ASCO's State of Cancer Care in America Report Addresses Access and Affordability Challenges

Surabhi Dangi-Garimella, PhD

The American Society of Clinical Oncology’s (ASCO) fourth annual State of Cancer Care in America report was released today and has been published in the Journal of Oncology Practice. The report, which provides an update on all the monumental changes witnessed by the field of oncology over the last year, highlights 3 key achievements: new investments in science and insurance coverage, payment models that emphasize quality, and rapid-learning healthcare systems.

The report points out that while there has been progress with care and delivery models, access and affordability challenges and increased practice burdens remain persistent barriers. There were 15.5 million cancer survivors in 2016, and the number is expected to grow to 20.3 million by 2026. Increased awareness and innovative treatment approaches are significantly credited with increasing the survival rate.

“Since 1991, we’ve been able to save 2.1 million lives because of significant advances in prevention, diagnosis, and treatment—something unimaginable even a decade ago," ASCO President Daniel F. Hayes, MD, FACP, FASCO, said in a briefing on Capitol Hill. "But there’s still more work to be done to ensure that every patient with cancer, no matter who they are or where they live, has access to high-quality, high-value cancer care.”

The report addresses the following challenges within cancer care:

1. Financial distress. A cancer diagnosis can prove financially catastrophic even if patients have insurance coverage. Newer treatments offer better outcomes for many patients, but are becoming more expensive and can burden patients and the healthcare system.
 
2. Healthcare disparities. Independent of insurance status, significant health disparities, driven by race, socioeconomic status, and geographical location, continue to persist and impact patient health outcomes.
 
3. Administrative burdens. Increased practice burdens, especially with increased reporting requirements to conform to value benchmarks, can divert provider time and resources away from patients, the report stated. Robin Zon, MD, FACP, FASCO, drew attention to this growing problem faced by physician practices during her presentation at the 2015 ASCO annual meeting. The current report states that in 2016 alone, practices from common medical specialties spent a total of $15.4 billion and an average of 785 hours per physician annually to meet reporting requirements. Using non-physician providers—advanced practice providers, nurses, and genetic counselors—has helped ease some of this burden.

However, innovative treatments and practice transformation have helped maintain the growth in the field.  

1. Treatment advances. Investments in biomedical research have led to major advances in precision medicine and immunotherapy, the report stated. The Beau Biden Cancer Moonshot Initiative and the National Institutes of Health (NIH) Precision Medicine Initiative are full of promise to coordinate care and improve the delivery of “precision care.” In 2016 alone, the FDA approved 16 new and expanded use cancer therapies. Additionally, 2 revolutionary diagnostic tests were approved by the regulatory body the same year: a liquid biopsy test for lung cancer mutations and a next-generation sequencing test to identify patients with advanced ovarian cancer eligible for a particular cancer treatment.
 
However, these clinical advances need the support of decision tools, rapid-learning systems that can help providers assimilate patient data and make more informed decisions, which includes the emergence of big data initiatives, such as ASCO’s CancerLinQ.
 
2. Practice transformation. Innovative payment models incentivize high-quality cancer care while ensuring the cost is held in check. After CMS implemented the Medicare Access and CHIP Reauthorization Act of 2015, several innovative payment models in oncology care were developed that emphasize and incentivize high-quality cancer care and pave the way toward value-based reimbursement. The report states that about 43% of physicians (from all specialties) receive some portion of their reimbursement under value-based systems and 58% of oncology practices are using clinical pathways.

“We are making good progress but additional efforts are needed to ensure oncology practices remain economically viable, that the oncology workforce transitions to a value-based system, we witness continued improvements in interoperability and data sharing, and treatments remain affordable and accessible to patients,” Hayes said during the briefing.
 
Zon, who chairs ASCO’s Task Force on Clinical Pathways, also participated at the briefing and expressed concern about the funding cuts proposed in the White House budget blueprint for 2018. She emphasized that NIH and the FDA need additional funding to be able to maintain the pace of innovation currently witnessed in oncology care.
 
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