Richard Schilsky, MD
Patients with cancer are living longer thanks to new treatments, but the US oncology care system is burdened by growing administrative responsibilities, difficulties obtaining payment, and runaway costs, ASCO said in its 2015 report: The State of Cancer Care in America
. Such turbulence is “creating uncertainties about the system’s capacity to continue to provide high-quality care,” ASCO noted in the report.
Among the concerns: an aging oncology workforce, practices under pressure to close or merge, oncologist burnout, the threat of rising cancer rates, and insufficient government funding for clinical research.
“This year’s examination of current data and trends clearly shows that oncology practices in all settings continue to experience tremendous pressures and volatility in the marketplace,” the report said. “At the same time, advances in both cancer treatment and health information technology are spurring exciting innovations in oncology care.”Replacing an Aging Workforce
For the first time, there are more oncologists over the age of 64 than under the age of 40, said Richard Schilsky, MD, chief medical officer for ASCO, in an interview with OncLive
. The report predicts a 45% rise in cancer cases in coming years, creating a “looming mismatch” between the demand for services and the supply of oncologists.
The median age of oncologists remains at 52, the same as last year, while those 40 or younger amount to just 16% of the workforce, and 19.8% are closing in on retirement, being 64 or older, ASCO reported.
However, the proportion of women in medical oncology is on the rise at more than 30% of oncologists this year, just slightly below the 32.6% of women in medicine. Women oncologists are younger on the whole than male oncologists, with a median age of 46 versus 56 years. The report notes that 48% of those in oncology fellowships are women, a figure that is higher than for women in medical training programs overall (46%).
The figures on diversity show a wide gap between the proportion of African-American oncologists and the black population, 2.3% versus 13% respectively. “The rate is not much better in training programs, where only 4% of oncology fellows are African American,” ASCO said. Hispanic practicing oncologists amount to just 3% of the total, whereas Hispanics make up 17% of the US population and 5.8% of oncology fellows, the report said.
ASCO said it has instituted a mentoring program for underserved communities in the belief that “increasing ethnic and racial diversity in the cancer care workforce has the potential to advance cultural competency and expand access to quality care.”
However, pilot efforts to reach underserved cancer patient populations in Nebraska and Iowa are seeing results, the report said.Whether to Merge or Close
Pressures forcing practices to close or merge with larger institutions are a particular threat to rural practices, where 18 % of the US population lives but only 5% of oncologists practice, Schilsky said.
“Ten to 15% of small oncology practices report that they’re likely to merge or close or sell themselves to larger healthcare systems in the coming year, and that is a significant issue, particularly for people who live in the more rural parts of the country,” he said.
One-quarter of practices said they were likely to become affiliated with a community hospital over the next year, similar to what was reported by oncologists in the 2013 census.New Health Threats Will Increase Need for Oncology Care
The report identifies new threats to the nation’s health from rising obesity and e-cigarettes, both of which threaten to send cancer incidence rates higher.
The report noted recently uncovered links between obesity and cancer risk, including endometrial, esophageal, postmenopausal breast and colon cancers, “with as many as 84,000 cases attributed to obesity each year. If trends continue unabated, obesity may lead to an excess of more than 500,000 cancer cases by 2030.” The report also noted a link between obesity and worse outcomes for breast, prostate, and colon cancer, among others.
Similarly, the report says a question mark hovers over the cancer risks of e-cigarette use, which is rising and which, ASCO says, has not yet been sufficiently studied and may encourage more people to try tobacco smoking.Practices in State of Flux
ASCO said nurse practitioner and physician assistant numbers are rising rapidly and their use in practices of various sizes is expected to rise: 52% of oncology practices reported employing advance practice nurses—mostly nurse practitioners—and/or physician assistants. These practices employ 2752 advanced practice nurses and 1136 physician assistants, though most practice in academic settings, according to the report.