Patient access to cancer care will be threatened as cost pressures force the closure of small physician practices that form the backbone of care in many communities, reported representatives of the American Society of Clinical Oncology (ASCO) in a Congressional briefing.
Advances in cancer treatment, screening and prevention have resulted in a record 13.7 million cancer survivors living in the U.S. But an aging population and lifestyles could drive new cancer cases to increase by as much as 42% by 2025 and the cost of care to rise by 40% to $175 billion by 2020, ASCO said in a press release.
“We’re facing a collection of challenges, each one of which could keep cancer treatment advances out of reach for some individuals.” said ASCO President Clifford A. Hudis, MD, FACP. “Collectively, they are a serious threat to the nation’s cancer care system, which already is straining to keep up with the needs of an aging population. Without immediate efforts to address these threats to oncology practices, we’re at real risk of failing tomorrow’s cancer patients.”
The State of Cancer Care in America: 2014 appeared online March 11 at the Journal of Clinical Oncology.
Despite a near doubling of demand for cancer care services, the number of oncologists will likely grow by only 28%, creating a potential deficit of nearly 1,500 physicians in the next 10 years. Nearly 450,000 new patients may have problems accessing care.
An aging oncology workforce and physician retirements play a role, the report stated. Currently, nearly 1 of every 5 cancer specialists is over the age of 64. In 2008, the number of oncologists over age 64 exceeded those under 40 for the first time, and ASCO projects this gap will widen.
Oncologists are already in short supply in many rural communities. Only 3% practice in rural areas, where nearly one-fifth of Americans live. More than 70% of U.S. counties have no medical oncologists at all.
Further complicating the supply of cancer care services is a growing concern about survival of smaller independent practices, especially in American’s rural communities. According to an ASCO survey of 530 U.S. oncology practices representing more than 8,000 oncologists, practices with 6 or fewer physicians face recent cuts to Medicare physician payments and other factors. These practices, concentrated in the South and West, serve more than one-third of new patients, according to ASCO’s research.
Nearly two-thirds of oncology practices with 2 or fewer physicians reported that they are likely to merge, sell or close in the next year. In small towns and rural communities, small practices are often the primary providers of cancer care, enabling people to receive high-quality, personalized treatment close to home. Closure of these practices will worsen potential workforce shortages, making access to care that is already uneven worse still.
ASCO also pointed out that use of physician extenders and experiments with new delivery models and reimbursement systems may help alleviate the problem, and asked Congress for legislative support.