Robin Zon, MD
The Affordable Care Act (ACA) has improved access to cancer care for millions of Americans, and many new drugs and new indications for existing cancer drugs were approved in 2016, but there are frontiers in improving cancer care that include information barriers, disparities in the availability of rural care, and stressors on physicians and oncology practices, ASCO said in its annual report State of Cancer Care in America: 2017, which was released today.
“This year’s State of Cancer Care report really shows that we’re in a time of rapid change all across the US cancer care delivery system,” said Robin Zon, MD, chair-elect of the ASCO Government Relations Committee.
One of the chief hurdles looming is providing ongoing care for the rising numbers of Americans who are diagnosed with cancer and who are surviving their cancer, thanks to improved therapies. ASCO said the number of cancer survivors is expected to grow by one-third, from 15.5 million in 2016 to 20.3 million by 2026. “Because more Americans receive a cancer diagnosis each year and more patients survive, ensuring patient access to affordable, high-quality care remains a critical challenge to the American healthcare system,” ASCO said.
Last year 5 new drugs and biologic therapies were added to the armamentarium of greater than 200 FDA-approved cancer fighting drugs, ASCO said. Use was expanded for 13 cancer therapies; and also approved were diagnostic tests including a liquid biopsy test for lung cancer mutations and a next-generation sequencing test to identify patients with advanced ovarian cancer who would be eligible for a particular cancer treatment. In addition to that, the 21st Century Cures Act signed into law late last year gave a start to the Moonshot for Cancer and precision medicine initiatives, ASCO noted.
The report briefly mentions the ongoing Republican-led ACA repeal and replace effort and the impact that could have on the number of covered Americans. “As proposals to alter or replace the ACA move forward, ASCO advocates for policies that provide for adequate coverage for cancer related services, especially for vulnerable and underserved communities,” ASCO said, noting that the ACA had by early 2016 added 20 million Americans to the ranks of the medically insured. “All individuals with cancer should have health insurance that guarantees access to high-quality care delivered by a cancer specialist.”
In an interview about the report, Zon said that ASCO is paying close attention to the proposals for health coverage changes. “We’re committed to working with policymakers on both sides of the aisle and the entire cancer community to provide equal access to affordable, quality healthcare for people with cancer,” she said.
“The report shows that access to affordable care continues to be a major challenge. Even when patients have health insurance, the cost of receiving treatment can be too high, with approximately one-third of working-age cancer survivors incurring debt as a result of treatment. Also, disparities—by race, ethnicity, geography, and other socioeconomic factors—continue to persist,” Zon said.
The report does not discuss the more recent 2018 budget proposal from President Donald Trump that outlines a major withdrawal of funding from certain health programs, such as $5.8 billion from the National Institutes of Health, which Trump has proposed in tandem with a $54 billion effort to strengthen the nation’s defense. However, ASCO has taken a position in opposition to the proposed budget change. Zon remarked, “Reducing NIH's funding by over 18% will devastate our nation's already fragile federal research infrastructure and undercut a longstanding commitment to biomedical science that has fueled advances in cancer prevention, diagnosis, and treatment.”
In addition, the ASCO report urges that the federal government “provide adequate funding and infrastructure support for cancer research in addition to funding for the Moonshot initiative to ensure ongoing development and delivery of promising new treatments for patients.”