The State of Cancer Care in America: 2016, published online in the Journal of Oncology Practice¹ and presented earlier this month at a Congressional briefing in Washington, DC, is ASCO’s third annual assessment of national trends in cancer care delivery. The report highlights many promising cancer care developments, including new drugs and technologies, declining mortality rates, expanded access to health care generally, and a shift toward value-based care. But ASCO also highlights major challenges for patients and physicians, including uneven health insurance coverage, rapidly rising costs, and other barriers to accessing new treatments.

“Continued scientific and medical progress is urgently needed to improve cancer care, but treatment advances will only be as good as our ability to deliver them to patients,” said ASCO President Julie M. Vose, MD, MBA, FASCO. “If we hope to achieve Vice President Biden’s goal of doubling the pace of progress, the work of strengthening cancer care delivery has to be pursued just as aggressively as the cancer research agenda.”

Progress in Research and Outcomes

The ASCO report highlighted the continued decrease in cancer incidence and mortality rates for key cancers. This progress can be attributed in part, noted ASCO, to the growing number of novel drugs and technologies, fueled by the nation’s investment in cancer research. In 2015, the U.S. Food and Drug Administration (FDA) approved 15 new cancer drugs, as well as the first product deemed “biosimilar” to an existing biologic product. The FDA also approved several screening and diagnostic tests to help better identify cancers at an early stage, target treatments, and improve outcomes for patients.

The nation is also recommitting significant resources to cancer research after a 10-year period of stagnant funding: Congress took an important first step by increasing fiscal year 2016 federal cancer research funding by 5.34% over the previous year; and Vice President Biden’s moonshot initiative would commit over $700 million and pursue new collaborations to accelerate progress.

Care Delivery and Practice Challenges

Although patients face better treatment prospects than ever before, ASCO cautioned that cancer care may be compromised due to the growing complexity of care delivery, inadequate health-care access and affordability, and other external practice pressures.

“Virtually every aspect of cancer care has become more complex in recent years, and this presents profound challenges,” said Dr. Vose. “New approaches to cancer treatment are extending and improving lives, but they also raise tough questions about how to apply what we’re learning for patients quickly, efficiently, and equitably.”

The report highlighted a number of critical issues that could hinder the nation’s ability to deliver on the promise of advances in cancer research and treatment:

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 and other chronic health needs pose new challenges for physicians as they work to deliver consistently high-quality care.

Remaining gaps in insurance coverage—The Affordable Care Act has enrolled 17 million Americans and includes a number of provisions that benefit people with cancer. However, approximately 35 million nonelderly adults remain uninsured, 31 million more are underinsured, and Medicaid expansion is still incomplete. 

Rising cost of cancer care—The escalating cost of cancer care is having an enormous impact on people with cancer and their families. Some estimates suggest that 10% to 20% of patients with cancer may not take prescribed treatments because of cost, putting them at risk for poor cancer outcomes and bankruptcy.

Looming access issues—Three noted trends may impede future access to high-quality cancer care:

• An imbalance between the number of U.S. oncologists practicing in and the number of Americans living in rural areas (5.6% and 11%, respectively). Many cancer patients in rural communities must drive long distances to access cancer care. 
• A dramatic increase in the number of cancer patients—a 45% increase from 2010 to 2030—largely due to the aging of the U.S. population.
• An aging oncology workforce, with 20% of oncologists now over the age of 64, and the expected 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—With the potential to significantly improve the quality of cancer care, the integration of electronic health records has led to significant administrative burdens that reduce physicians’ available time for patient care, research, teaching, and other professional activities. In fact, nearly half (45%) of oncology practices surveyed by ASCO cited implementation of electronic health records as the leading practice pressure, surpassing all other pressures in 2015. Further, the common incompatibility of different health information technology systems used by providers inhibits the sharing of information that is needed for optimal cancer care.

The Path Forward

ASCO’s report emphasized the importance of capitalizing on new opportunities to deliver high-quality, high-value cancer care, namely in four key areas: insurance coverage, payment reform, value of cancer care, and health information technology adoption and interoperability. In the report, 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 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, not just its Oncology Care Model, including ASCO’s Patient-Centered Oncology Payment Model.
• Improve value in cancer care by working with stakeholders to develop alternative payment models, as well as clinical guidelines and resources such as the Choosing Wisely campaign 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 information technology that supports efficient, coordinated care. The adoption of electronic health records 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 called on policymakers to take steps to make data-sharing fast, efficient, and secure so that these new initiatives can achieve their potential for patients.

For more information on The State of Cancer Care in America: 2016, please visit www.asco.org/stateofcancercare. ■

Reference

1. The State of Cancer Care in America, 2016: A Report by the ASCO. J Oncol Pract (early release online).