Specialization Trend Is Changing the Oncology Landscape

Natalie Pompilio
Published: Monday, Oct 15, 2018
Frederick M. Schnell, MD

Frederick M. Schnell, MD

An increasing number of oncologists are choosing to specialize, affecting how patient care is delivered and the futures of small practices and large cancer clinics.

In its 2018 oncology trend report, California-based biotech company Genentech found that more than a third of participating oncologists (38%) specialized in particular tumor types.1 In the previous 5 years, 40% of general oncologists and 64% of specialized oncologists have seen their mix of patients become more concentrated by tumor type, according to the survey. Just 6% of general oncologists and 1% of specialized oncologists reported treating a wider mix of tumor types.

The report’s conclusions were based on more than 630 completed surveys from 100 managed care organizations, 30 specialty pharmacies, 200 oncologists, 202 oncology practice managers, and 101 employer health benefit sponsors.1 Genentech spokeswoman Courtney Aberbach said the specialization trend is a result of oncology treatment innovations and the increasing adoption of personalized medicine and digital technologies.

“Our growing understanding of the biology of cancer has made the disease more complex to manage and treat. Today there are more than 100 identified types of cancer, and some, such as breast and lung cancers, have even further subtypes, often requiring different diagnostic tests and treatments. Specialization allows oncologists to gain expertise in treating specific types of cancer, with the goal of improving patient care,” she said.

This shift is contributing to another trend: Smaller practices are consolidating or being purchased by larger hospitals and care centers. “It has the potential to improve the quality of care that patients receive because the specialist oncologist will be more knowledgeable about a specific type of cancer. From an economic and cancer-care delivery standpoint, it may be most efficient to have centralized availability of specialist oncologists who work with oncology generalists in the community and in rural areas,” Randall F. Holcombe, MD, director of the University of Hawaii Cancer Center in Honolulu, said.

“Insurance coverage for seeking second opinions from specialist oncologists, or to allow patients to transfer care to these specialists, will be important to facilitate patient choice and under stress, and a reliever is to consolidate,” said Frederick M. Schnell, MD, medical director of the Community Oncology Alliance (COA). “There’s a very active movement to consolidate, and there are burgeoning networks around the country.”

Many of these networks are based in or near major population areas, which could mean the very specialized immune and targeted thera- pies that now define modern oncology might not be available to rural populations. “The biggest risk is to patients in more remote areas, rural America,” Schnell said. “These consortiums don’t reach there.”

EMBRACING SPECIALIZATION

The specialization trend seems destined to continue and gain momentum. And although there may be drawbacks, many doctors believe it’s a good thing.

“It has the potential to improve the quality of care that patients receive because the specialist oncologist will be more knowledgeable about a specific type of cancer. From an economic and cancer-care delivery standpoint, it may be most efficient to have centralized availability of specialist oncologists who work with oncology generalists in the community and in rural areas,” Randall F. Holcombe, MD, director of the University of Hawaii Cancer Center in Honolulu, said. “Insurance coverage for seeking second opinions from specialist oncologists, or to allow patients to transfer care to these specialists, will be important to facilitate patient choice and access,” he added.

The explosion of knowledge about tumor types is a major driver of the specialization trend. With cancer care, “there’s an increasing degree of knowledge and sophistication and dramatically more therapeutic options and [ways] to use them,” said Martin J. Edelman, MD, professor and chair of the Department of Hematology/Oncology at Fox Chase Cancer Center in Philadelphia, Pennsylvania. “With lung cancer, as recently as 2000, you had small cell and non–small cell, and all our studies were based on those. Now there are more and more subsets, and you need to know the options for each."

FIGURE. ONCOLOGIST SPECIALIZATION IN TUMOR TYPES10

 FIGURE. ONCOLOGIST SPECIALIZATION IN TUMOR TYPES
Figures are based on survey of 200 oncologists for the 2018 Genentech Oncology Trend Report Survey.



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Community Practice Connections™: Oncology Best Practice™ Decision Points in Advanced NSCLC: Assessing Treatment Options Beyond Disease ProgressionNov 30, 20181.0
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