Accommodating modern cancer treatment procedures in an outpatient facility

The aging of the American population, the recent increasing prevalence of smoking in females, and the decline in heart disease mortality are setting the stage for cancer to be the most common cause of death in the United States by the year 2000. The technology exists today to increase survival rates from 50% to 75%, but this continuing care will increase cancer-related expenditures to 20% of the nation's total health care expenditures. Many advances in cancer diagnosis and treatment offer promise for less invasive procedures, and some new interventions focus on prevention or early detection of limited disease in ambulatory patients. The likelihood and the length of hospital admissions are declining, and the proportion of care delivered in an inpatient setting is expected to represent less than 10% of total cancer patient care. While the delivery of care shifts to the outpatient setting, the need for a continuum of care, interdisciplinary collaboration, and access to regional centers for technology and research is likely to encourage the formation of systems that combine a tertiary care hub and a network of community-based ambulatory centers.