ASCO recently released The State of Cancer Care in America: 2016 in the Journal of Oncology Practice and on Capitol Hill during a Congressional briefing. The report is ASCO's third annual analysis of the current trends and developments influencing oncology practice.
Even the most promising cancer treatment advances are only as good as our ability to deliver them to patients, and this year’s report found a mixed picture—from scientific and practice innovations that are contributing to declining cancer mortality rates to persistent problems that challenge the delivery of high-quality care for every individual with cancer.
This year’s report clearly shows that strengthening the delivery system for cancer care has to be pursued just as aggressively as its research agenda.
There is a lot to feel hopeful about in this year's State of Cancer Care in America report. The nation’s investment in federally funded cancer research has led to a growing number of novel drugs and technologies used to treat cancer and a resulting decrease in cancer incidence and mortality rates for key cancers in the United States.
Even more progress may be on the horizon. After 10 years of stagnant funding, Congress increased federal funding for cancer research by 5.34% for Fiscal Year 2016 (compared to FY 2015)—and the national commitment to cancer research continues to grow as Vice President Biden’s "moonshot" initiative would commit more than $700 million and pursue new collaborations to accelerate progress against cancer.
The national investment in cancer research can only pay dividends in improved care if there is a rational infrastructure in place to deliver that care. The report highlights a number of issues that may hinder our ability to bring cancer advances to our patients, including:
- Increasing complexity of care delivery: The evolving scientific evidence around individual risk of developing cancer and frequent revisions to screening guidelines, the rapidly advancing field of precision medicine, and an aging U.S. population with changing treatment needs and other chronic health issues pose new challenges for physicians as they work to deliver consistently high-quality care.
- Remaining gaps in insurance coverage: The Affordable Care Act enrolled 17 million Americans, and includes a number of provisions that benefit people with cancer. However, approximately 35 million non-elderly adults remain uninsured, 31 million more are underinsured, and Medicaid expansion has not been adopted consistently. Clinical trial sites also see persistent denials of coverage for routine costs, despite a coverage requirement.
- Rising cost of cancer care: The escalating cost of cancer care is having an enormous impact on people with cancer and their families. Estimates suggest that 10% to 20% of patients with cancer may not take prescribed treatments because of cost, putting them at risk for poor outcomes and making them more likely to declare bankruptcy than those without cancer.
- Access issues: Trends that may further impede access to high-quality cancer care include:
- An imbalance between the number of U.S. oncologists practicing in and number of Americans living in rural areas. Many patients with cancer in rural communities must drive long distances for cancer care, making it even harder for them to access what is often complicated treatment and routine screenings
- A predicted 45% increase in the number of patients with cancer from 2010 to 2030, largely due to the aging U.S. population.
- An aging oncology workforce, with 20% of oncologists now over the age of 64, and the anticipated growth in the number of oncologists by 2030 not expected to match the growth in patients.
- Inconsistent adoption, lack of interoperability of health information technology: Electronic health records (EHRs) have the potential to significantly improve the quality of cancer care, but their integration has led to significant administrative burdens that reduce physicians’ available time for patient care, research, teaching, and other professional activities. Additionally, the common incompatibility of different health information technology (IT) systems used by providers inhibits the sharing of information that is needed for optimal cancer care.
Patient-centered care has never been more important, and as patients and their providers interact within a volatile health care system, our collective wisdom must be harnessed to overcome obstacles to successful outcomes. ASCO recommends the following:
- Expand publicly funded insurance programs to offer consistent and adequate benefits to people living with cancer. This should include parity in coverage for oral and intravenous cancer drugs, as well as for clinical trial participation under Medicaid.
- Test multiple payment and care delivery models to identify effective solutions. Now that the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is being implemented, policymakers and federal agencies should work with professional organizations to develop and test innovative care models that can incentivize and support high-quality, high-value care. The Medicare program should explore multiple payment options, including ASCO’s Patient-Centered Oncology Payment Model—beyond the Oncology Care Model being implemented by Center for Medicare & Medicaid Innovation.
- Improve value in cancer care by working with stakeholders to develop alternate payment models, as well as clinical guidelines and resources that can help reduce waste and avoid inappropriate treatment. ASCO recently published a conceptual framework to help physicians and patients assess the value of new cancer treatment options and develop treatment plans that are consistent with patients’ needs, values, and preferences.
- Advance health IT that supports efficient, coordinated care. The adoption of EHRs has led to the rise of big data analytics platforms like ASCO’s CancerLinQ, which collects and analyzes real-world clinical information to improve cancer care. ASCO calls on policymakers to take steps to make data sharing fast, efficient, and secure so that these new initiatives can achieve their potential for patients.
From all the data that has emerged and trends that have been analyzed, one overarching idea is clear. Information is the key to surviving—and thriving—in today’s cancer care environment, and The State of Cancer Care in America is a data-driven tool that identifies the strengths and weaknesses of the current system. With each annual report, our goal is to provide meaningful insight that can help the cancer care community shape system-wide interventions and advocate for needed policy changes.
I am grateful to the many clinicians, practices, researchers, and staff who made this important work possible. I learned a great deal from this year's report, and I know you will too. If you haven't read it already, read the report now.