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Top1. Introduction
Cancer is a group of diseases that is characterized by the pervasive growth and spread of abnormal cells (American Cancer Society (ACS), 2017; Mayo Clinic, 2019). If uncontrolled, the spread of cancer can ultimately result in death. Approximately 25% of deaths in the United States (U.S.) are believed to be cancer-related (Centers for Disease Control and Prevention (CDC), 2019). Cancer also impacts the psyche due to subsequent feelings of fear and despair. In the 1950s, the British Empire Cancer Campaign (BECC) showed that education on early symptoms of cancer such as campaigns promoting self-examinations for early signs of cancer promoted fear and panic among the population (Law, 2004; Toon, 2007). Polls in both the U.S. and Europe found that at least half the population fear cancer more than any other disease in the world; and one-third to one-fifth fear it more than even potential catastrophes like violent crime, debt, and the loss of a job (Cancer Research UK, 2010; Cancer Research UK, 2011; Eisinger et al., 1994).
Current cancer statistics in the U.S. show that approximately 14 million people are cancer survivors. It is estimated that by 2022 there will be 18 million cancer survivors (American Cancer Society (ACS), 2017). Each year more than 1.6 million people are newly diagnosed with cancer, and by 2030, this annual number is estimated to rise to about 2.3 million people (American Cancer Society (ACS), 2017). Four cancer sites (i.e., lung, breast, prostate, and colorectal) account for approximately half of all cases and deaths (Tweed et al., 2018).
It has been over 10 years since the Institute of Medicine (IOM) addressed and brought to focus, the quality of cancer care in the U.S. And still, cancer care continues to present a daunting challenge (Institute of Medicine (IOM), 1999). The increasing demand for cancer care, the complex nature of the disease, the increasing cost of healthcare, and a shrinking of the healthcare labor force, are some contributory factors that aggravate this challenge (Jemal et al., 2005). For instance, the high complexity in cancer care can limit the ability of doctors in formulating and administering treatment plans with the needed speed, quality and precision. As a result, some decisions may end up not being completely evidence-based (Institute of Medicine (IOM), 2008; Institute of Medicine (IOM), 2012). Patients may not receive sufficient explanation of the treatment goals at the commencement of treatment or may not be sufficiently informed about the treatment consequences at the conclusion of treatment phase (Institute of Medicine (IOM), 2011). Finally, some patients may not receive the necessary palliative care for managing cancer symptoms and treatment side effects.
A key factor further complicating the national healthcare situation is the changing demographics in the U.S. Increases in the population aged 65 and older place new demands on the delivery of care (Smith et al., 2009). Cancer disparities are an endemic found throughout healthcare systems in the U.S. and other industrialized nations (Choi et al., 2016). The disparities may be based on socioeconomic/demographic indicators such as income, education, ethnicity/race, age, sex, geographic location, or sexual orientation (Albain et al., 2009; Chang et al., 2014; Chang et al., 2013; Field et al., 2005; Molina et al., 2008). The Healthy People 2020 initiative of the U.S. Department of Health & Human Services marked the elimination of health disparities as one of its overarching goals (People, 2020).