Challenges Facing US Cancer Care in 2014: ASCO’s First Annual Report to the Nation

May 2014, Vol 5, No 4

Advances in cancer treatment, from detection and diagnosis to drugs, surgical techniques, and new imaging capabilities, have collectively enabled many patients to live longer, healthier lives with or after cancer. However, a new landmark report, “The State of Cancer Care in America, 2014: A Report by the American Society of Clinical Oncology” (ASCO), identifies the many challenges that will impact the future delivery of cancer care (ASCO. J Oncol Pract. 2014;10:119-143). These challenges include an increasing demand for care, predicted workforce shortages, rapidly rising costs, imbalances in access to care, and an unstable practice environment.

“To overcome these challenges, it will be essential for policymakers to recommit to the fight against cancer and make sustained investments in cancer research and care programs,” said ASCO President Clifford A. Hudis, MD, FACP. “It will also be necessary for cancer care professionals to be even more nimble and creative as we seek to bring valuable cancer advances to a growing number of patients.”

Current and Future Challenges in Cancer Care
Although the delivery system of cancer care in the United States is among the best in the world, significant challenges will impede the nation’s ability to meet the growing demands of the needs of patients with cancer. Key challenges are highlighted in the report.

Rapid growth in the demand for cancer prevention, screening, and treatment. ASCO projects that by 2030, the number of new cancer cases in the United States will increase by 45%—from 1.6 million to 2.3 million annually—and cancer will become the nation’s leading cause of death, driven mainly by the nation’s rapidly aging population. Simultaneously, the number of cancer survivors, now at 13.7 million, will continue to grow. It is estimated that by 2022, there will be almost 18 million cancer survivors—a more than 35% increase from today.

Disparities in access to quality cancer care. Millions of people with cancer lack access to quality medical care, and African Americans and Latinos have disproportionally lower rates of access to care. Although the Congressional Budget Office has projected that the Patient Protection and Affordable Care Act (ACA) will provide insurance coverage to an additional 29 million Americans by 2017, the ACA alone may not solve the disparities in cancer care—in part because it places considerable emphasis on expanding Medicaid coverage, which has been linked with poor outcomes for patients with cancer.

The economic burden has created an urgent need to improve the value of patient care. The economic burden is especially critical in cancer care. The US annual costs of cancer care are projected to rise from $104 billion in 2006 to more than $173 billion in 2020. “This increase is a result of many factors, including the cost of many new cancer therapies. 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,” the report states.

A potential workforce shortage will have a far-reaching impact. The authors of the ASCO report estimate that by 2025, the demand for oncology services will grow by 42%, whereas the supply of oncologists will grow by only 28%, leaving a projected deficit of 1487 physicians over the next decade. Given that an oncologist sees an average of 300 new patients annually, nearly 450,000 new patients are likely to face obstacles in accessing cancer care. ASCO reports that the projected shortfall is driven in part by an aging oncology workforce and an impending wave of physician retirements. Currently, 1 in 5 cancer specialists is aged >64 years. Furthermore, there is an inadequate number of oncologists in many rural communities. Only 3% of oncologists are based in rural areas, where 20% of Americans live.

The financial viability of small and mid-sized practices is a growing concern. Further complicating the supply of cancer care services is a growing concern about the survival of smaller, independent practices. Small (1 or 2 physicians) and mid-sized (<7 physicians) local oncology practices serve more than 33% of new patients in the United States, according to the 2013 ASCO National Oncology Census. Nevertheless, nearly 66% of small oncology practices reported that they are likely to merge, sell, or close in the next year because of financial pressures. The number of private community practices represented in the census fell by approximately 25% between 2012 and 2013 (from 335 to 253), according to the ASCO report.

A Call to Action to Oncology Stakeholders
The report includes a call to action with specific recommendations in 3 critical areas—the oncology workforce, the state of oncology practices, and the quality of cancer care (Table). These recommendations focus on preserving patient access to care, while improving the quality of care and controlling or slowing the projected rise in costs.

Policymakers Are Key to the Solutions
The report makes clear that action by Congress and other policymakers, including payers and hospitals, is crucial to head off impending threats in the state of cancer care in the United States. ASCO has outlined several actions for federal policymakers that would help to support its mission of continued quality of care. These include:

  1. Develop and test new healthcare delivery and payment models that preserve the viability of small community practices while encouraging high-quality care
  2. End persistent financial threats to community practices caused by sequester-related cuts in Medicare physician payments, and by the sustainable growth rate formula
  3. Embrace and support physician-led initiatives, such as ASCO’s established Quality Oncology Practice Initiative, and CancerLinQ learning health system currently under development.

“This first annual report to the nation on the state of cancer care in America offers insight into many issues raised by the IOM [Institute of Medicine] and provides recommendations for action. By taking these steps, the cancer community will be able to move beyond crisis mode to achieve a high-functioning, rapid learning system that promotes progress and delivers patient-centered, high-value care for every individual with cancer,” concluded the report.

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