One obstacle to better measurement compliance has been the practical fact that cancer patients often cross departments within an institution, "and it's not clear who is ultimately accountable for that patient: the primary care doctor, the one who diagnosed the patient, or the first or second specialist," Muther says.
With the advent of public reporting, he adds, "these measures become institutionalized so people understand what needs to be done, regardless of who is accountable, to deliver the right care to each patient."
Brawley points out that cancer has benefited from a lot more emotional forgiveness and delayed standard-setting than other life-threatening diseases like heart disease. He believes tighter scrutiny and care practice measures are long overdue.
"Maybe my own organization [the ACS] 80 or 90 years ago worked very hard to create that emotional tie to cancer," resulting in much less scientific scrutiny of whether treatments and testing actually work.
"Now that's changing, going away, and that's a good thing." Eventually, he sees many more cancer measures coming on line, especially those reflecting rates of needless care. It may take a few more years, he says, but "I think we're going to see a lot of growth in measures for cancer quality," he predicts.
I hope he's right.