also Cancer registries; Clinical trials; Monitoring and reporting; National Cancer Data Base; Surveillance, Epidemiology, and End Results program Decision making, 148, 201, 220 consumer information, 146-148; see also Public education patient-centered care, 23, 79, 165, 194 public policy, 80 treatment options, 2, 3, 6-7, 59, 62, 80, 83, 105-106, 170-171, 175 , 220 Demographic factors, 11, 47 data collection practices, 9, 90 rural areas, 4, 54, 56, 58, 129, 198, 212, 216 urban areas, 4, 54, 58, 93, 129, 134, 135, 136, 198, 212, 216 see also Age factors; Educational attainment; Gender differences; Geographic factors; Minority groups; Poverty; Socioeconomic status Department of Defense, 180, 199-202 Department of Health and Human Services, 184-199 see also National Cancer Institute; other specific agencies and offices Department of Veterans Affairs, 104, 125, 180, 202-203 Depression, 64-65 Diagnoses, 2, 15, 19, 20, 22, 41, 79, 154 biopsies, 92-93, 156 guidelines, 4-5 HEDIS, 157 insurance, 41, 48 late-stage cancers, 8, 51, 117-118, 128 lung cancer, 117 national statistics, 13 see also Screening Diet and nutrition, 24, 162 Documented Outcomes Collection System, 90 Drugs end-of-life care, 64 insurance coverage, 10, 43, 49, 50, 66, 223-224 Medicare coverage, 50, 66 prostate cancer, 107 standards, 162, 164, 168 see also Chemotherapy; Hormone therapy; Pain and pain management E Economic factors, 13-14, 15, 116, 181, 182 fee-for-service care, 37, 39, 40, 43, 99, 116, 117, 133-137, 138, 151-152 loss of earnings, 20, 35 market forces, general, 145, 150-151 screening incentives, 55, 56 see also Costs; Health insurance; Poverty; Socioeconomic status Education, see Patient education and counseling: Professional education; Public education Educational attainment, 11, 47, 53, 61, 134, 148 Elderly persons, 224, 225 breast cancer, 14, 42, 51, 54, 99-101, 134-135, 194, 196 mammography, 14, 42, 51, 54, 192, 197 clinical trials, 62 colorectal cancer, 51, 153 educational interventions, 191 incidence, 20, 37, 145-146 pain management, 47, 64, 191 prostate cancer, 103, 152, 153 screening, 54; see also "breast cancer-mammography" supra SEER, 186

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--> treatment, 11-12, 30, 31, 32, 33, 59, 60-61, 62, 66, 99-101, 121, 128, 136, 152, 196 see also Medicare Emotional support, see Psychosocial impacts and support Employee Retirement Income Security Act, 39-40, 41 End-of-life care, 25-26, 33, 63-66, 67, 191, 193, 194, 213, 220 chemotherapy, 167 hospice care, 65, 149, 152, 163, 197 Medicare, 64 patient education, 25-26, 64-65 England, 129, 130, 133 Esophageal cancer, 4, 121, 122 Ethnicity, see Minority groups F Federal government, general, 16, 18-19, 144, 151 clinical trials, funding, 8 coordination of agencies, 19, 145 coordination of care, 2, 19, 41, 175 research sponsorship, 180, 184-203 see also Legislation, federal; specific departments and agencies Fee-for-service care, 37, 39, 40, 43, 99, 116, 117, 133-137, 138, 151-152 see also Medicare Food and Drug Administration, 92 Foreign countries, see International perspectives; specific countries Foundation for Accountability, 146, 158, 159 France, 171-172, 174 Funding breast cancer research, 8, 10, 185, 186, 187, 199 research, other, 8, 18, 180, 181, 185, 187, 193, 197, 200, 202, 203 , 205, 209 G Gender differences incidence, 20 physician attitudes toward screening, 55 treatment, 61, 135 see also Men; Women General Accounting Office, 81-82 Geographic factors, 14 as access barrier, 11, 46, 224 insurance, 197 screening, 136, 152 SEER, 9, 89, 222 survivorship, 118 treatment, 58-59, 62, 95-96, 133, 136, 204 see also Regional factors; Rural areas; Urban areas Guidelines, see Clinical practice guidelines H Health Care Financing Administration, 6, 19, 39, 146, 151-154, 175 , 185, 196-197, 209, 219 SEER-Medicare data, 9, 89, 108, 121, 123, 134, 138, 185, 186, 196 Health Care Quality Improvement Program, 152 Health insurance, 1, 6-7, 14, 15, 18, 32, 47, 117, 133-137, 146, 149 accountability, 144 accreditation, 6, 39, 151-152, 174, 175, 219 age factors, 117 colorectal cancer, 42, 136 complaints and appeals, 39-40 costs to individuals out-of-pocket, 50, 52, 57, 59, 64, 66 premiums, 47, 48, 50, 52 databases, 9, 98, 152, 154, 156-158 disease management specialists, 40-41, 133 drugs, 10, 43, 49, 50, 66, 223-224 chemotherapy, 50, 59 HMOs, 35, 36, 37, 38, 39, 54, 57, 117, 133-137, 138, 152, 186-187, 199 legislation, federal, 38, 48 legislation, state, 11, 39, 40, 41, 42-43 mammography, 42 preferred provider organizations, 152, 155, 158 standards, 175; see also "accreditation" supra treatment, 10, 41, 42, 43, 49, 50, 59, 66, 98, 99, 223-224 uninsured/underinsured persons, 10, 11, 13-14, 15, 35, 48-49, 66, 213, 223-224 see also Managed care; Medicaid; Medicare Health Insurance Portability and Accountability Act, 48 Health Maintenance Organization Act, 38 Health maintenance organizations, 35, 36, 37, 38, 39, 54, 57, 117, 133-137, 138, 151-152, 186-187, 199

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--> Cancer Research Network, 186-187 Health Plan Employer Data Information Set (HEDIS), 152, 154, 156-158 Health services research, defined, 181 Healthy People 2000, 154 Hematopoietic growth factors, 169-170 Hill-Burton Act, 48 Hispanics, 47, 190, 191 screening, 53, 54-55 treatment, 59 HMO Cancer Research Network, 186-187 Hodgkin' s disease, 82, 129 Home care, 32, 163 Hormone therapy, 22, 23, 32, 60, 94-95, 98, 107, 174, 188 Hospice care, 65, 149, 152, 163, 197 Hospitals, 19, 30-34, 59, 118 approval/accreditation status, 6, 30-31, 146-147, 152, 155, 158, 219 breast cancer surgery, 42, 97, 101, 135 charity requirements, 48 clinical trials, 34 costs, 35 National Cancer Data Base, 89-90 pain management, 153 specialist, 128-130, 133 volume-outcome relationship, 4, 116, 118-128, 151, 212, 217 see also Cancer care centers; Surgery HSRProj, 184, 192, 197, 206 I Immune system, 23 Incidence, 13, 20 African Americans, 20, 21 breast cancer, 20, 91, 157 by cancer site, 21-22 elderly persons, 20, 37, 145-146 Insurance, see Health insurance Interdisciplinary approaches, 26, 36, 61, 65, 119, 130, 139, 149, 161, 162, 167 continuous quality improvement programs, 163-164 patient education, 26, 30, 65 research, 180, 181 see also Specialists and specialist care International Bone Marrow Transplant Registry, 127 International perspectives, 126-128 chemotherapy, 171-172 clinical trials, 34 specialty care, 129 see also specific countries Internet, 15 (footnote), 145, 146, 155, 158, 184, 185, 194, 197 Italy, 171, 173 J Joint Commission on Accreditation of Healthcare Organizations, 146 , 155, 156, 160 L Language factors, 11, 46, 47 Larnyx cancer, 27, 28 Legislation, federal, 18, 19, 39, 182 Employee Retirement Income Security Act, 39-40, 41 Health Insurance Portability and Accountability Act, 48 Health Maintenance Organization Act, 38 Hill-Burton Act, 48 Mammography Quality Standards Act, 186 National Cancer Act, 13, 18, 19, 89 National Institutes of Health Revitalization Act, 62-63, 165 Patient's Bill of Rights, 41 Legislation, state, 18, 19, 67, 182 insurance, 11, 39, 40, 41, 42-43 Leukemia, 4, 27, 28, 30, 61, 127-128, 190 Liver cancer, 102, 121, 122 Local factors, 2, 4, 166 Lung cancer, 4, 10, 156 chemotherapy, 166-167, 190 clinical practice guidelines, 166-167, 169, 172 incidence, 20 SEER, 185 survivorship, 47, 88, 117-118 treatment, 27, 28, 30, 31, 59, 60, 61, 82, 117-118, 119-122, 156, 166-167, 185, 190, 203 Lymphoma, 27, 28, 30, 31, 61, 82, 88

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--> M Mammography, 3, 14, 22, 50-57 (passim), 83, 87, 91-92, 102, 108, 159, 167, 185-186, 189, 196, 198, 205, 216 age factors, 54, 91, 167 insurance, 42 standards, 3, 92, 102, 167, 173 Mammography Quality Standards Act, 186 Managed care, 6, 16, 36, 37-43, 116, 133-137, 138, 146, 144, 196 clinical practice guidelines, 172 clinical trials, 37, 41, 63 defined, 37, 38 HMOs, 35, 36, 37, 38, 39, 54, 57, 117, 133-137, 138, 152, 199, 186 -187 Medicare, 36, 37, 39, 134-135, 151-152 pain management, 193 preferred provider organizations, 152, 155, 158 screening, 40-41, 42, 52, 54 specialist care, 37-38, 40-41, 133 surgery, 38, 42 see also Employer-based plans Market forces, 145, 150-151 Mass media, 147, 198 Internet, 15 (footnote), 145, 146, 155, 158, 184, 185, 194, 197 see also Public education M.D. Anderson Cancer Center, 165 Measurement issues, 1, 2, 3, 5, 15, 16, 67, 80-88, 107-109, 116-139 , 145, 212, 215-216, 218-219 managed care vs fee-for-service care, 133-137 process quality, 80, 81-84, 94, 108, 116, 126, 128, 135, 152, 181 structural quality, 80, 80-81 see also Monitoring and reporting; Outcome analysis Medicaid, 6, 10, 34, 42, 43, 48, 52, 66, 99, 153, 197, 198, 212, 219 complaints and appeals, 39 Medical records, 3, 88-89, 98, 101, 117, 123-124, 125, 160, 212 Medicare, 2, 6, 10, 30, 34, 48, 52, 66, 99, 100, 136, 145-146, 175 , 196-197, 198, 212, 219 certification of providers, 151-153 complaints and appeals, 39 coverage options, 152 drug coverage, 50, 66 end-of-life care, 64 managed care, 36, 37, 39, 134-135, 151-152 out-of-pocket costs, 50, 64 SEER linked to, 9, 89, 108, 121, 123, 134, 138, 185, 186, 196-197 Medline, 181-183 Memorial Sloan-Kettering Cancer Center, 165 Men, 33, 58 incidence, 20 see also Prostate cancer Minority groups, 11, 47, 190, 191, 198, 202, 224 Asians, 54, 190, 206 clinical trials, 34, 62-63 Hispanics, 47, 53, 54-55, 59, 190, 191 hospitalizations, 33 Native Americans, 47, 191, 198 pain management, 64 screening, 51, 53-55, 58, 62, 189, 190, 198 survival rates, 20, 21, 47 treatment, 59, 61, 62-63, 66, 205 see also African Americans Monitoring and reporting, 2, 5, 6, 117-118, 215, 218, 220-223 see also Data collection and surveillance Mortality rates, 4, 9, 86 breast cancer, 91 national statistics, 13 prostate cancer, 103 volume-outcome relationship, 4, 116, 118-128, 151, 212, 217 see also Survivorship Multidisciplinary care, see Interdisciplinary approaches; Specialists and specialist care N National Ambulatory Medical Care Survey (NAMCS), 27, 30 National Cancer Act, 13, 18, 19, 89 National Cancer Advisory Board, 19 National Cancer Data Base, 9, 89-90, 109, 124, 160, 222 National Cancer Institute, 8, 18, 19, 34, 99, 104, 148, 185-192, 209 clinical trials, 34, 62, 99 funding, 185, 186 Office of Cancer Survivorship, 187-188 see also Surveillance, Epidemiology, and End Results program National Cancer Policy Board, 65-66, 180, 181, 184, 211, 214-215, 216

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--> National Cancer Program, 19 National Center for Chronic Disease Prevention and Health, 198-199 National Center for Health Statistics, 27, 199 National Coalition of Cancer Survivors, 149 National Committee for Quality Assurance, 6, 146 HEDIS, 152, 154, 156-158 National Comprehensive Cancer Network, 90, 165, 166, 167 National Hospital Ambulatory Medical Care Survey (NHAMCS), 27, 30 National Institute of Dental Research, 192 National Institute on Aging, 192 National Institutes of Health, 185-192 see also National Cancer Institute National Institutes of Health Revitalization Act, 62-63 National Library of Medicine, 181, 192 Native Americans, 47, 191, 198 Nontraditional treatments, see Alternative treatments Norway, 130 Nurses and nursing, 26, 30, 162, 200, 204 Nutrition, see Diet and nutrition O Office of Cancer Survivorship, 187-188 Organ Transplant Fund, 49 Outcome analysis, 9, 10, 40, 66, 80, 81, 84-87, 90, 116, 117, 154, 181, 194, 205 breast cancer, 109, 126, 152, 185-186, 194 funding, 185 process and, 83-84, 116, 130 prostate cancer, 104, 105, 106, 109, 125, 185, 194, 200, 205 specialist care, 128-133, 137-138 survival rates in, 84-85, 86, 88, 117-118, 122-133 volume-outcome relationship, 4, 116, 118-128, 137, 151, 212, 217 see also Survivorship Outcomes and Assessment Information Set (OASIS), 152 Outpatient care, see Ambulatory care Ovarian cancer, 88, 128, 130-131, 171, 172, 174, 200 P Pacific Business Group on Health, 151 Pain and pain management, 7-8, 10, 24, 25, 30, 64, 67, 149, 153, 190, 191, 194 American Pain Society, 153 attitudes toward pain, 53 clinical guidelines, 4-5, 165, 170 elderly persons, 47, 64, 191 managed care, 193 prostate cancer, 107 socioeconomic status, 47 standards, 4-5, 153, 163, 165 Palliative care, see Pain and pain management Pancreatic cancer, 4, 119, 121, 122, 124-125, 128-129, 190 Pap smears, 22, 51, 54-55, 56, 57, 190 Patient education and counseling, 23, 30, 105, 148, 149, 150, 153, 182, 188 clinical practice guidelines, 165, 168, 173 diagnosis, 2 end-of-life care, 25-26, 64-65 insurance coverage, 55 interdisciplinary, 26, 30, 65 screening, 55, 57 side-effects, 59 standards, 161, 162, 165, 168, 173 telephone services, 57, 148, 205 treatment options, 2, 3, 6-7, 59, 62, 80, 83, 105-106, 170-171, 175 , 220 see also Psychosocial impacts and support Patient Outcomes Research Teams, 194 Patterns of Care studies, 90, 185, 192, 204 Peer review organizations, 152, 153 Pharmaceuticals, see Chemotherapy; Drugs; Hormone therapy Physician Data Query system, 148 Physicians, 14, 18, 26, 27, 31, 130-133, 138, 146, 197, 204 access to, 54-55 accountability, 6, 40 ambulatory care, 27-30 attitudes and beliefs of, 54, 55, 59, 60, 63, 85 board certification, 6, 26, 219 clinical trials, 34 costs associated with, 35 elderly patients, 54, 60 managed care and, 38, 40 performance assessment, 83 referral to specialists, 38 screening variables, 54, 55, 56, 66

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--> specialty care, 130-133, 138, 146 treatment variables, 59, 60, 61-62 volume-outcome relationship, 118 Poverty, 66, 190, 224 cervical cancer, 51, 224 end-of-life care, 64 screening, 19, 43, 49, 51, 53, 56, 224 survival rates, 47 treatment, 43, 59 uninsured/underinsured, 10, 11, 13-14, 15, 35, 48-49, 66, 213, 223-224 Preferred provider organizations, 152, 155, 158 Preventive interventions, 11, 15, 87, 90-91, 134, 149, 154, 188, 189, 190-191, 193 guidelines, 4-5, 162 NCI, 19 smoking, 87, 187 see also Screening Preventive Services Task Force, 104, 195 Private sector, general, 15, 16, 144, 175, 203-209, 218 clinical practice guidelines, 165 clinical trials, 8, 213 market forces, 145, 150-151 public-sector collaboration, 5, 175, 212, 218 research sponsorship, 180 see also Health insurance; specific organizations Professional education, 2, 9, 182, 212 end-of-life care, 67 health services research, 10 lack of appropriate, 47 screening, 56 standards, 161, 162, 168 see also Clinical practice guidelines Prostate cancer, 4, 88, 103-109, 125, 194, 198-199, 200-201, 202-203, 205-206 age factors, 103, 105, 202 American Urological Association, 90, 104, 105, 106, 166, 179-171 chemotherapy, 107 clinical practice guidelines, 165, 170-171, 172 cost of, 36, 201 elderly persons, 103, 152, 153 incidence, 20, 103 insurance, 42, 136 radiation therapy, 105-107, 170-171 screening, 22, 42, 103, 104-105, 186, 190, 193, 198-199, 200, 201, 202 surgery, 103, 105, 106, 107, 125, 152, 153, 170-171, 204, 217 survivorship, 104, 105, 107, 108 treatment, 27, 28, 30, 31, 61, 103-108, 125, 170-171, 186, 190, 199, 200 Prostate Cancer Intervention Versus Observation Trial, 103 Prostate, Lung, Colorectal, and Ovarian screening trial, 103 Psychosocial impacts and support, 7, 25-26, 30, 149, 150, 153, 163, 187, 188, 190, 198, 200, 201, 205, 206, 220 end-of-life care, 64-66 pastoral care, 162 see also Decision making Public education, 34, 57, 146-150, 151, 158, 182, 198, 212, 220 Internet, 15 (footnote), 145, 146, 155, 158, 184, 185, 194, 197 mass media, 147, 198 standards, 161 Public opinion, 1, 2, 13, 14, 150 see also Mass media Put Prevention into Practice, 195 Q Quality Interagency Coordination Health Care Task Force, 145 Quality of care, defined, 79, 116, 211-213, 215-216 R Race/ethnicity, see Minority groups Radiation therapy, 3, 22, 23, 61, 62, 83, 88, 90, 128 American College of Radiology, 90, 106-107 attitudes toward, 53 breast cancer, 97, 98, 100, 101, 102, 108, 134, 135, 159, 171, 173, 174 insurance coverage, 59 prostate cancer, 105-107, 170-171 specialist certification, 26 RAND, 108 Recurrent cancers, 8, 25, 104, 188 Rectal cancer, see Colorectal cancer Referral to care, 38, 39, 96, 146, 151, 224 Regional factors, 2, 62, 116 breast cancer, 95, 97 Medicare reporting, 6

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--> see also Geographic factors; Rural areas; Urban areas Reporting systems, see Data collection and surveillance; Monitoring and reporting Reproductive effects, see Sexual and reproductive effects Research Data Assistance Center, 197 Road to Recovery, 49 Rural areas, 4, 54, 56, 58, 129, 191, 198, 212, 216 S Scotland, 126-127, 130, 132, 172 Screening, 3, 5, 11, 22, 48-49, 50-56, 90-91, 149, 154, 189, 190, 198 African Americans, 51, 53, 54-55, 58, 62, 189, 198 breast cancer, 3, 14, 22, 42, 50-57 (passim), 83, 87, 91-94, 156, 167, 185-186, 189, 198, 200, 201, 205, 216, 224; see also Mammography cervical cancer, 11, 14, 51, 185 colorectal cancer, 22, 42, 51, 54, 57, 58, 193, 198, 199, 203, 205 costs of, 50, 52, 57, 186, 189, 190 databases, 57, 157 follow-up, 5, 56-58, 91-94 geographic factors, 136, 152 HEDIS, 157 Hispanics, 53, 54-55 insurance coverage, 40-41, 42, 52 managed care, 40-41, 42, 52, 54 minority groups, 51, 53-55, 58, 62, 189, 190, 198 patient education, 55, 57 poor persons, 19, 43, 49, 51, 53, 56, 224 prostate cancer, 22, 42, 103, 104-105, 186, 190, 193, 198-199, 200, 201, 202 standards, 162, 167, 168 women, general, 51, 53, 55, 57, 190; see also Mammography; Pap smears Sexual and reproductive effects, 188 Side-effects, 24, 59, 64, 187, 188, 225 prostate cancer, 103, 105-106 Skin cancer, 22, 27, 28, 30, 31, 192, 203 Smoking, 87, 187 women, 20 Social factors, see Cultural factors; Demographic factors; Psychosocial impacts and support; Socioeconomic status Social Security Administration, 39 Society for Surgical Oncology, 166 Socioeconomic status, 14, 47, 48, 224 breast cancer survival, 136 educational attainment, 11, 47, 53, 61, 134, 148 end-of-life care, 64 prostate cancer, 198 treatment, 61, 66 see also Poverty Specialists and specialist care, 16, 26-27, 55, 116, 128-133 ambulatory care, 27 breast cancer, 128, 129-130 certification, 26, 146 chemotherapy, 128, 129, 130, 131 diagnosis, 22 hospitals, 128-130, 133 insurance, disease management specialists, 40-41, 133 international perspectives, 129 managed care and, 37-38, 40-41, 133 surgery, 129, 130-133 survival rates and, 128-133 see also Interdisciplinary approaches Standards, 2, 23, 37, 81, 102, 155, 214 accreditation/approval, 6, 30-31, 39, 81, 146-147, 148, 151-152, 155-164, 174, 219 insurers, 6, 39, 151-152, 174, 175, 219 ambulatory care, 163 breast cancer, 3, 92, 102, 167, 173 chemotherapy, 164 continuous quality improvement programs, 163-164 data collection, 154, 164, 175 diagnostic/screening, 154 drugs, 162, 164, 168 HEDIS, 157 hospital program approval, 6, 30-31 mammography, 3, 92, 102, 167, 173 National Coalition for Cancer Survivorship, 149-150 pain management, 4-5, 153, 163, 165 patient education, 161, 162, 165, 168, 173 professional education, 161, 162, 168 public education, 161 research, 13, 82, 83 screening, 162, 167, 168 specialist certification, 26 staging classification, 198

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--> survivorship, 161 see also Clinical practice guidelines State-level actions, 144, 151, 154, 203 insurance, 11, 39, 40, 41, 42-43, 49 legislation, 18, 19, 67, 182 insurance, 11, 39, 40, 41, 42-43 National Cancer Data Base, 9, 89-90, 109, 124, 160, 222 peer review organizations, 152, 153 Supplemental Security Income, 48 Surgery, 22-23, 59, 61, 83, 88, 90, 190, 217 ambulatory care, postoperative, 30 American College of Surgeons, 6, 9, 30-31, 124, 147, 155, 158, 160, 174, 203 breast cancer, 14, 59, 88, 94, 95-102, 109, 126, 129, 133-135, 153, 159, 160, 165, 173, 189, 204, 217 clinical practice guidelines, 99, 133, 166, 167, 170-171, 172 high-risk, 4, 119-125, 217 managed care, 38, 42 ovarian cancer, 130-131 prostate cancer, 103, 105, 106, 107, 125, 152, 153, 170-171, 204, 217 specialty care, 129, 130-133 volume-outcome relationship, 4, 116, 118-128, 137, 151, 212, 217 see also American College of Surgeons Surveillance, see Data collection and surveillance Surveillance, Epidemiology, and End Results program, 9, 89, 90, 185, 186, 222 breast cancer, 60, 100, 108-109, 186 elderly persons, 186 geographic coverage, 9, 89, 222 incidence, by race, 21 Medicare linked to, 9, 89, 108, 121, 123, 134, 138, 185, 186, 196 overview and goals, 89 specialist care, 128, 129 survival rates, 21, 88 treatment, 9, 82, 185 Survivorship, 7, 117-118, 149-150, 187-188, 204 African Americans, 20, 21, 47 breast cancer, 46, 88, 94, 126, 128, 129, 133, 134-136, 159 costs and, 36-37 follow-up care, 8, 13, 25, 96, 102-103, 149-150 geographic factors, 118 insurance and, 48 length of, 9 lung cancer, 47, 88, 117-118 minority groups, 20, 21, 47 national statistics, 13 outcome measures, survival rates as, 84-85, 86, 88, 117-118, 122-133 patient overestimation, 65 process measures, 81-82, 116, 130 prostate cancer, 104, 105, 107, 108 rates, by cancer site, 88 rates, by race, 21 special care and, 128-133 standards, 161 see also End-of-life care; Outcome analysis Susan Komen Foundation, 187 Sweden, 130 T Taking Action to Reduce Tobacco Use, 14 Tamoxifen, 94-95, 171 see also "chemotherapy" under Breast cancer Telephone services, 57, 148, 205 Testicular cancer, 4, 126, 129, 130 Time-series studies, 82 Total quality management programs, see Continuous quality improvement programs Transportation, 49 Treatment, 9, 13, 15, 18, 20, 22-26, 49, 58-63, 89, 138, 149, 167, 187, 189, 193-194 African Americans, 59, 62, 63, 205 age factors, 60-61, 62, 99-101, 120 alternative, 24, 204 appropriateness of, 2, 59, 81, 128 children, 34, 62 costs, general, 35, 186, 189, 190 decision making, treatment options, 2, 3, 6-7, 59, 62, 80, 83, 105-106, 170-171, 175, 220 elderly persons, 11-12, 30, 31, 32, 33, 59, 60-61, 62, 66, 99-101, 121, 128, 136, 152, 196 follow-up care, 8, 13, 25, 96, 102-103, 149-150 gender differences, 61, 135; see also Women geographic factors, 58-59, 62, 95-96, 133, 136, 204 Hispanics, 59 insurance coverage, 10, 41, 42, 43, 49, 50, 59, 66, 98, 99, 223-224 minorities, 59, 61, 62-63, 66, 205 physician variables, 59, 60, 61-62 posttreatment surveillance, 25, 63, 203

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--> recurrent/late-stage cancers, 8, 25 SEER, 9, 82, 185 women, general, 59, 60, 61, 62-63; see also Breast cancer; Cervical cancer; Ovarian cancer see also Adjuvant therapy; Ambulatory care; Clinical trials; Drugs; Interdisciplinary approaches; Outcome analysis; Pain and pain management; Radiation therapy; Side-effects; Specialists and specialist care; Surgery; ''treatment'' subheads under specific cancers/cancer sites U Unconventional treatments, see Alternative treatments United Kingdom, 129, 130-131, 133, 182 Scotland, 126-127, 130, 132 Urban areas, 4, 54, 58, 93, 129, 134, 135, 136, 191, 198, 212, 216 Utilization reviews, 38, 46, 182 V Volume-outcome relationship, 4, 116, 118-128, 137, 151, 212, 217 W War on Cancer Act, see National Cancer Act Women, 33 clinical trials, 62-63 colorectal cancer, 51 female physicians, 55 pain relief, 47 screening, general, 51, 53, 55, 57, 190; see also Mammography; Pap smears smoking, 20 treatment, general, 59, 60, 61, 62-63 see also Breast cancer; Cervical cancer; Ovarian cancer World Wide Web, see Internet