The use of different methods of treatment for cancer, such as surgery, hormone therapy, radiation, chemotherapy, and biologic therapy, is based on a number of factors, including the type of cancer, the stage of the cancer, and the patient’s age and general health. (ACS Guide) The effectiveness of treatment for many types of cancer has advanced significantly over the past two decades. Nonetheless, many cancer patients do not receive state-of-the-art treatment. Were they to do so, it is estimated that the mortality rate from all cancers combined would be reduced about one-fourth. Two well-tested programs improve a cancer patient's access to the best treatments: clinical trials and American College of Surgeons (ACOS) approved hospital cancer programs.

Palliative care has also improved greatly in recent years. Palliative care is special care given to patients who are dying. The goals of palliative care are to help patients go about their daily lives as normally as possible, and then, as they are able to do less, to make them as comfortable as possible.

Clinical Trials

Clinical trials are tests used to improve cancer treatments. They help doctors make the best cancer treatments even better. They help patients get the best cancer treatments available today. Patients who enroll in clinical trials are assigned by lottery to one of two groups. The "control" group gets the best cancer treatment available today. The "experimental" group gets the same treatment, but with a small change that likely makes the treatment even better. Neither the patients nor their doctors get to choose the group to which the patients are assigned by lottery. The doctors in charge of the trial keep track of the patients in each group very closely. If one group or the other appears to be doing better, all patients are switched to that group, to make sure they all share in the best treatment.

Patients who want to be part of clinical trails are assessed by their doctors to see if they qualify. Each trial has clear rules about which patients qualify. Usually, the rules have to do with age, sex, general health, and type of cancer. Almost always, patients must join clinical trials within a few weeks of being diagnosed with cancer. Otherwise, they cannot enroll, even if they qualify in other ways. Important: if you think you may want to enroll in a clinical trial, you must act quickly. If you don't qualify for a clinical trial, this does not always mean that you can't get the same treatment as the patients who do qualify. Sometimes you can, even though you aren't officially in the trial. Ask your doctor about this.

In the U.S., about 80% of children who have cancer are enrolled in clinical trials, but only about 3% of adults who have cancer are enrolled. At least 20% of adults with cancer could be enrolled in clinical trials. Many cancer patients don't know about the benefits of clinical trials. Also, the health system often misses deadlines for enrolling patients in trials.

Under Rhode Island law, most health plans must pay for cancer treatment given as part of the most common clinical trials, known as "phase II" and "phase III" clinical trials. Patients must be officially enrolled in the trials to qualify for this benefit.

The following resources have additional information about clinical trials:

The National Cancer Institute (NCI): 1-800-4-CANCER

The NCI is the largest U.S. government agency involved in cancer research and training. The goal of this research is to find better cancer treatments and therapies and to support the use of these treatments in medical practice. The NCI web site offers general information on state-of-the-art cancer prevention, diagnosis, and treatment. There is also information on clinical trials (see below), other NCI research, topics of current interest, and many other features.

National Cancer Institute's Cancer Trials

This web site provides information on understanding clinical trials, trying to decide whether to enroll in a clinical trial, and finding specific trials for which a patient is eligible.

National Cancer Institute's Clinical Trials: Questions and Answers

The Rhode Island Cancer Council's Clinical Trials Index

IMPORTANT! This index provides information about clinical trials accessible in RI. It lists available trials by cancer type and provides contact information for each clinical trial.

ACOS Approved Hospital Cancer Programs

The purpose of ACOS approved cancer programs is to make sure hospitals "offer optimal care to the patient with cancer." ACOS approved cancer programs make sure the best care is given to cancer patients by doing four things:

by organizing a cancer committee of physicians and other professionals
by evaluating the care of cancer patients
by tracking cancer patients over time with a tumor registry
by measuring how well cancer patients do

For more information on how the ACOS approves cancer programs, visit the ACOS Approvals Program (offsite).

At present, 10 of the 11 private acute care hospitals in Rhode Island have ACOS approved cancer programs:

Kent County Memorial Hospital
Landmark Medical Center
Memorial Hospital of RI
Miriam Hospital
Newport Hospital
Rhode Island Hospital
Roger Williams Medical Center
St. Joseph Health Services of RI
South County Hospital
Women & Infants Hospital of RI

One is actively seeking approval:

Westerly Hospital

For additional information on ACOS approved cancer programs in RI, search the ACOS database (off site).

Palliative Care

Palliative care is special care given to patients who are dying. The goals of palliative care are to help patients go about their daily lives as normally as possible, and then, as they are able to do less, to make them as comfortable as possible. The control of pain is a very important part of palliative care.

"Hospice" care uses a proven mix of palliative care which is very supportive of patients and of their families, as well. Hospice care is very successful in controlling cancer pain.

Unfortunately, only about 40% of cancer patients who are dying get hospice care, and many don't get it until the last few weeks of life, after enduring the side effects of treatments they shouldn't have had, and pain they shouldn't have felt.

As it is currently offered in the U.S., including Rhode Island, hospice care is not easy to get for patients of low income. It is usually given at home, and depends on family to meet the needs of dying patients 24 hours a day. Hospice care may be given in hospitals and nursing homes, but many of these places have not developed the staff and services needed for good hospice care.

For more on Hospice Care, click here.

Helpful Links for More Information About Cancer Treatment and Palliation:

Cancer patients, their families, and other concerned persons may obtain information on cancer treatment and palliation by visiting the following web sites or by calling the following toll free phone numbers:

National Cancer Institute (NCI):1-800-4-CANCER

National Cancer Institute’s cancerTrials

This web site provides information on understanding clinical trials, trying to decide whether to enroll in a clinical trial, and finding specific trials for which a patient is eligible.

American Cancer Society (ACS):1-800-ACS-2345

The ACS is the main volunteer organization in the United States devoted to cancer issues. Their programs include cancer education, research activities, support groups, and guidelines for care and treatment. The ACS web site features cancer information related to preventing, detecting, treating, and surviving cancer. There is also information on the latest cancer news, research, and specific ACS programs (e.g., Great American Smokeout).

Cancer Care:1-800-813-HOPE

Cancer Care is a United Way agency that "provides assistance to people with any type of cancer, at any stage of illness. All of Cancer Care's services are free of charge." Cancer Care offers counseling and emotional support, information about cancer and treatment, referrals to other support services, educational seminars, conferences and material, and guidance on financial needs. Visit Cancer Care's site to learn more about managing cancer pain and online cancer support groups.

Agency for Healthcare Research and Quality (AHRQ)

The AHRQ has just published Now You Have a Diagnosis: What's Next? which covers topics such as finding reliable health care information, different types of healthcare research, making your decision, and getting support.

Highlights

Cancer in Rhode Island, 2003
is a comprehensive report that includes cancer rates, risk factors, prevention, screening, treatment, and survival rates for each cancer site/type.

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