Other geographic challenges also exist. “A third of all oncologists reside in California, New York, and Texas, and the majority reside in nine states,” Dr. Zon noted.

“Rural areas have a serious problem with access,” she said, and the loss of community oncology practices will exacerbate that problem. Nearly a fifth of Americans live in rural areas—59 million people—but only 5.5% of oncologists, or about 600 oncologists, serve those communities, Dr. Zon noted.

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“You can see there’s quite an imbalance. This is not a trivial matter. Patients with cancer are often debilitated or dealing with toxicities from their treatment. Or they’re elderly… or dependent on transportation. Radiation therapy can be daily for 6 weeks at a time.”

Insurer pressures and costs, including escalating drug prices, “persisted as the most pressing oncology practice concern,” with more than 70% of practices continuing to operate in a fee-for-service payment system, the report’s authors stated.1

Many practices plan to transition, or are already transitioning, to alternative payment systems like bundled payments or care-coordinating medical homes.

Implementation of electronic health records that will facilitate coordination has been complicated by vendors’ failures to create platforms that can communicate with one-another, noted Richard Schilsky, MD, FACP, FASCO, who is the Chief Medical Officer of ASCO. He urged Congress to require better interoperability among health IT vendors.

Preauthorization and insurers’ administration burdens on practices are also highlighted in the report as major concerns. Many oncology nurses are “burdened by paperwork” to a degree that diminishes the time they have to help patients, Dr. Zon noted.

“The problems revolve around the fact that we have an aging workforce that is getting ready to retire,” concluded Dr. Zon.

“We have burnout, we have a change in expectations for types of careers that new oncologists want to have; we have a diminishing of smaller practices and challenges with [insurance] payers, drug inventory, and competition. And we have access problems with rural America.”

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Access and workforce issues are not the only problems slowing progress in oncology, noted Dr. Schilsky. Approaches to developing new treatments also deserve reconsideration, he says.

“In oncology, we often celebrate small incremental gains,” Dr. Schilsky said. “That’s been the state of our art for a long time now and it’s certainly the case that over many years, those small incremental gains have translated into big improvements and much better outcomes for our patients. But the time has come to set the bar higher. We need to encourage clinical trialists and drug developers to aim higher, to aim for greater incremental gains. Nobody wants to spend $100,000 a year on a drug that improves survival by approximately six weeks. We have to do better than that.”

ASCO has emphasized the importance of achieving “clinically meaningful outcomes in cancer research to move us beyond just the ‘statistical significant’ improvements,” Dr. Schilsky concluded.


  1. American Society of Clinical Oncology. The State of Cancer Care in America, 2015: A Report by the American Society of Clinical Oncology. J Oncol Pract. March 17, 2015. [Epub ahead of print] doi: 10.1200/JOP.2015.003772.