Cancer services may be provided in a variety of care settings, including in a single facility, co-located at one site, or available across multiple sites and locations. In the words of one cancer program administrator,"Having cancer services does not mean you have a cancer program." Coordination of care and communication across the multidisciplinary care team, interdisciplinary services, and settings of care is paramount for delivery of quality patient-centered care from diagnosis, to treatment planning and delivery, and into survivorship care.
With advances in the understanding of the biology of many cancer types and subtypes, diagnosing, staging, treatment planning, care coordination, and post-treatment follow-up continues to evolve and the multidisciplinary team involved in delivery of cancer care continues to expand. These changes are underway in a healthcare environment that is also undergoing transformation. This section of the Cancer Program Fundamentals outlines the following basic components of a cancer program:
Along with clinical advances for detection, diagnosis, and treatment of cancers, for more than a decade oncology has seen mounting evidence and acknowledgment of the importance of supportive care services to patient-centered cancer care delivery. In 1999, the National Comprehensive Cancer Network (NCCN)1 issued a consensus statement recommending the development of improved screening mechanisms to enhance the detection and management of distress in oncology patients and to establish distress screening as a standard of care within oncology. In 2008, the National Academy of Medicine (then named the Institute of Medicine) released its report, Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs,2 advancing the guidelines for detection and management of supportive care concerns and recommending that supportive care services within oncology be implemented as a national standard across all cancer treatment settings of care.
In late 2019, the American College of Surgeons Commission on Cancer released Optimal Resources for Cancer Care: 2020 Standards. These new accreditation standards, some of which are phased-in, went into effect in January 2020. Standard 4 covers Personnel and Services Resources, Standard 5 includes Patient Care: Expectations and Protocols; and Standard 7 focuses on Quality Improvement.3
1. National Comprehensive Cancer Network (2014) NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Distress Management. (Version 2.2014).
2. Institute of Medicine. Cancer Care for the Whole Patient: Meeting psychosocial health needs. In Adler NE, Page AEK Page (Eds.). 2008. Washington, DC: Institution of Medicine.
3. American College of Surgeons, Commission on Cancer. Optimal Resources for Cancer Care: 2020 Standards. American College of Surgeons: Chicago, IL: 2019.