The goal of cancer treatment is to cure the person with cancer or control the progression of the disease while maintaining the highest quality of life possible.   Treatment for many types of cancer has improved over the past 10 years.    New chemotherapy drugs, better surgical techniques, improved radiation therapy, and increased use of multi-modality therapy have combined to increase survival rates.

High Quality Cancer Care

One indicator of high quality care is accreditation through the American College of Surgeons (ACoS) Commission on Cancer.   Accredited hospitals ensure quality care through various cancer-related programs, including prevention, detection, pretreatment evaluation, staging, optimal treatment, rehabilitation, surveillance for recurrent disease, support services, and end-or-life care.   Currently, there are 37 hospitals in Maine that diagnose and treat cancer patients.   Of those, t here are 11 American College of Surgeons (ACoS) approved hospital cancer treatment centers throughout Maine.

Another indicator of high quality care is the use of nationally recognized treatment guidelines. These guidelines provide guidance to health care professionals on standardized cancer treatment, leading to quality of care.   Consistent use of national guidelines by health care professionals will assure that all Mainers with cancer are receiving treatment equitably.  

Clinical Trials

Access to clinical trials is an indicator of quality care because it provides access to innovative   therapies and treatment modalities.   Before a new treatment method is made available to the public, it must undergo a clinical trial. These strictly monitored and carefully evaluated trials test the therapy's safety and efficacy. Any new treatment must successfully complete three phases of trials before the federal Food and Drug Administration approves it for general use.

Despite efforts by the National Cancer Institute and other organizations, participation in clinical trials remains low with only 2-3% of eligible adult patients enrolling in clinical trials. Barriers to participation include lack of infrastructure that supports physicians to enroll patients, refusal of eligible patients to participate, misunderstanding of the nature and purpose of the trials, and social, cultural and economic issues.  

In Maine, private insurers are required to pay for routine patient care costs associated with clinical trial.   Also, Medicare offers reimbursement for the routine costs associated with a trial, such as office visits and tests.

Geographic Access to Treatment

In Maine, there are 37 hospitals that provide some cancer treatment services.  In the past, there has been an assumption that people in Maine do not have adequate access to cancer treatment and specialty services.   To identify whether those diagnosed with cancer in Maine have access to high quality cancer treatment and specialty services, the Maine Cancer Registry surveyed hospitals regarding select cancer-related services, including American College of Surgeon Commission on Cancer certification, the availability of specialist physicians, the existence of imaging modalities, and the provision of cancer treatment.  

According to the results, a smaller percentage of Mainers are close to ACS-certified hospitals than the other services.   For example, 38.4% of Mainers are less than 10 miles from an ACS-certified hospital, while 58.6% are within this range of an oncologist.   Additionally, radiotherapy facilities are the least widely distributed of cancer treatment modalities.   The survey indicated that in some circumstances, significant portions of Maine residents may be at risk for inadequate cancer care, based on distance to services. 

Although some of the distance effect on health care utilization may be system-related, it has been shown that when facing travel barriers, patients are consciously willing to assume more risk in order to receive local care.  This indicates the need for and importance of the availability of skilled health care professionals and high quality cancer treatment services in all of Maine's communities.

In Maine, every county has a medically underserved area.   This could be a whole county or a group of contiguous counties, a group of county or civil divisions or a group of urban census tracts in which residents have a shortage of personal health services.  Additionally, there are over 117,000 Mainers considered to be medically underserved, meaning they face economic, cultural or linguistic barriers to health care.  

Financial Access to Treatment

Cancer is a costly disease, both for the society and the individual.   In addition to the direct cost of medical care and wages lost due to illness, the financial burden on cancer patients is exacerbated due to the increased out-of-pocket expenses.   Even those with insurance can be devastated by elevated expenses associated with high deductibles and co-payments, transportation, child and elder care, home care expenses, special foods or equipment, and compounded by lost wages. Disparate groups, including racial and ethnic minorities and those with lower socioeconomic status, often have reduced access to treatment because of lack of insurance or due to cultural barriers.   In addition to the financial burden of medical care and associated out-of-pocket expenses, cancer survivors may experience long-term financial and legal difficulties stemming from disability and other problems associated with returning to work.  

Access to Information

In order for patients and their families to make sound decisions about cancer treatment, there is a need for timely, reliable, and understandable information.   Unfortunately, many in Maine do not have access to such information.   Patients with low literacy levels or who may not speak English face significant barriers to obtaining understandable information on cancer treatment options.  

Unmet needs for information and assistance in understanding one's own medical situation often lead to non-compliance with the recommended treatment and follow-up.   In addition, a lack of information and understanding contributes negatively to patients' quality of life and increases anxiety about their condition.

Cancer in Children

In 2005, approximately 9,510 children in the United States under the age of 15 were diagnosed with cancer, and about 1,585 children died from the disease.  An estimated 61 children are diagnosed each year in Maine.   While cancer is the second leading cause of death among Maine children 1 to 14 years of age, it is still relatively rare (Figure 29).   The three most common types of childhood cancer in Maine are leukemia (23%), central nervous system (20%) and lymphomas (14%).  

Currently there are two pediatric cancer centers in the state, Eastern Maine Medical Center in Bangor and Maine Children's Cancer Program in Portland .   Although there have been significant advances in the treatment of childhood cancer, many children in Maine can only access these services by long and frequent journeys. Research indicates that because of the medical complexities and psychosocial needs of children with cancer, they need a comprehensive team of highly trained pediatric cancer experts. With only two pediatric facilities in Maine, obtaining high quality, accessible treatment can be a challenge.  

Additionally, treatment of children's cancers is extremely traumatic for both children and their families and should be treated as a family disease.   Quality of life concerns that must be addressed include the significant emotional, physical and financial costs that are related to treatment, as well as identified any quality of life or long term supportive or palliative care.   Long-term survivors of childhood cancers are also at high risk for second malignancies.

Integrated Medicine

In addition to the traditional medical treatments for cancer, there are other forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices generally are not considered standard medical approaches, which go through a long and careful research process to prove they are safe and effective.    

Moreover, there is integrative medicine, which is a total approach to care that involves the patient's mind, body, and spirit. It combines standard medicine with the complementary and alternative medicine (CAM) practices that have shown the most promise, such as using relaxation as a way to reduce stress during chemotherapy.  CAM may include dietary supplements, megadose vitamins, herbal preparations, special teas, acupuncture, massage therapy, magnet therapy, spiritual healing, and meditation.   Research on the effectiveness of CAM is ongoing and should be reviewed and evaluated annually.  

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Priorities for Cancer Treatment

To assure that all Maine residents have access to high-quality cancer treatment information and services.

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To get involved in Maine's treatment activities, contact Netta Apedoe at 287-4715.

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