The American Society of Clinical Oncology (ASCO) released a new report on Tuesday that describes a “perfect storm” of future challenges, which could easily undermine access to the many life-saving advances in cancer care. Among these impending challenges are soaring costs, a physician shortage, a fast growing population of survivors, and threats to smaller practices. “We think we owe it to the 1.6 million Americans who will be diagnosed with cancer this year to address these problems,” said Dr. Clifford A. Hudis, ASCO president, in a live webcast.

Cancer Care 2014... and Beyond

"The State of Cancer Care in America: 2014" is a first-ever comprehensive report on the difficulties facing the U.S. cancer care delivery system. Nearly 35,000 oncologists and other professionals are represented by ASCO and their many opinions inform the new report. Months in the making, the report examines both current and projected demand for services and compares this to oncologist workforce supply while also including scrutiny of the full range of economic, regulatory, and administrative pressures that oncology practices face.

Key findings include a swift growth in demand for prevention, screening, and treatment services. By 2030, the number of new cancer cases will increase by 45 percent. “At the same time, the number of cancer survivors, now at 13.7 million, will continue to grow,” the report states. Because survivors require ongoing care, the demand for oncology, other cancer treatment services, as well as end-of-life care will naturally increase. “It’s hard for me to think that any other issue that will have a bigger impact on American families than this,” Representative Earl Blumenauer (D-Ore.) noted in the webcast. He added, “This condition extends onto family and friends and if we don’t do it right, the impact on the caregiver, the impact on the family … can be extraordinarily stressful.”

Additionally, the report speaks to uneven access to cancer care across the nation. “Rates of access to care are disproportionately lower for African Americans and Latinos,” is stated in the report. The Affordable Care Act (ACA) may provide millions more with health insurance coverage and though this helps, ASCO believes it will not solve disparities in cancer care due to the fact that it emphasizes expanding Medicaid coverage. (In the past, Medicaid has been associated with poor outcomes for patients with cancer.) Other difficulties with regard to access to care may soon arise due to a doctor shortage.

Disconnect between Patients and Doctors

“As of 2012, there were 13,400 oncologists practicing in the U.S.,” said Dr. Carolyn Hendricks, who runs a private oncologist practice in Bethesda, Md. However, Hendricks noted, there are more oncologists who are over 64 and approaching retirement than oncologists under 40 and so the data predicts a shortage of physicians: by ASCO estimates, a deficit of almost 1,500 doctors in the coming years. Add to that a natural and uneven distribution. According to Hendricks, one in five Americans live in areas designated as rural, while only one in 33 oncologists practice in rural areas. This “disconnect” between patients and doctors will matter more in the coming years, especially as smaller oncology practices (under seven oncologists) are becoming more rare. Though they serve more than a third of new patients, nearly two-thirds of small community practices may merge, sell, or close in just the next year alone. With chemo costs based on quantity, Hendricks explained, “We [smaller practices] pay more for the same drugs as bigger practices.”

And though costs are increasing throughout the healthcare system, this trend is most pronounced within cancer care, where annual costs are projected to rise to more than $173 billion in 2020 — a whopping 40 percent increase between the years 2010 and 2020. “Access to high-quality cancer care will be sustained and expanded only if we address these rising costs, including the use of unnecessary or ineffective tests and treatments,” noted the report.

Despite the glum news, ASCO has developed several initiatives to ease the way into the future. Dr. Blase Polite, University of Chicago Medicine, discussed measures to help waylay costs while addressing distribution of doctors and focused particularly on the expansion of health IT. The Quality Oncology Practice Initiative (QOPI) and Cancer LINQ help oncologists access standards of care and data no matter where their practice is located. As Polite explained, currently, oncologists “collect information from patients on a daily basis but it sits in our own silos.” The Cancer LINQ, an advance IT system, brings all the data together so when a doctor in a rural practice confronts some rarely seen cancer, he or she will be able to get information from practices across the country.

Other recommendations by ASCO include support for SGR Repeal and Medicare Provider Payment Modernization Act 2014, which modifies payment structures, and the establishment of national standards to measure value in oncology care. Consistent, high-quality cancer care will only be achieved if Medicare and private insurers work with physicians to introduce new payment models. “We want to develop the solutions,” Hudis said, referring directly to ASCO's report. “We want to be solving the problem of delivering quality care across the country to the people who need it.”

 

Source: The State of Cancer Care in America: 2014. American Society of Clinical Oncology. 2014.