Barriers Persist Despite Rapid Advances in Oncology

Amid rapid advances in oncology, barriers such as treatment costs, health inequities, and clinician burnout remain critical challenges, as highlighted by experts at a regional Institute for Value-Based Medicine (IVBM) event hosted by The American Journal of Managed Care in Seattle, Washington, on July 31, 2025.

Across 4 panels, speakers explored treatment breakthroughs, strategies to expand access, the evolving role of oncology pharmacists, and the urgent need to address financial toxicity and workforce sustainability. The discussions underscored that innovation must be met with collaboration, policy solutions, and patient-centered approaches to ensure equitable care for all.

Experts Review Advances, Challenges in Lung Cancer Precision Medicine
The first panel addressed advances in precision medicine for lung cancer, which is increasingly subtyped due to the continuous approval of new drugs that target specific mutations and offer better responses. Moderated by

Rafael Santana-Davila, MD, medical director of oncology at Swedish Cancer Institute in Seattle, Washington, the panel featured 3 experts from Fred Hutchinson Cancer Center (Fred Hutch) in Seattle: Lei Deng, MD, a medical oncologist; Viswam S. Nair, MD, MS, an associate professor in the Clinical Research Division; and Sherry Hu, MD, PhD, a medical oncologist and hematologist.

“One day, I had a very early morning [telehealth visit] with a patient, and I was telling them about a treatment,” Deng said. “Once I finished, I checked my email, and the FDA had approved another new drug that appeared to have a more durable response and better [adverse event] profile. I was like, ‘What should I do? Do I call the patient back?’”

Panelists said decision-making is becoming increasingly nuanced as new therapies emerge, particularly given the lack of direct head-to-head trial data. Deng explained that more individualized approaches are often necessary, considering patient comorbidities and preferences along with the toxicity profiles of available therapies.

The discussion also highlighted the increased complexity of biomarker testing, which requires larger tissue samples. Panelists emphasized the difficulty of obtaining adequate tissue samples while ensuring patient safety.

Although circulating tumor DNA (ctDNA) offers advantages such as faster, noninvasive testing, the experts debated its utility in surveillance and adjuvant settings, expressing concern that earlier recurrence detection may not improve survival. Instead, it could heighten patient anxiety or prompt unnecessary interventions.

Looking ahead, Hu said she hopes to gain more experience with targeted therapies and to better help patients manage adverse events. Deng advocated for the approval of a pan-KRAS inhibitor and improvements in biomarker testing practices to streamline precision oncology care. Lastly, despite the availability of advanced lung cancer diagnostic tools, Nair highlighted that systemic delays prevent patients from receiving timely information and care.

“I think it’s difficult because each hospital has its own ecosystem, but there’s got to be universal principles that we can apply,” he said. “I think we’re working on it from a guideline standpoint…but we’re still not there.”

Expanding Access to CAR T-Cell Therapy, Bispecific Antibodies, and Clinical Trials

The second panel at the IVBM event, moderated by Danai Dima, MD, an assistant professor in the Clinical Research Division at Fred Hutch, explored how academic centers and community oncologists can collaborate to expand access to advanced hematologic therapies, particularly chimeric antigen receptor (CAR) T-cell therapy and bispecific antibodies. The discussion featured:

Kara Cicero, MD, MPH, assistant professor of clinical practice, hematology and oncology in the Clinical Research Division at Fred Hutch and an assistant professor in the Division of Hematology and Oncology at the University of Washington School of Medicine; Bin Xie, MD, a medical oncologist at Swedish Cancer Institute; and Bart Scott, MD, a professor in the Clinical Research Division and a professor in the Clinical Research Division and the Miklos Kohary and Natalia Zimonyi Kohary Endowed Chair at Fred Hutch and a professor in the Division of Hematology and Oncology at the University of Washington School of Medicine.

Dima started by discussing access to CAR T-cell therapy, focusing on patient selection, care coordination, timing of referral for treatment, all of which makes a difference in outcomes.¹ Cicero explained that although the therapy is transformative, its risks make careful patient selection essential. She stressed the need for early referrals from community oncologists, who should review both the benefits and logistical challenges of CAR T-cell therapy with patients.

“I think that we’ve had really good relationships with a lot of community oncologists where we do talk about patients and such, and I hope that that could help bridge that gap in order to make these conversations yield and invest in trust for patients,” Cicero said.

Scott reinforced the value of strong relationships and direct communication with community oncologists, adding that having colleagues’ contact information helps with quick patient consults and smoother referrals.
Xie offered the community perspective, describing how past delays with waitlists and patient selection limited patient access. Access has since improved, he said, with shorter waitlists and earlier referrals helping more eligible patients receive therapy.

The discussion then shifted to bispecific antibodies. Dima explained that although more community centers are adopting these treatments, initial ramp-up and complication management are still typically handled at academic centers. From the community perspective, Xie agreed that treatment should start at specialized centers due to the risk of acute toxicities. Once patients are stable, he said that community oncologists are more comfortable continuing therapy. Scott also highlighted that academic centers have stronger supportive care infrastructure to manage complications during ramp-up.

Cicero emphasized the need for academic centers to share best practices and operational models so community colleagues can build confidence and capacity for treatment. Similarly, to ensure safe transitions back to community care, Dima underscored the importance of clear guidance from academic centers for community oncologists.

The panel concluded with a conversation on expanding access to clinical trials for hematologic malignancies through academic-community partnerships. Dima noted that clinical trials remain concentrated at main academic centers, making it difficult for community patients to participate due to travel and logistical challenges.

Xie noted additional hurdles, including acute disease onset, patient/provider anxiety, and the reluctance to travel or be randomly assigned. To break down some of these barriers, Scott added that trials must provide support for patient travel and housing expenses. Consequently, Dima stressed the importance of proactive communication and relationship building from academic centers to solve some of these clinical trial challenges.

“…[C]ommunication is very important,” Xie said. ”[But] sometimes we need to [realize] that our community colleagues are so busy, [so] we should make the first step in reaching out to them. Say, ‘Hey, did you have a patient for a clinical trial?’ Just inform them and update them about what we have and do that early.”

Pharmacists Driving Innovation, Standardization in Oncology

Moderated by Sophia Humphreys, PharmD, MHA, BCBBS, executive director of pharmacy at Providence in Seattle, Washington, the next panel showcased how oncology pharmacists are advancing innovation, standardization, and value-based care delivery in an increasingly complex policy and therapeutic landscape.

Panelists included Rachel Feaster, PharmD, BCOP, BCPS, and Ivan Huang, PharmD, BCOP, both clinical oncology pharmacists at Fred Hutch, along with Eve Segal, PharmD, BCOP, lead clinical pharmacist, oncology, at Fred Hutch and University of Washington School of Medicine.

Segal opened the discussion by describing new models that enable pharmacists to move beyond dispensing to independent clinical decision-making, including prescribing, dose adjustments, and supportive care management. She highlighted the oral chemotherapy clinic at Fred Hutch, where pharmacists prescribe under their own licenses, manage risk evaluation and mitigation strategies, and order laboratory tests.

“Our internal studies have shown that patients have similar rates of adherence, so we provide similar rates of care, and we have saved our care teams 240 hours a month worth of time,” Segal said.

Building on this, Feaster noted the expansion of integrative medicine services has allowed pharmacists to lead supplement reviews to strengthen patient safety, adherence, and satisfaction, with plans to further extend these services into community sites.

The panel then emphasized the institutional push for protocol standardization, particularly in antiemetics, growth factors, anti-infectives, and supplement reviews. Each panelist offered examples from their practice, underscoring how standardization reduces practice variation, improves outcomes, and streamlines workflows.

To close, the discussion turned to legislation and policy models. Panelists reflected on how the Enhancing Oncology Model and Inflation Reduction Act (IRA) are beginning to improve the patient financial experience; for example, the IRA caps out-of-pocket costs for Medicare Part D drugs.²

“Patients that I’ve talked to are very glad that, even though they are still paying a co-pay amount, it’s being capped at $2000 a year, which is actually a saving grace for many because they are able to have at least the amount of money to get started,” Huang said. “Once they pay out the $2000 [for the] year, it will be significantly cheaper if not completely covered so that really has allowed a lot of patients to start therapy without any sort of a delay in care.”

However, the panelists concluded by emphasizing that uncertainty remains around the broader impact of these policies.

Addressing Financial Toxicity and Workforce Challenges in Oncology

The IVBM event concluded with a panel that addressed the widespread challenges of financial toxicity and workforce strain in oncology, moderated by Sara Jo Grethlein, MD, MBA, FACP, CEC, a professor of medicine at Drexel University College of Medicine in Philadelphia, Pennsylvania. Experts included in the conversation were Angel Liu, PharmD, a clinical oncology pharmacist at Fred Hutch; Veena Shankaran, MD, MS, codirector of the Hutchinson Institute for Cancer Outcomes at Fred Hutch; and Fengting Yan, MD, PhD, a medical oncologist at True Family Women’s Cancer Center, Swedish Cancer Institute.
Grethlein began by emphasizing that financial hardship remains a major barrier to optimal outcomes, impacting treatment adherence, quality of life, and care delivery. Shankaran presented research showing that approximately 75% of patients with colorectal cancer experience significant financial hardship.³ As a result, she advocated for proactive financial screening and navigation through the care continuum.
“We really need to think about financial screening and assistance for financial toxicity proactively at the time of diagnosis,” she said. “This should be embedded as a part of care—and not just at a single time point, but at multiple time points.”

Liu outlined pharmacy workflows to reduce patient costs, including collaborating with billing teams, navigating prior authorizations, and leveraging internal specialty pharmacies to minimize treatment delays and proactively manage expenses. Yan added that financial toxicity affects all patient populations, noting the essential roles of social workers and fundraising programs at her organization while underscoring the need for systemic solutions alongside individualized support.

Additionally, the panel discussed the importance of addressing social determinants of health, a driver of financial strain. Liu highlighted initiatives such as the National Cancer Institute’s Screen to Save program and donation-based services that offer free medications.⁴ To help relieve burdens on patients and the workforce, Grethlein encouraged the consideration of new care models, such as home-based screening and reduced in-person visits. Building on that, Shankaran stressed that financial toxicity is multifactorial and requires policy-level solutions, noting the positive impact of telehealth on access and affordability.

The conversation then shifted to big data, with Liu raising concerns about ethics, practicality, and consistency across institutions. In contrast, Shankaran argued that, with proper safeguards, big data can illuminate care quality and cost drivers, with Yan emphasizing the value of real-world evidence in guiding research and decisions.

Lastly, the panel examined the sustainability of the health care workforce. Liu highlighted burnout within the pharmacy workforce, stressing the need to recruit and train professionals while expanding technician roles. Because the oncology trainee pipeline is shrinking, Yan emphasized the importance of being transparent about the highs and lows of the job and described her efforts to mentor and inspire the next generation.

“I don’t have the immediate, systemic solution, but as one single person, I volunteer to speak to high schoolers, to the undergraduates to make sure they understand what my life looks like,” she said. “It can be a lot, but it can be rewarding too.”

References
1. Grischke TK, Cooperrider JH, Pula A, et al. Brain-to-vein and vein-to-vein times and outcomes in CAR T-cell therapy in myeloma. Blood Cancer J. 2025;15(1):47. doi:10.1038/s41408-025-01262-4
2. Sepassi A, Gabriel N, Sullivan SD, Fendrick AM, Zell JA, Mukamel DB. Estimated true out-of-pocket cost changes from the Inflation Reduction Act on Medicare Part D beneficiaries with cancer. Value Health. Published July 15, 2025. doi.org/10.1016/j.jval.2025.07.003
3. Khor S, Carlson JJ, Basu A, et al. The association between new cancer therapy innovations and financial toxicity. J Natl Cancer Inst. Published online June 20, 2025. doi: 10.1093/jnci/djaf152.
4. Screen to Save: NCI colorectal cancer outreach and screening initiative. National Cancer Institute. Accessed September 28, 2025. https://www.cancer.gov/about-nci/organization/crchd/community-outreach/screen-to-save