He explained that oncologists today are trying to adapt to the changes in the health care delivery systems and to the economic pressures of running small community practices. ASCO research suggests that nearly 65% of small oncology practices (those that have only one or two physicians) are reporting that they are likely to merge, sell, or close their practice within the next 12 months. “Small physician-based practices face unintentional financial threats because of the impact of sequestration and payment cuts for the life-saving drugs they must purchase and dispense,” said Clifford Hudis, MD, president of ASCO, who is also a professor of medicine at the Weill Medical College of Cornell University, in New York, NY.

Dr. Hudis said access to convenient, high-quality care should not depend on where a patient lives, although it often does. He said that traveling long distances for care is potentially harmful for older patients with cancer who have compromised immune systems and struggle with fatigue. 

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The new ASCO report calls for developing and testing new health care delivery and payment models that preserve the viability of small community practices. Dr. Hudis noted the current system needs to be changed so that it provides small oncology practices with incentives to provide care. “We need to eliminate the threat that they face as smaller purchasers and providers. We need to standardize and rationalize the regulatory and quality standards they work so hard to adhere to,” Dr. Hudis told ChemotherapyAdvisor.com.

The report calls for greater collaboration with primary care professionals (physicians and nurse practitioners) on overall coordination of patients’ cancer care, allowing oncologists to focus on patients receiving active treatment for their disease. In addition, the report calls for leveraging technology and innovative practices, such as telemedicine and visiting consultants, to improve patient access.

Currently, new technologic innovations and a better understanding of cancer biology are improving survival rates and quality of life for millions of patients. Yet, oncologists are now being faced with serious challenges that include increasingly complex cancer diagnoses and treatment plans, and an unsustainable growth in cancer care costs. Dr. Polite said now is a time for revamping the payment system.

“The way they are doing it now is not sustainable,” said Dr. Polite. “We need to change the way payments are handled. We need different payment models that could help stabilize the practices out there.”


  1. American Society of Clinical Oncology. The state of cancer care in America, 2014: a report by the American Society of Clinical Oncology. J Oncol Pract. 2014;10(2):119-142.
  2. Smith B, Smith D, Smith GL, et al. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol. 2009;27(17):2758-2765.
  3. Kirkwood M, Bruinooge SS, Goldstein MA, et al. Enhancing the American Society of Clinical Oncology workforce information system with geographic distribution of oncologists and comparison of data sources for the number of practicing oncologists. J Oncol Pract. 2014;10(1):32-38.