• Facebook
  • Twitter
  • Youtube
  • Instagram
  • LinkedIn
  • Rss
  • Store
  • Donate
NCCS - National Coalition for Cancer Survivorship
  • About
    • Our Mission
    • Our History
    • The 1986 Club
    • Ways to Give
    • Our Team
      • Policy Advisors
    • Employment
    • Partnerships
    • Financial Information
  • Policy
    • Quality Cancer Care
    • Access to Care
    • Health Equity
    • Comprehensive Cancer Survivorship Act (CCSA)
    • Cancer Care Planning and Communications Act (CCPCA)
    • State of Survivorship Survey
      • 2022 Survey
      • 2021 Survey
      • 2020 Survey
    • Redefining Functional Status (RFS)
  • Get Involved
    • What is Advocacy?
    • Cancer Policy and Advocacy Team (CPAT)
    • Advocate Engagement Opportunities
    • Survivorship Champions
    • Subscribe to NCCS Updates
    • Elevating Survivorship
    • Survivor Stories
    • Cancerversary
    • State-Based Cancer Advocacy
  • Resources
    • COVID-19 Resources for Cancer Survivors
    • Survivorship Checklist
    • Cancer Survival Toolbox
    • Cancer Rehabilitation
    • Integrative Oncology
    • Publications
      • Talking With Your Doctor
      • Self Advocacy
      • Employment Rights
      • Remaining Hopeful
    • Telehealth
    • Taking Charge of Your Care
    • Care Planning for Cancer Survivors
    • Tools For Care Providers
    • Order Our Resources
  • News
  • Events
    • Ellen L. Stovall Award
      • 2023 Winners
      • Awardees
      • Reception and Sponsorship
      • Committees
      • Nominations
    • Cancer Policy Roundtable (CPR)
      • Spring 2023 CPR
      • Fall 2022 CPR
      • Spring 2022 CPR
    • Cancer Policy and Advocacy Team (CPAT) Virtual Symposium 2022
    • 2022 State of Survivorship Survey Results
    • Webinars
  • Contact Us
  • Search
  • Menu Menu
  • 0Shopping Cart

Your generous year-end donation will be matched $1 for $1    DONATE

AtulGawande New Headshot ProfilePhoto

Dr. Atul Gawande’s Recent “Overkill” Article Examines Screening, Overtreatment, and Anxiety

May 11, 2015/in Cancer News, Cancer Policy Blog Access to Care, Care Coordination, Clinical Guidelines, Health Care Coverage, Payment Reform, Quality Cancer Care, Survivorship Care NCCS News

In another excellent piece in the The New Yorker entitled “Overkill,” Dr. Atul Gawande writes about what he calls an “avalanche” of unnecessary care Americans are receiving. With his characteristic mix of hard data, policy analysis, and personal stories, he describes the harms of overtreatment, to both individuals and the health care system. He writes, “Millions of people are receiving drugs that aren’t helping them, operations that aren’t going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm.”

Gawande describes specific examples of overtreatment for cancer, including screenings that are detecting cancers that will not cause harm. He shares the story of a patient, Mrs. E., who had a pinpoint microcarcinoma in her thyroid. While he advises against surgery and suggests to Mrs. E. that the risks of surgery outweigh any potential benefits, Mrs. E cannot live with the uncertainty that the microcarinoma in her body might spread. So she insists on surgery and Gawande performs it.

Dr. Atul Gawande

While at a policy level, we can state that certain procedures or treatments may not be evidence-based, or that the risks outweigh the benefits, we do have to remember the personal and human toll of the fear and anxiety many face with the knowledge that they have cancerous cells in their body. Gawande argues that Mrs. E would have been better off if she had never been screened, and he points out that some experts suggest we should stop calling noninvasive microcarcinomas “cancer.”

When Mrs. E thanked Gawande for relieving her anxiety, he says, “I couldn’t help reflect on how that anxiety had been created. The medical system had done what it so often does: performed tests, unnecessarily, to reveal problems that aren’t quite problems to then be fixed, unnecessarily, at great expense and no little risk…An entire health-care system has been devoted to this game.”

In an influential 2009 piece entitled, “The Cost Conundrum,” Gawande wrote about the high cost of care per Medicare patient in McAllen, Texas, and compared the costs with El Paso, another Texas border town with similar demographics and outcomes, but half the per patient Medicare costs. I was fascinated by that piece, as I have visited relatives in McAllen numerous times and seen the many billboards advertising home health care agencies, one of the cost drivers at the time. I also noticed the entrepreneurial spirit of small business owners in McAllen, another factor driving high costs as many physicians owned stakes in the imaging facilities and home health care agencies to which they referred patients.

In a positive turn of events, Medicare costs in McAllen have declined dramatically in the last six years for a variety of reasons, including investigations, lawsuits, and fraud prosecutions. But those actions do not fully explain the cost reductions. Physicians in McAllen were forced to look at the data and consider how they could do better.  Some physicians participated in activities that yielded rewards for better quality and provided lower cost of care through shared savings programs with insurers.  Gawande describes several of these programs, both employer-based and payer-driven.

“McAllen, in large part because of changes led by primary-care doctors, has gone from a cautionary tale to something more hopeful. Nationwide, the picture is changing almost as fast. Just five years after the passage of health-care reform, twenty percent of Medicare payments are being made to physicians who have enrolled in alternative-payment programs,” Gawande writes. NCCS has been advocating for alternative payment models for cancer care, including the Center for Medicare and Medicaid Innovation (CMMI) Oncology Care Model  (OCM) for Medicare patients with cancer. We are hopeful that this model as well as other innovative delivery and payment reforms  will yield the improvements in quality that Gawande describes.

Post by NCCS CEO Shelley Fuld Nasso

Tags: Cancer Survivorship, clinical guidelines, ePatient, Medicare, Oncology Care Model, payment reform, quality, screening
Share this entry
  • Share on Facebook
  • Share on Twitter
  • Share on WhatsApp
  • Share on LinkedIn
https://canceradvocacy.org/wp-content/uploads/2015/02/AtulGawande-New_Headshot_ProfilePhoto.jpg 1424 2144 actualize https://canceradvocacy.org/wp-content/uploads/2020/06/NCCA-Logo.png actualize2015-05-11 12:28:132020-11-20 11:16:20Dr. Atul Gawande’s Recent “Overkill” Article Examines Screening, Overtreatment, and Anxiety

Latest News

Brett Wilson – Navigating Childhood Cancer and Finding Purpose in Advocacy

September 13, 2023
Advocate Spotlight: Brett Wilson Brett Wilson's cancer experience started when she was just two years old. Her mother was concerned…
Read more
https://canceradvocacy.org/wp-content/uploads/Brett-Wilson-Advocate-Spotlight-Blog-Banner.jpg 600 1200 NCCS Staff https://canceradvocacy.org/wp-content/uploads/2020/06/NCCA-Logo.png NCCS Staff2023-09-13 13:55:422023-09-13 14:29:44Brett Wilson – Navigating Childhood Cancer and Finding Purpose in Advocacy

Registration Open: 2023 State of Survivorship Survey Results Briefing | October 3

September 7, 2023
The National Coalition for Cancer Survivorship (NCCS) conducts an annual State of Survivorship Survey, in partnership with Edge…
Read more
https://canceradvocacy.org/wp-content/uploads/Survey-2023-briefing-mc-1200px-2-1.jpg 600 1200 NCCS Staff https://canceradvocacy.org/wp-content/uploads/2020/06/NCCA-Logo.png NCCS Staff2023-09-07 11:00:202023-09-07 11:00:20Registration Open: 2023 State of Survivorship Survey Results Briefing | October 3
We did it! DIEP Flap Codes Saved

CMS Announces It Will Retain Breast Reconstruction Codes, A Reversal That Protects Patient Access to DIEP Flap Surgery

August 22, 2023
Yesterday, the Centers for Medicare and Medicaid Services (CMS) announced that it will retain procedure codes for breast cancer reconstruction,…
Read more
https://canceradvocacy.org/wp-content/uploads/DIEP-Flap-Reconstruction-CMS-Codes.jpg 600 1200 NCCS Staff https://canceradvocacy.org/wp-content/uploads/2020/06/NCCA-Logo.png NCCS Staff2023-08-22 14:26:202023-08-22 14:26:20CMS Announces It Will Retain Breast Reconstruction Codes, A Reversal That Protects Patient Access to DIEP Flap Surgery

Take Action

Link to: Survivorship Champions

Become a Survivorship Champion

Survivorship Champions is a program for all clinicians and researchers, both oncology and primary care, who are interested in improving survivorship care and primary care’s role in caring for cancer survivors.

Learn More and Join »
Link to: Cancer Policy and Advocacy Team (CPAT)

Join CPAT

The NCCS Cancer Policy & Advocacy Team (CPAT) is a program for survivors and caregivers to learn about pressing policy issues that affect quality cancer care in order to be engaged as advocates in public policy around the needs of cancer survivors.

Learn More and Join »
Link to: Survivor Stories

Share Your Story

NCCS represents the millions of Americans who share a common experience – living with, through and beyond a cancer diagnosis. By sharing your story of how you have been touched by cancer, you are supporting the national cancer survivorship movement.

Share Your Story »

STAY CONNECTED

Together we can improve cancer care for survivors! Sign up to be the first to know about cancer policy issues and ways to take action

  • This field is for validation purposes and should be left unchanged.

  • About
    • Our Mission
    • Our History
    • The 1986 Club
    • Ways to Give
    • Our Team
      • Policy Advisors
    • Employment
    • Partnerships
    • Financial Information
  • Policy
    • Quality Cancer Care
    • Access to Care
    • Health Equity
    • Comprehensive Cancer Survivorship Act (CCSA)
    • Cancer Care Planning and Communications Act (CCPCA)
    • State of Survivorship Survey
      • 2022 Survey
      • 2021 Survey
      • 2020 Survey
    • Redefining Functional Status (RFS)
  • Get Involved
    • What is Advocacy?
    • Cancer Policy and Advocacy Team (CPAT)
    • Advocate Engagement Opportunities
    • Survivorship Champions
    • Subscribe to NCCS Updates
    • Elevating Survivorship
    • Survivor Stories
    • Cancerversary
    • State-Based Cancer Advocacy
  • Resources
    • COVID-19 Resources for Cancer Survivors
    • Survivorship Checklist
    • Cancer Survival Toolbox
    • Cancer Rehabilitation
    • Integrative Oncology
    • Publications
      • Talking With Your Doctor
      • Self Advocacy
      • Employment Rights
      • Remaining Hopeful
    • Telehealth
    • Taking Charge of Your Care
    • Care Planning for Cancer Survivors
    • Tools For Care Providers
    • Order Our Resources
  • News
  • Events
    • Ellen L. Stovall Award
      • 2023 Winners
      • Awardees
      • Reception and Sponsorship
      • Committees
      • Nominations
    • Cancer Policy Roundtable (CPR)
      • Spring 2023 CPR
      • Fall 2022 CPR
      • Spring 2022 CPR
    • Cancer Policy and Advocacy Team (CPAT) Virtual Symposium 2022
    • 2022 State of Survivorship Survey Results
    • Webinars
  • Contact Us

National Coalition for Cancer Survivorship
8455 Colesville Road  |  Suite 930  |  Silver Spring, MD 20910
877-NCCS-YES  |  info@canceradvocacy.org
Privacy Policy  |  Terms and Conditions

Copyright © 1995-2023 by the National Coalition for Cancer Survivorship
National Coalition for Cancer Survivorship, NCCS, Cancer Survival Toolbox, and related Logos are registered in the United States as trademarks of the National Coalition for Cancer Survivorship.

WCOE: Becoming a Caregiver, Homemade Cards From A Survivor, Quality of Life...NCCS Starburst Thumbnail20yearsRevisiting the Fifth Principle of the Imperatives for Quality Cancer Care
Scroll to top
Download the Survey Report

"*" indicates required fields

Fill out the form below, and we’ll send the survey report, detailed presentation, and infographic to your email.
Name*
I am a...*
Select any/all that apply.
Consent*
By downloading the survey materials, you will receive updates and information from NCCS via email, which you may unsubscribe from at any time. Your information will never be sold to any third parties.
This field is for validation purposes and should be left unchanged.

Get Updates From NCCS

Be the first to hear about cancer policy and survivorship issues! Subscribe and receive the biweekly NCCS Health Care Roundup, invites to webinars and events, and more.

  • This field is for validation purposes and should be left unchanged.

Connect With Us

Twitter     Facebook     Instagram     LinkedIn     YouTube

Harmar Brereton, MD

Founder
Northeast Regional Cancer Institute

 

“Perhaps one of the most impactful collaborations in Dr. Brereton’s extraordinary career remains his early work and long friendship with Ellen Stovall. Through him, and in turn through the thousands of lives he has touched, Ellen’s work continues, and her mission lives on.”

—Karen M. Saunders
President, Northeast Regional Cancer Institute