The cancer care system in the United States is facing serious threats when it comes to delivering quality care, according to a new comprehensive assessment by the American Society of Clinical Oncology (ASCO). On March 11, 2014, ASCO released a landmark report suggesting that cancer care is being threatened as the growing demand for care exceeds the supply of oncologists.1
One major concern is that cost pressures are forcing the closure of small oncology practices, which form the backbone of care in many communities. In addition, there is extremely poor medical coverage in rural areas, thus exacerbating the problem. The authors of the ASCO report say it is time for the cancer community to move beyond crisis mode to achieve a high-functioning, progressive system. “We have to rethink and rebuild how we deliver care,” said Blase Polite, MD, chair-elect of ASCO’s Government Relations Committee.
Dr. Polite, an assistant professor of medicine at the University of Chicago, said that, unless some inherent problems are immediately addressed, there could be a steady erosion of quality cancer care in America. It is now projected that, by 2030, the number of new cancer cases will increase by 45% in the United States, rising from 1.6 million to 2.3 million cases annually, becoming the nation’s leading cause of death.2 This trend is largely due to the aging population as well as lifestyle factors such as skyrocketing obesity rates. At the same time, there is a projected shortfall of oncologists, in part as a result of an aging oncology workforce and impending wave of physician retirements. Currently, approximately one in every five cancer specialists is over age 64 years. In 2008, the proportion of oncologists aged 64 years and older surpassed the proportion of those aged 40 years and younger.3
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Annual cancer costs have also been skyrocketing. Today, some newly approved cancer drugs cost more than $100,000 for one course of treatment. This is triggering a debate on how to develop a more rational system for drug pricing. Some clinicians say it is time to address longstanding problems, such as a health care system that incentivizes the use of tests, treatments, and services, which may not always be necessary or effective.
“This is one of the toughest times for oncologists out there, and this is the time for us to look at what needs to happen. We want community oncology to survive and thrive because there are going to be more and more patients,” said Dr. Polite.
He said ASCO has conducted a workforce analysis that suggests oncologists are already in short supply in many rural communities, and the problem is expected to get much worse. The analysis shows only 3% of oncologists practice in rural areas, where nearly one in five Americans live.3 The analysis shows that the distribution of oncologists is heavily skewed toward urban areas; the lack of oncologists is especially acute in some rural areas of Nevada, Oklahoma, North Dakota, South Dakota, and Wyoming.
“The workforce distribution is what really surprised me. Only 3% of our cancer doctors are in rural areas and 70% of counties don’t have oncologists,” said Dr. Polite in an interview with ChemotherapyAdvisor.com. “The problem is definitely getting worse with the cost pressures. It is harder and harder for small practices to survive.”