US Healthcare System Needs a Revamp to Maintain Pace With Innovation: ASCO Report

A new report published by the American Society of Clinical Oncology (ASCO) in the Journal of Oncology Practice—a review of cancer care in America in 2015—has drawn a mixed picture of reduced mortality, increased survivors, and progress in treatment coupled with unsustainable costs and an unstable clinical setting.

“Continued scientific and medical progress is urgently needed to improve cancer care, but treatment advances will only be as good as our ability to deliver them to patients,” said ASCO President Julie M. Vose, MD, MBA, FASCO, in an associated statement. “If we hope to achieve Vice President Biden's goal of doubling the pace of progress, the work of strengthening cancer care delivery has to be pursued just as aggressively as the cancer research agenda.”

According to the report, 2015 drew attention to the complex task of balancing progress with the challenges of cancer care. 2015 saw 15 new molecules being approved and 12 expanded approvals, along with the first biosimilar approved for treating chemotherapy-associated neutropenia. Additionally, the federal government set aside funds to support the Precision Medicine Initiative. Cancer mortality, however, has remained steady, with variations seen based on the organ of origin. Additionally, the report states that African American women were, for the first time, documented to have the highest incidence of breast cancer, which underscores access inequity.

While applauding the success of cancer screening programs in reducing morbidity and mortality associated with certain cancers (breast, colorectal, and cervical), the report states that the risk-benefit considerations for other cancers have not been as straightforward. The other challenge, on the treatment front, has been for providers and patients to keep up with the overwhelming amount of information on genetic testing to take advantage of personalized medicine options—especially when patients are in need of expanded treatment options.

“Virtually every aspect of cancer care has become more complex in recent years, and this presents profound challenges,” said Vose. “New approaches to cancer treatment are extending and improving lives, but they also raise tough questions about how to apply what we're learning for patients quickly, efficiently and equitably.”

The following are some of the critical issues highlighted by the report that can present substantial challenges to improving the nation’s cancer care status:

• Increasing complexity of care delivery. The evolving scientific evidence around individual risk of developing cancer and frequent revisions to screening guidelines, the rapidly advancing field of precision medicine, and an aging U.S. population with changing treatment and other chronic health needs pose new challenges for physicians as they work to deliver consistently high-quality care.

• Gaps in insurance coverage. Despite the high enrollment rate under the Affordable Care Act (ACA) and a number of provisions that benefit people with cancer, 35 million non-elderly adults remain uninsured, 31 million more are underinsured, and Medicaid expansion is still incomplete. Importantly, the report identifies persistent denials of coverage for clinical trial participation, despite the ACA mandate.

• Rising cost of cancer care. Multiple studies have shown that the growing cost of cancer care, and healthcare in general, results in increased non-adherence, patients stopping treatment, resulting in poor outcomes.

o Insufficient oncologists practicing in rural areas.

o Growing aging population contributing to a dramatic increase in the number of cancer patients: a 45% increase from 2010 to 2030.

o Insufficient number of oncology providers overall.

• Patient access. The following challenges have a significant impact on barriers to patient access to care, the report states.• Challenges with interoperability of health information technology (HIT). Oncology practices staunchly identify the implementation of electronic health records as a leading practice pressure. Also, the common incompatibility of different HIT systems used by providers inhibits the sharing of information that is needed for optimal cancer care.

Suggested Directions

ASCO recommends the following changes to meet some of these challenges, especially to allow for payment reform, value optimization, and performance improvement.

• Expand publicly-funded insurance programs to offer consistent and adequate benefits to people living with cancer.

• Test multiple payment and care delivery models to identify effective solutions.

• Improve value in cancer care by working with stakeholders to develop alternate payment models, as well as clinical guidelines and resources such as the Choosing Wisely campaign that can help reduce waste and avoid inappropriate treatment.

• Advance HIT that supports efficient, coordinated care.

Reference

American Society of Clinical Oncology. The State of Cancer Care in America, 2016: a report by the American Society of Clinical Oncology [published online March 15, 2016]. J Onc Pract. doi:10.1200/JOP.2015.010462.