The State of Cancer Care in America: 2014, a landmark report published in the Journal of Oncology Practice (Epub 2014 Mar 10), examines how oncologists are trying to adapt to a growing demand for services, to changes in health care delivery systems, and to the economic pressures of maintaining small practices.

The report was launched at a Congressional briefing on Capitol Hill on March 11, in which ASCO President Clifford Hudis, MD, stressed upcoming threats to patient care as demand outstrips supply and as cost pressures threaten the viability of community practices. “We’re facing a collection of challenges, each one of which could keep cancer treatment advances out of reach for some individuals,” Dr. Hudis said. “Collectively, they are a serious threat to the nation’s cancer care system, which already is straining to keep up with the needs of an aging population. Without immediate efforts to address these threats to oncology practices, we’re at real risk of failing tomorrow’s cancer patients.”

The publication and briefing generated widespread media coverage, including coverage on CNN, Reuters, CBS Radio News, and The Huffington Post.

Shortage of oncologists

Despite a near doubling of demand for cancer care services, the number of oncologists will likely grow by only 28%, leaving a projected deficit of 1,487 physicians in just over a decade. ASCO reports that the projected short-fall is driven in part by an aging oncology workforce and impending wave of physician retirements. Additionally, ASCO’s workforce analysis has found that oncologists are in short supply in many rural communities. More than 70% of U.S. counties analyzed by ASCO have no medical oncologists at all.

Viability of small and mid-sized practices

Further complicating the supply of cancer care services is a growing concern about survival of  smaller independent practices, especially in America’s rural communities. According to an ASCO survey of 530 U.S. oncology practices representing more than 8,000 oncologists, small and mid-sized community practices (those with six or fewer physicians) are under tremendous financial pressure due to recent cuts to Medicare physician payments and other factors. Additionally, nearly two-thirds of small oncology practices (those with only one or two physicians) reported that they are likely to merge, sell, or close in the next year.

Recommendations

The State of Cancer Care in America: 2014 makes it clear that action by Congress and other policymakers is critical to head off emerging threats. “If we want convenient access to cancer care, we will have to agree to act accordingly,” said Dr. Hudis.

In that pursuit, ASCO calls on federal policymakers to help create an environment where quality patient care can thrive. This includes working with the oncology community to:

• Develop and test new health care delivery and payment models that preserve the viability of small community practices while encouraging high-quality care.
• End persistent financial threats to community practices caused by sequester-related cuts to Medicare physician payments and by the sustainable growth rate (SGR) formula, Medicare’s current reimbursement system.
• Embrace and support physician-led quality initiatives, such as ASCO’s established Quality Oncology Practice Initiative (QOPI®) and the CancerLinQ™ learning health system currently under development.

For more information on The State of Cancer Care in America: 2014 (including a downloadable PDF of the report and a webcast recording of the ASCO Congressional briefing), visit asco.org/stateofcancercare. The report can also be accessed and downloaded at jop.ascopubs.org.