The State of Cancer Care in America: A 2018 Retrospective Report

March 11, 2019

On March 11,  the Journal of Oncology Practice (JOP) published, “State of Cancer Care in America: Reflections on an Inaugural Year,” which highlights key takeaways from the 2018 State of Cancer Care in America series. The JOP series, which examines trends and critical challenges in the delivery of cancer care, used the findings from the 2017 ASCO Practice Census (the Census), a survey of U.S. oncology practices, as its starting point to identify the most pressing issues in cancer care. The series includes articles on trending topics on cancer care, along with commentaries from payers, oncologists, and regulators.

The overarching message from this year’s series is that cancer care teams are navigating a challenging healthcare delivery system that is complicated by

  • Reimbursement and financial pressures
  • Limitations of electronic health record (EHR) systems
  • Wide variations in the organization and geographic distribution of the oncology workforce

Links to specific articles and commentaries from the series are included in each section below.

Reimbursement and Financial Pressures

In 2017, practices identified payer pressures as their top concern and prior authorization as their top payer pressure. Practices reported needing an average of 6.1 full-time employees to manage payer prior authorization requirements.1 Additionally, providers are concerned that prior authorization has negative effects on treatment outcomes, timeliness of care, patient stress, clinician burnout, and administrative costs.

In written commentaries, both providers and payers agreed that when prior authorization is used, it should be efficiently implemented and focus on services involving high potential to reduce costs and improve care.2 The SOCCA editors suggest that a possible path forward could involve exempting providers from prior authorization if they follow high-quality clinical pathways and treatment guidelines agreed upon by providers and payers.

Limitations of EHR Systems

Respondents to the Census reported that they are struggling to efficiently incorporate EHRs into clinical practice. They are utilizing systems that are only partially interoperable; many cannot electronically integrate patient information from other practices, and few can share information with patients. The rates of interoperability reported are virtually unchanged from the 2016 Census. Current EHR limitations largely stem from the fact they were designed for billing and coding, not for improving care delivery. State of Cancer Care in America editors will continue inviting EHR vendors and other technology companies to contribute to the series with the hope of identifying areas where providers can influence the design and utility of technology for clinical care.

Geographic Distribution of the Workforce

Findings from the Census indicated that rural areas have a shortage of oncologists; only 7 percent of oncologists practice in rural areas, yet 19 percent of the U.S. population resides there.3 This impacts the accessibility and quality of care for many cancer patients and may contribute to clinician burnout. Many practices are turning to advanced practice providers (e.g., nurse practitioners and physician assistants) to meet the treatment needs of cancer patients. A recent analysis estimated that there are between 5,350 to 7,000 advanced practice providers in oncology.1

ASCO has established a task force to begin examining the issue of cancer care in rural America and will be hosting a State of Cancer Care in America event on April 10, 2019, entitled “Closing The Rural Cancer Care Gap,” to further examine the landscape of cancer care in rural areas and explore initiatives that are improving cancer care for rural patients. Register for the event.

During 2019, ASCO will continue to use the State of Cancer Care in America series as a “living framework” to evaluate changes occurring in the cancer care delivery system. The ongoing goal is to move towards solutions that address the pressures and challenges in oncology practice and, ultimately, to improve the quality of care for all individuals with cancer in the United States.

Read the full JOP article.

Read more articles in the State of Cancer Care in America series.


1Bruinooge SS, et al. J Oncol Pract. 2018 Sep;14(9):e518-e532.
2Newcomer LN, et al. J Oncol Pract. 2017 Jan;13(1):e57-e61.
3Kirkwood MK, et al. J Oncol Pract. 2018 Jul;14(7):e412-e420.