ASCO Cites Multiple Pressures on Cancer Care

The number of cancer patients in the United States is growing; the oncology workforce is shrinking; and increasing costs and healthcare policy changes in this country are likely to put quality cancer care, screening, and preventive services in flux. This is according to a new report by the American Society of Clinical Oncology (ASCO) on current and future challenges, as well as the changing market dynamics, in oncology care.

The report is published in the Journal of Oncology Practice, aiming to provide stakeholders with an overarching picture of the demographics, economics, and other trends in the cancer field. ASCO plans to update this regularly to show a realistic view of the process of delivering cancer care in the United States, as well as to provide rational plans and suggestions for cancer care, said Clifford Hudis, MD, ASCO president and medical oncologist at Memorial Sloan-Kettering Cancer Center in New York City, during a Congressional briefing Webcast.

According to the report, new cancer cases are expected to increase by 45% by the year 2030, from 1.6 million this year to 2.3 million. “This is a reflection of healthcare success,” said Hudis. “The number one risk factor for cancer in our US population is aging. If you live longer, people get cancer-one in two to one in three Americans will die of cancer.”

The number of cancer survivors, currently estimated to be about 13.7 million people, will also continue to increase to 18 million in the next few years. “The number of cancers that were once fatal but are now treatable or even curable continues to grow, and the number of patients who live with incurable cancers for prolonged periods of time continues to go up and that is one of the good problems that we have to confront,” said Hudis.

Uptick in Demand for Oncology Clinicians

Both cancer survivors and cancer patients living long periods with their disease will add to the pressure of providing quality care for a large and growing population and will increase the demands of the oncology care community. According to the report, the number of practicing oncologists will increase by 28%, while demand for cancer care will increase by 42% by 2025, resulting in a deficit of more than 1,487 oncologists. Because each oncologist sees an average of 300 new patients per year, 446,100 new cancer patients will have challenges in receiving appropriate and timely cancer care.

Compounding the problem is the approximately 13,400 oncologists in the United States who are older than 64 years of age. As of 2008, the proportion of oncologists younger than 40 was lower than that of those who were older than 64. This gap is projected to increase.

Rural areas of the United States will particularly feel the impact of a greater demand for cancer care: While 20% of the US population lives in rural areas, only 3% of oncologists practice in these areas. As nearly 97% of physicians practice in urban areas, more than 70% of US counties analyzed for the report have no medical oncology practice. “There is a real burden when it comes to getting cancer care remotely from home,” said Hudis.

The increase in the number of those insured will also increase the need for oncology care.

The report also emphasized a need for greater diversity in the oncology workforce, particularly to boost the low percentages of African-American and Latino-American physicians in oncology care today.

Cost of Cancer Care

The costs of oncology care are also rising. The ASCO report estimates that the annual cost of the nation’s cancer care will be more than $173 billion by the year 2020, from the $104 billion cost in 2006.

The higher cost of cancer drugs, infrastructure, and insurance are putting pressure on community oncologists, who “are the backbone of the US cancer care delivery system, serving more than one-third of the new patients that are diagnosed with cancer,” said Hudis, emphasizing that high-quality care needs to be distributed throughout community oncology centers and not sequestered at large, state-of-the-art academic institutions.

There is an ongoing trend of consolidation in the healthcare industry, including in oncology practices; as many as two-thirds of community oncology practices are likely to merge, sell, or close within the next year. This trend could further restrict access to cancer care. Hudis called this the most concerning data that ASCO is confronting.

Financial pressures on oncology practices, and particularly small practices, are contributing to their instability. Medical practices have had to cut back on clinical and research support staff and send their patients to hospitals to receive treatment. According to the Medscape Physician Compensation Report, on average, oncologists saw a 4% decline in annual income between 2011 and 2012-only one of two specialties that saw a decline.

“I have been in solo practice since 2001 and am dedicated to breast cancer treatment,” said Carolyn Hendricks, MD, a medical oncologist who has a private practice in Bethesda, Maryland, at the briefing. “I have a terrific staff, phenomenal patients, and I really love my practice, but right now I am seriously considering closing my practice.” Hendricks cited the increasing cost of chemotherapy drugs and the decrease in reimbursement for these same agents as taking her practice “to the tipping point” financially.

Hendricks also said that providing chemotherapy care is complex and expensive for smaller practices, requiring talented support staff and having to place the burden of the higher cost on patients, compared with larger practices that use higher volumes of these drugs. In 2013, Hendricks had to purchase $3.4 million worth of chemotherapy agents for patients-an average amount, but the majority of this cost is made up of only a handful of newer agents that carry high price tags. Increasing patient load is not an option, as this compromises care, said Hendricks, whose practice has lost revenue in the last few years and is in debt. Hendricks said her options are to either close her practice or to merge with a local or regional group.

Novel and expensive cancer therapies, some of which can cost as much as $100,000 for a course of treatment over several months, are also increasing costs and may not be accessible even for those patients who have health insurance, according to the report. With new technological advances resulting in novel targeted therapies, the median price of cancer drugs per month have increased from just $100 to $10,000 in 2013.

See ASCO Sets Up Framework to Improve Cancer Carefor part II of the coverage of the State of Cancer Care in America, 2014: A Report by the American Society of Clinical Oncology.