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Assuring Value in Cancer Care

CHALLENGE:  A 2009 IOM National Cancer Policy Forum workshop defined challenges and opportunities for improving value in cancer care.  Persistent economic pressure in the health sector, debate regarding health reform, and differing opinions about defining ‘value‘ and means for achieving it add to the challenge.

SHARED GOAL:  Improve the quality of life of cancer patients through fully informed, patient/family decisions resulting in significantly increased use of palliative care services and increased length of stay in which patients are enrolled in hospice care.


  • Americans believe that discussions about palliative care and end-of-life treatment options should be fully covered by Medicare.
  • Ninety-seven percent of Americans believe that it is important that patients and their families be educated about palliative care and end-of-life care options available to them along with curative treatment.
  • Fewer than 40% of patients with advanced cancer have realistic conversations with their providers about treatment options and alternatives.
  • Approximately, 20% of patients receive chemotherapy within 14 days of death.
  • Patients are often referred to hospice care in the last days of life as a means of managing death, rather than as a tool for palliation of symptoms in the later months of advanced disease.
  • One-third of hospice stays are three days or fewer.
  • The median length of stay in hospice is approximately three weeks, with 10% of patients enrolling in their last 24 hours of life.
  • Patients who have advanced care discussions have lower rates of ventilation, resuscitation, ICU admission, earlier hospice enrollment, longer hospice stays associated with better patient quality of life, and better caregiver quality of life.

Palliative Care

Hospice Care

Specialized medical care for people with serious illnesses. A team of specialists works with a patient’s physicians to provide relief from symptoms, pain, and stress. Palliative care is appropriate at any age and at any stage of illness, and can be provided together with regular treatment. The goal is to improve quality of life for both the patient and the family.

  • Palliative care interventions can significantly improve quality of life and mood, lower symptom intensity, and at the same time help patients to live longer.
  • Palliative care improves transitions of care, lowers the likelihood of readmission, and reduces hospital costs.
  • The use of opioid and sedative medications for symptom relief does not hasten death.
  • Palliative care recipients spend less time in intensive care units, are less likely to die in intensive care units, and are more likely to receive hospice referrals than usual care patients.  

Comprehensive support for people with terminal illnesses. A team of specialists including nurses, social workers, aides, volunteers, spiritual care staff, and doctors collaborate with the patient’s physician to support the patient and family. Hospice care also includes palliative care to help people to live with dignity, comfort, and peace as they approach the end of their lives.


  • Most patients with terminal illness prefer to die at home. Patients with cancer who die in the hospital experience more physical and emotional distress compared with patients who die at home with hospice
  • Hospice has been associated with an average of 29 days longer survival time for cancer patients.
  • The Medicare hospice benefit has been associated with lower hospital costs and has not been associated with shorter time until death.

C-CHANGE'S APPROACH - C-Change Value in Cancer Care Value Platform

  • Change practice to embrace palliative care and hospice care services at appropriate points
  • Create capacity (personnel, policies, and resources) to support the appropriate delivery of palliative care and hospice care
  • Create demand for palliative care and hospice care by informing the public about the nature, importance, and benefits of these services


Take Action:

  • Promote awareness of palliative care and hospice services at appropriate points in patient care
  • Support best professional and institutional practices to improve the quality and availability of services
  • Advocate for policy changes that will support reimbursement for advanced care planning conversations; concurrent use of hospice care during active treatment; and a coordinated research agenda
  • Partner with C-Change on our Value in Cancer Care initiative

Advisory Committee Chair:
Tom Kean, MPH
Allen Lichter, MD

Advisory Committee List

Other Resources

C-Change Reports and fact sheets













C-Change’s success is made possible by the commitment of our members, funding of our donors, and dedication of our staff, for which we are deeply grateful.   The 2012 Value Initiative has been funded in part by Susan G. Komen for the Cure and the United Health Foundation.  Additional funding also comes from individuals, the American Cancer Society, Hogan Lovells (pro bono), Robert Wood Johnson Foundation, and State Farm Insurance Companies. (Updated 5/15/12)