The State of Cancer Care in America: Advances and Challenges
The recently released American Society of Clinical Oncology (ASCO) annual report, “The State of Cancer Care in America, 2015,” is a mixed bag: the report cites multiple advances in the progress against cancer, but also elaborates on the many hurdles in implementing state-of-the-art cancer care for all Americans (J Oncol Pract. 2015;11:79-113).
The report, which was presented at a congressional briefing, lists the current realities of the cancer care system and discusses trends in the oncology workforce and practice environment that affect access to care and care itself.
“This year’s report clarifies multiple stresses in our nation’s cancer care system, but there is reason to be hopeful,” stated ASCO President Peter Paul Yu, MD, in a news release from ASCO. “With this knowledge and insight, we can identify ways to ensure that all cancer patients receive high-quality care—and help oncology practices adapt, survive, and succeed in today’s demanding healthcare environment.”
Emphasis on New Treatment Options
The report emphasizes the growth in treatment options for many cancers. In 2014, 10 new treatments were added to the list of 170 FDA-approved anticancer drugs, as well as new medical devices and tests to identify cancers early. More than 770 new cancer therapies are in various stages of research and development.
These advances have led to improved survivorship, with 68.5% of all patients with cancer living beyond 5 years from diagnosis compared with 49% in 1975, the report states. The survivors need follow-up care to monitor for complications and side effects, as well as future cancer screening.
The changes that affect the delivery of high-quality care include a growing demand for cancer treatment (a 45% increase is expected by 2030), which is partly as a result of an aging population, and increasing obesity, leading to an estimated 500,000 additional cases of cancer over the same time period.
Disparities in access to cancer care put additional pressures on the healthcare system; cancer screening and treatment are not evenly distributed among racial and ethnic minorities.
The Changing Oncology Workforce
The size of the oncology workforce is another issue; although the supply of oncology personnel remains constant, the demand is expected to outpace the supply. The oncology workforce is aging, and new medical school trainees are not filling the gap. In addition, the makeup of the oncology workforce does not reflect the racial and ethnic diversity of the US population. Rural areas of the country are not well served, and more than 59 million Americans who live in these areas do not have access to modern cancer care. Only 10% of all physicians practice in rural areas currently, whereas only 4.8% of new physicians are planning to practice in these areas.
Professional burnout also threatens the oncology workforce. The report states that at least 33% of oncology fellows experience professional burnout and do not plan to work as many hours as their senior colleagues. ASCO calls for addressing burnout and other quality-of-life issues to avoid serious workforce shortages.
Moreover, oncology practices have to adapt to financial instability and changing payment models, a continuing trend toward practice consolidation of community-based practices, and the administrative burden imposed by insurance companies and the time spent dealing with patient insurance issues that cut into the time available for providing patient care.
Achieving and Incentivizing High-Quality Value-Based Care
In the ASCO news release, Dr Yu said, “Patients need us to find better ways to pay for and incentivize high-quality, value-based care. ASCO is currently developing and testing an alternative payment approach that reflects the current realities of oncology practices and ensures that patients receive the full range of services that are integral to their care.”
The report contains specific recommendations addressed to Congress and to stakeholders to address the problems, including repealing the Sustainable Growth Rate formula and replacing it with a sustainable structure that incentivizes the delivery of high-quality care; legislation to ensure interoperability of medical records and provide resources for tracking quality measures; and increasing funding to support for research and innovation by $32 billion for the National Institutes of Health and by $5.32 billion for the National Cancer Institute.