State of Cancer Care in America
ASCO’s State of Cancer Care in America™ initiative explores challenges and opportunities in today’s oncology delivery system, with the ultimate goal of improving quality of care for all patients with cancer. Through national events with thought leaders and a series of timely, in-depth articles, the State of Cancer Care in America examines emerging issues and trends in oncology practice that impact the delivery of efficient, cost-effective, and high-quality cancer care.
Find a full list of articles, graphics, and commentaries published in the JCO Oncology Practice as part of the State of Cancer Care in America initiative.
Graphics and other supporting materials highlighting key data points from the State of Cancer Care in America are available at the bottom of the page.
The State of Oncology Practice in America, 2018 found that as of 2017, there are 12,423 U.S.-based oncologists in the United States. The article indicated that the workforce is still concentrated in nonrural areas, with only 7% of oncologists practicing in rural areas.
A 2014 study commissioned by ASCO projected a significant shortage of hematologists/oncologists and radiation oncologists in the United States by 2025. The study found that an aging and growing population and increasing numbers of cancer survivors would lead to a 40% growth in demand for oncologist services. The study projected slower growth in the supply of oncologists (25%), resulting in an anticipated shortage of approximately 2,250 oncologists by 2025.
Because cancer care is delivered through a clinician team, ASCO also examined the availability and role of advanced practice providers (e.g., nurse practitioners and physician assistants) to meet the treatment needs of patients with cancer. ASCO’s 2018 study estimated that there are between 5,350 to 7,000 advanced practice providers in oncology. A 2016 study found that oncology patients are aware when care is provided by a non-physician provider and are very satisfied with the care they receive in a collaborative practice model.
Another article looks at several initiatives ASCO established to support medical students and oncology trainees so that they have access to information and resources as they consider entering the field.
More details about the oncology workforce are available in ASCO’s Workforce Information System, which provides ASCO with an ongoing method for data collection and reporting on the current status of the oncologist workforce.
In 2017, practices identified payer pressures as their top concern and prior authorization as their top payer pressure. In written commentaries, providers expressed concern that prior authorization has negative effects on treatment outcomes, timeliness of care, patient stress, clinician burnout, and administrative costs. Practices reported needing an average of 6.1 full-time employees to manage payer prior authorization requirements.
Oncology practices are also still 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 over the past three years. Current EHR limitations largely stem from the fact they were designed for billing and coding, not for improving care delivery.
Pharmacy benefit managers (PBMs) develop and manage more prescription drug benefits for insurers and act as an intermediary in the prescription drug supply chain. As the role of PBMs has expanded, their opaque business practices and impact on drug prices make it difficult to know if the cost saving measures they promise translate to a reduced costs for patients. Data collected during the 2018 ASCO Practice Survey has shown PBMs may reduce access and quality of care while increasing burdens on providers. For example, three-quarters of practices surveyed said PBMs interfered with patient care and/or made it difficult to deliver care, and 56% say that PBMs disrupted practice workflow. An article and infographic from 2020 in JCO OP summarizes these effects.
In 2017, the oncology practice landscape continued to be in flux. In the ASCO Practice Census, one-third (34%) of practices reported some change in organizational structure, including opening a new practice (18%), experience a merger/joint venture (9%), or closing a practice (7%).
Of the total 2,248 oncology practices in the United States, 25% increased their number of oncologists from 2016-2017, while 18% had fewer oncologists in the same period.
Despite this consolidation, most practices remain small, with 76% of practices employing 1-5 oncologists, and 72% reporting only one site.
These and other data points from the 2017 ASCO Practice Census are included in the infographic to the right.
Opioids for Managing Cancer Pain
In the wake of policies intended to address the opioid crisis, it has become harder for cancer patients to access the pain treatment they need. According to ASCO’s 2017 Practice Census, 40% of U.S. oncology practices say their patients had trouble filling their opioid prescriptions and 92% of U.S oncology practices say they are concerned that restrictions on opioid prescribing will result in undertreating cancer pain. ASCO’s new infographic (see right) highlights some of the barriers to access opioids for cancer pain management.
In a related commentary, a survivor of cancer describes some of the barriers she and other patients have experienced when trying to access opioids, and writes that “anti-opioid sentiment can be pervasive and hurtful” for patients and survivors of cancer. In another commentary, two oncologists describe some of the policies that have been enacted at the state and federal level and how those policies have impacted patients and oncologists. Officials from U.S. Food and Drug Administration (FDA) also outline the role of the FDA in ensuring access to pain management therapies for patients with cancer.
Precision medicine is rapidly becoming the standard of care for patients with advanced cancer, administrative, clinical, and financial challenges make it difficult for non-academic practices to implement precision medicine. A February 2019 article delves deeper into these challenges and highlights how practices can use clinical decision support and administrative support for prior authorization and clinical trial matching to successfully implement precision medicine.
The article is accompanied by a series of commentaries focused on precision medicine, how to implement it in oncology practices, and precision medicine’s impact on patients. ASCO also developed a new visual guide for clinicians to help determine whether a targeted therapy is a viable treatment option for an individual patient.
In January 2018, ASCO hosted the inaugural State of Cancer Care in America event, Precision Medicine: Expanding Opportunities, which focused on the country’s most urgent challenges in precision medicine and strategies to ensure new therapies are available to individuals with cancer.
Graphics and Other Resources
ASCO has developed graphics and other resources to help illustrate the current state of oncology care in the United States. The resources are freely available for use in presentations or on social media. To download graphics, right click the image and click “save as.”
Overview of top practice pressures
Summary of cancer care access in rural and southern United States
Overview of changes taking place in oncology practice
Snapshot of how practices are getting ready for the Merit-Based Incentive Payment System (MIPS)
Overview of practice size and trend of practice consolidation
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