Ensuring Quality Cancer Care .V hpesoJ dna ttiweH airaM Simone, srotidE draoB yciloP recnaC lanoitaN ENICIDEM FO ETUTITSNI dna ,SECNEICS EFIL NO NOISSIMMOC NATIROENSAELCA ORUCNHC IL NATIAOCNAPADRLEE MSYS ,.9nC9o.9tD1gnihsaW 8 1 .4,C0n.2oDtg n .i,W he.•suNa nWneoviAtuti tS s S 1nYE•0oMR1CEP2 DLAACNAOITAN hcraese Rlanoita Neh tf odrao Bgninrevo Geh ty bdevorpp asa wtrope rsih tf otcejbu seh ts itah ttcejor peh T:ECITON f oymedac Alanoita Neh t,secneic Sf oymedac Alanoita Neh tf oslicnuo ceh tmor fnwar der asrebme mesoh w,licnuoC rof elbisnopser si hcihw ,draoB yciloP recnaC lanoitaN eht fo srebmem ehT .enicideM fo etutitsnI eht dna ,gnireenignE .ecnalab etairporppa rof drager htiw dna secnetepmoc laiceps rieht rof nesohc erew ,troper eht dehsiugnitsi dtsiln eo tsecneic Sf oymedac Alanoita Neh ty b079 1n ideretrah csa wenicide Mf oetutitsn IehT n.Icilb ue phfhtotla ee hhogttniniatr esprett aymcil ofnpooitanima xe ehnstinoissefo reptairporp pe ahfstorebmem yt iol t irebe b isonsiteanv hodrtpaes telrraanhocisse rs3g’6ny 8 o mr1hec seettetddouhc anbtta,cu isAetihshtntI . Ihtenne K.r D.noitacud edn a,hcraese r,era clacide mf oseuss igniyfitned in ievitaitin inw ost idn atnemnrevo glaredef .enicideM fo etutitsnI eht fo tnediserp si enihS cs 6 oen1osci9ts n1ay emfieoc dSlaacnA od ieyetzbhaitNn alsgiarcwo nhucorCa elsaenRo iethaTN i- egd de gnlsna weiy eyosr ts tgnoe hi’efaok phetnycold fr thiumnoaeoudrtwmeenohpnumdihrtafoaccbccseAt dge nne iics n m ne lyohr .ainabitegtdcirtit,nnri ecweyieole n ndmsmcohleeueincptaghFdvrartadeecavdAoegf l eigyhcn c t nisnelutaem aoahgof pCracoe ie ehhcp ybttnolmo i aebsrend ephoafct icondtAenaiaN ceShtN a - c i d,f, nci g tdaite nsnnlnheeeeabe thcm uioting pct vrnesgreihnevdt isoi nrgvyieom e relnfpdaioangconAiEt i- y ld. te ss nrl eeyieie i i bot chetdmhjs .nTti netiseuun gadonino tuenabi.iCfimhicmrcotmtradDisoeadnceeInM ecurB .M streblA dna .rD mailliW .A fluW near ma,ry ildaenhv ac i, ftneocacemiprv sileeaahrhntcoitaRN e - .licnuo Chcraes -OC-2O N.o NtcartnoC (etutitsn Irecna Clanoita Neh ty bdedivor pgnidnu fhguorh tdetroppu ssa wydut ssihT ;yteicoS recnaC naciremA eht ;noitneverP dna lortnoC esaesiD rof sretneC eht ;)42017 taroba Lttobb A;.cn I,negmA o - noira Mtshceo Hdn a;seir .cn I,lessuoR dy e ct tr nirenese lilos ecir saopoesnhafwnPehh eatoeortTerCiihpvttaN .snoitazinagr ognidnu feh tf oesoh tylirassece nto ner adn adraoB t aeni ln oelbaliav as itrope rsih tf otxe tllu fehT /snoitacilbup/gro.seimedacalanoitan.www roF erom noitamrofni tuoba eht etutitsnI fo enicideM dna eht lanoitaN recnaC yciloP ,draoBtisiv fsn.emohmoi/moi/gro.seimedacalanoitan.4www ata DnoitacilbuP-ni-gnigolata Cssergno Cf oyrarbiL . Vhpeso Jdn attiwe Haira M /era crecna cytilau qgnirusnE ,enomiS dn aenicide Mf oetutitsn I,drao Bycilo Precna Clanoita N ;srotide .licnuo Chcraese Rlanoita N,secneic Sefi Ln onoissimmoC .m c. p .xedn idn asecnerefe rlacihpargoilbi bsedulcn I ISBN 0-309-06480-5 ( ).kbp . 2.setat SdetinU--tnemtaerT--recna C. 1 . 3.lortno cytilauQ--tnemtaerT--recnaC .htebazil Eaira M,ttiwe H. I.setat SdetinU--eraC--stneitaP--recnaC .II ).S.U (drao Bycilo Precna Clanoita N.II I. Vhpeso J,enomiS 999 175 E3C.546A R 12cd--37900'49969'1.26 3 99-6488 PI C :revoC”.romut tnangilam ,barc“ gninaem drow nitaL eht morf semoc ”recnaC“ .barC eht ,recnaC noitalletsnoC .devreser sthgir llA .secneicS fo ymedacA lanoitaN eht yb 9991 thgirypoC aciremA fo setatS detinU eht ni detnirP DRAOB YCILOP RECNAC LANOITAN YEL WROEHTEP ( riahC ), George ,ygoloht aftPonemtrap e,Dnamria hd Cnraossefo rnPaybaF looh clSacid edMravraH HPESOJ ENOMIS ( ri aehcCiV ,etutit sdnnnoIaitadn uroeFc nnaaCmst n,urHotce rliaDci d,e)M ha t fUyotisrevinU JOHN BAILAR, ogaci h fCyotisrevi n,Useidu thStla e fHtonemtrap e,Dnamria hC NAMRON ,SLEINAD ytisrevi nsUtf u,Tyhposoli h fProosseforP ,HEPIEVSAODJ ,hcraes eftRonedise rePc iV sttesuhcas s,aeMgdirb m,a.C c,nnIegoiB ROBERT DAY, htla ecHilb u fPnooisiv i,Drebm edM n,arotcer idD ntanedise rsPutiremE ,retn ehCcraes erRecn anCosnihct udHe r,FsecneicS notgnih s,aeWlttaeS N,EYEELLHOTFAK -nao llSairom e,Mygoloru e fNtonemtrap e,Decivr enSi a,Pfei hC y tk irw,CoerYNet nreeCc nganCiretteK E,IDTRROEFB ,latips oeHdisreviR/tna r,Gyrtsig ed Rnhacraes eyRgoloc n,Oregan aM oi h,OsubmuloC ,ZTI RNGELLE nosred n.AD .,Msecnei clSaroivah eftBonemtrap e,Dria hd CnraosseforP recnaC ,retneC ,notsuoHsaxeT ,T RHATHEBAZILE sax e,Tsall a,Dlanoitanret ntIr a,Hrecif feOvituce xfEei hdC ntanediserP THOMAS KELLY, d nyagolo irBalucel oftMonemtrap e,Dnamria hd Cnraossefo ryPruoB enicid e fMloooh cyStisrevi nsUnikp osHnh o,JsciteneG ,O LNZHSOAJL aigr o,eaGtnaltA MAILLIW McGUIRE, ,noitaropr oeCraChtla edHeti n,Urecif feOvituce xfEeihC ,aknotenniM atosenniM ,ITTI TAENPAID res i,anKoitaul a dvhnEcarae s,erRotceriD nre he ttfunooeSnamreP anedas a,PainrofilaC ,ZER IEMIALREMA ,enici dtfenoMemtra p,erDossef oertPaicossA feogell orColyaB enicideM ,NI RNFHFOEJS aigro e,Gatnal t,Ayteic orSecn anCacire m,Arecif feOvituce xfEeihC JANE E. SISK, namli a .MhLpes o,Jtnemegan adM nyacil ohPtla e fHnooisiv i,DrosseforP yt ikCr owY e,Nytisrevi naUibmul o,Chtla ecHilb u fPlooohcS ,LLA VNOETLSLE revl i,Spihsrovivr urSecn ar Confoitila olCanoit a,Nrotcer ieDvitucexE dnalyr a,MgnirpS S,EOCCNSAIRVF . C,.nDotgnih s,anWoitil aroeCc ntasCa elraBnoi t,atNnediserP ROBERT YOUNG, aihpledali h,Pretn erCecn aeCsa hxC o,FtnediserP FFATS A,ITRTAIMWEH Study Director, ROBERT COOK-DEEGAN, dr ayocBi lroePc nlaaCnoi t,arNotceriD , DNNEALBLLEEHG recif fmOargo rrPoineS N E,LNLOESNHOJ tnatsiss AevitartsinimdA ANNIKA OLSSON, tnatsis shAcraeseR ,HDTDEIBKAZILE nretnI ADNAMA ,ENEERG nretnI iii STNATLUSNOC ECURB ,.REENLLIH htlaewnommo Cainigri V,supma Cainigri Vf oegello ClacideM evinU r ytis ENNAEJ .S,TTALBLEDNAM retn elCacid eyMtisrevi nnUwotegro eG MARK A. SCHUSTER, acin oaMtn a,SDN AdR nsaeleg nsA o tLaainrofil a fCyotisrevinU THOMAS J. SMITH, htlaewnommo Cainigri V,supma Cainigri Vf oegello ClacideM ytisrevinU iv INDEPENDENTR EPORTR EVIEWERS sihT troper sah neeb deweiver ni tfard mrof yb slaudiv indensiohc rof rieht esrevidep r - sevitceps dna lacinhcet ,esitrepxe ni ecnadrocca htiw serudecorp devorppa yb eht lanoitaNR e - ed i wv seooiir tvptenrednepe ds enifsihootp re.uhepTettim mwoeCi vterRo pse’Rlicn uhocCraes deee nt hsg i ut tst nncft slraine iiioieilhlehlk dthsitbmtaadestswumcm iMnapoiddIctnniaarcc e - trop sa dnuos sa elbissop dna ot erusne taht eht troper steem lanoitutitsn isdradnats rofitcejbo v - sse noe t v t ,.is peeesty i hc gnnddrwtn e,droeunceethynapmtasidfTtahsmsuviaiceonevrrcaredm lait nt oecy ntdet.i itisaeeforsmh v nrgeetfieopec roth ctodaTsn rrreiepaehhobstB iiolwtekdnaht :trop esri h ftwoeiv eer h ntnioitapicitr arpie hrt osflaudivid nginiwoll oefht UL NNA,YADA htla ecHilb u fPloooh csSax e fTyotisrevi n,Urossefo rP NEELH,TLAEKGNA sttesuhcass a,Myawd iM ,ISE RLBUAALPAC ytisrevi nnUwo r,Bsutire mnEamria hdC neanicid e fMroossefo rP enicid e fMlooohcS MAILLIW .H,HTROFNAD ytisrevi nnUotgnihs a,Wseetsu r fTdora o,Bnamria hC DLORAH .P,NAMEERF rfoossef od,rnrPaet nleaCtip smoeHl r,ayHre g rrfouotSce riD snoegru Sdn asnaicisyh Pf oegello Cytisrevin Uaibmulo C,yregru SlacinilC , Z AN.IAACGIRTAP fyotisrevi n,Uhtla ecHilb udP neanicid e fMsolooh c,Srossefo rP lortn odC nnaoitneve rrPecn a fCnooisiv i,Drotcer idD n,aseleg nsA o tLaainrofilaC taainrofil a fCyotisrevi n,Uretn erCecn aeCvisneherpm onCossn o,JhcraeseR seleg nsAoL DONALD R. MATTISON, ,snia lePti h,Wnoitadnu osFtcef ehDtr isBem i fDhocr aM New York HTUR McCORKLE, d near asCsenl lcIinor hneCicnellec xr Eorfetn e,Crotcer id Dnraossefo rP gnisr uflNoooh cyStisrevi neUl a,Ymargo rlParotc o,DriahC DI V,.ALPDLAR ,secnei chStla elHatnemnoriv nfeEotutits nlIanoit ae Nhfrtootcer irDemr oF anilor ahCtr o,Nkr aePlgnai rhTcraeseR ROSEMARY ROSSO, ,pu oyrcGaco vrdeAc ntasCa enroBtgnihsaW-eromit lraeBta erG . C,.nDotgnihsaW e ls ildha eWu etdehsivtitvo l cibdeudaevrndatiihsvnoorcp e vsitne,msm nodocniatseggus ytti i tl rsidoubefmi z stieen a shbothlatpntahsenpetim rnfefooc s tiy rhlsot etphrsetieritrwneeht .enici defetoMutit s e ndhdIntra agonBirohtua v vi Contents SUMMARY ................................ ................................ ................................ ............................... 1 1 NOITCUDORTNI ................................ ................................ ................................ ....... 13 4,1dra oyBcil orPecn alCanoit ae NhfetoloR Framework of the Report, 15 2 ER”HE MTCEENRTAASCCYS“ ................................ ................................ ............ 18 ,8t1ro fef rEraeCc nlaaCre d eesfhFtotnemelE 0,2er arCecn afsCotnemelE ece RslaudividnI 0,2er arCecn agCnivi , er2yre 2racfoCnotacCejarT , e6rr2 eas cCrfneoadCivorP ,0e 3rrae Cc snfeaotCiS ,4h3crae sde enrrRaae Cc nnfoaoiCtcesre tenhIT 5,3er arCecn a fCsots olCaicnaniF ,er arCecn anmCoets yeSr ahCtla egHnign a fhtaoCcapmI 36 , ed7re3agCanaM 1,4sna lePcnarus nhItla edHednuF-fleS 1 4,sgnidni FyeK 3 S RSE GEERONCCATINCCRAAUCSNE ................................ .............................. 46 7,4smelbo rsPsec c fAeocnedivE 7 4?tsix Esecnereffi Deseh To DyhW 8,4er arCecn aosCtsec cosAtreirr alBaicnaniF t ieL h ftwoeiveR ,e, ese0fyrar5obahuCPtare ,0n5oitce tye l Der:sa1aEhP 6,5stlus egRnineer clSamron b fAnooitaula v :Ee2sahP ,t8n5emt areee src:aTn3haPC vii viii ENSURING QUALITY CANCER CARE e:s4ahP ,3e 6reacCnerru cdeencRanalliev rtunSemtaerttsoP ,3e6 reafCiL-fo- de:ns5EahP sgnidni FyeK , 66 4 S GEDNSNISANAIFED ERREA CCYNTAIC LGANUIQS ................................ .. 79 9 7,era Cf oytilau QgninifeD 0?8er arCecn a fCyotila ueQrusa eyMhW 0?8derusa eyMtila uswQIoH ,0y8til aluaQrutcurtS ,1y8til asusQecorP ,semoctuO48 8,8er ansCinoitairaV ytila u sQwIoH 8?8detcell onCoitamrof neIraC-fo- 0,9smelbo ryPtila ueQr arCecn a fCeocnedivE t s,areercBnaC19 Prostate Cancer, 103 80 1,sgnidni FyeK 5 E RRAE CC YNFTAOICL ADYUNRQAEVI LE ERHDATCLAEH ................... 116 sRecivr ehStla emHo refcnedi v fEhotgner teS hgtnitaulavE e ,h7c1r1aes 8 1,1snaicisy hlPaudivid n rIsolatips orH oefmul oeVsaC 9 1,1yregr urSecn akCsiR-hgiH Prostate Cancer, 125 ,y r 6ret2egs1cranueaSrCB 6 2,1seirtnu orCeh tmOo rpfihsnoital eeRmoctuO–emul oe VhnetocnedivE 8 2,1noitazilaicepS aicepS 82 1,seitilica Ff onoitazil 03 1,snaicisyh Pf onoitazilaicepS 3,3e 1reacCivreS-rof- eseuFs re erdVaeCganaM 73 1,sgnidni FyeK 6 TIL AE URRQAECCNAC E CYNARUSSA ................................ ............................ 144 5 4,1evitcepsr erPemusn olCaudivid n nI:Aecnarus syAtilauQ ,5s4r1er ugsnniIsoohC hC 6 4,1slatips odH nsanaicisy hgPnisoo ,8s4n1o ittnpeOmt agenriTsoohC 8 4,1sremusn o yCnboitamrof nyItila u fQeosU 0 5,1hcaorp ptAek r :aAeMcnarus syAtilauQ 1 5,1hcaorp prAotceS-cilb ue Ph:Tecnarus syAtilauQ 2 5,1noitartsinim dgAnicnan ieFr ahCtlaeH 4 5,1gnirotin ohMtla ecHilbuP 4 5,1hcraes edR nyacil oePr ahCtla erH oyfcnegA 5 5,1hcaorp plAanoissefo rePr ahCtla ee Hh:Tecnarus syAtilauQ 5 5,1snoitazinag reOrachtla efnHooitatiderc cnnAooissimm otCnioJ cnarus syAtila urQ oefettimm olCanoitaN e, 156 YRAMMUS xi 8 5,1CARU/.c n,Inoissimm oeCr ahCtla enHoitatiderc cnAaciremA 8 5,1ytilibatnuoc cr AonfoitadnuoF 8 5,1recn a nCnooissimm o’Csnoegr u fSeogell onCaciremA 0 6,1sretn erCecn ayCtinumm o fCnooitaicossA g reOr ahCtla enHiht itWnemevorp myItilauQ 3 6,1snoitazina 4 6,1seniledi ueGcitcarP 47 1,sgnidni FyeK 7 SEECRI VHRTELSAEH ERHRE CACNRCNIAAECS ................................ ..... 180 0 8?1hcraes esRecivr ehStla estHIahW 1,8h1crae sseeRciv rhetSl adeeHtaleR-re c snfuaotCatS Research Support, 184 aes edRerosno pySllaredeF ,hcr481 4 8,1secivr enSam ud Hnhatla eftHonemtrapeD 9,9e1sne ftfenoDemtrapeD 2 0,2sriaf fsAnaret eftVonemtrapeD 3 0,2hcraes egRnidn usFnoitazinag reOtavirP 3 0,2yteic orSecn anCaciremA 7,0n2oitarobal leonCarh ceohCT 70 2,sgnidni FyeK 8 F SGSNNIODINT IADDNNAEMMOCER ................................ ............................. 211 t asehIhWt 4?1”2mets yeS r“raeCc n eeafhtCotatS 5?1d2erus aws tdeoIeInMH raraeCc nyatCil atsuaIQhW spe ttSa hdW near arCecn a fCyotila ueQ h nttinedi veE rsAmelbo rtPahW ?6 e1er2v aonnC reaoepkCtBmaIT How Ca 1 2?2er arCecn afyCotila ue Qhttuo bwAo netKWa heWvorp menIW 3?2e2 rraeCc nyatCil asoustQe csfcroAeir reamBocr enovetO k neasaBTpC ettaShW YRASSOLG ................................ ................................ ................................ .......................... 226 ACRONYMS ................................ ................................ ................................ ......................... 231 XEDNI ................................ ................................ ................................ ................................ ... 235 1 Introduction eW lla tnaw ot eveileb taht nehw elpoep teg gnidulcni—r escenvalcesruo dna ruoler a - yeht—sevit lliw teg htlaeh erac fo eht tsehgi h.ytilauq sihT troper si tuoba woh ylesolc ewuc r - yltner hcaorppa siht laedi ni eht detinU .setatS snrecnoC tuoba a gniworg kcal fo cilbupfnoc i- ecned ni eht s’noitan metsys fo erac detpmorp eht lanoitaN recnaC yciloP draoB ot ekatrednua evisneh ewrepimvoecr fo eht ecnedive no eshstenevitcef ffeo recna csecivres dna yreviledys s - ,smet eht ycauqeda fo ytilauq ecnaru s,ssamsinahcem dna sreirrab taht edepmi ssecca otrecnac .erac sihT troper si eht tluser fo taht ;weiver ti sezirammus eht etats fo egdelwonk tuobaytilauq .etvior p womtotiuh osbnaoitadnemmo cseer k daenm raraeccnac ehT sekats era .hgih nI ,9991 erom naht 8 ,nsonialcliirm ermoA 3 tnecrep fo ehtlupop a - ,noit lliw eriuqer emos mrof fo erac esuaceb fo a sisongaid fo :recnac 2.1 noillim fo esehtdni i- slaudiv lliw eb ylwen desongaid siht raey dna etaitini ;tnemtaert ,emos desongaid nisuoiverp d e d t ynra elaeeovlgrnaunvth foe,sl s s o ree;hnevctwehacnethuebosm teaue n r,iltstlrniaowecy i- ecned f, orpe u cle-;nlrweaiiorcwula qlcdeonrfa r0 e0ev0lo,p 0ol0el5piw eid m.orrefcnneavcE ;9 9,9S 1CrAe(c nrdaoecfnee rn cee sevl balshiewt adteS t sientnh ilU tsufrdoeab mruengral seiR et al., 1997) . sA gniticx ewcei nfsietcnneaivcd saera gnikam eht ,swen ereht er asnrecn otcaht tahwsi ydaerl anwonk ot eb evitceff ersolfaudiv ihdtniiw recnac si ton gnihca eersoht ohw nac.tifeneb sihT nrecnoc si ton ;wen ti saw tnenimorp gnoma eht snosaer rof eht 1791 lanoitaN recnaCtcA ) 8. d1Lnd e2.inys- Paals2 s(gte9sa anrawsep acx4ee9r9 1ni taro prfleeoar cnenohaiAtCtaN d - , ,)ydB4rrA9oaC9soN1iB(v recna Ctasd aaorssorC . tA ye the,entmeriame asihs tttihrteocbnu t usosbean eeevh vitsfitnotcoaeil ftetyfnraneehavtmr eetrnai gnie bdesu dna a gninwgoorcger i- noit t ahhct rsatersoefr fdeeen ot e bdednapx eo t ysfdirtandendai tfso erac ,MO I.()499l1pmoC i- gnitac eht erutcip si eht dipar noitulove fo wen htlaeh erac yreviled ,smetsys esohw tcapmino .raelc nsuniam esremoct ueor arcecnac es ve ehgratd rt nphae nalfitteicaoc Sihen nnthadoUnniiatfa zsi t n nfraeiioghhjrtsaoM e - ee rrn uaoe,mvdeerusn iesnrnuaaci r refemob Amgun ni.w eoAcrngedi f s nnidois eciatractipic n - ,derusn idrnead ynam ohw era derevoc ni htlae hsnalp era deirro wtaht eht metsys rgonfireviled 13