Oncology: Today, Yesterday, and Tomorrow

The war against cancer has become expensive and pervasive in a society where half of the men and one-third of the women will be saddled with a cancer diagnosis in their lifetime.

“Cancer” is a scary word that brings with it many unforeseen circumstances and assumptions. But as we move full-speed ahead into the 21st century, is there finally some hope on the horizon?

Yesterday

As noted in an OncologyStat editorial last week, we have a cancer treatment industry that supports the effort to prevent/diagnose/treat/cure this large group of heterogeneous diseases. “The war against cancer has become expensive and pervasive in a society where half of the men and one-third of the women will be saddled with a cancer diagnosis in their lifetime.” The American Cancer Society estimates that cancer care costs close to $90 billion dollars in 2007, and projections estimate that number will only go up.

Cancer is projected to be the number one cause of death among Americans by early in the next decade. Subsequently, more money will be spent on cancer than on more-common diseases, like cardiovascular disease or diabetes. The question thus remains “who should pay for it?”

Today

The Journal of the American Medical Association (JAMA) published an article evaluating the effect of the Medicare Modernization Act (MMA) of 2003 on patient access to oncology care. Additionally, the Sunday New York Times Magazine ran a piece about the cost of new cancer drugs, and the Wall Street Journal discussed how new drugs are burdening cancer care providers.

The JAMA article presents an analysis of a nationally representative 5% sample of claims from the Centers for Medicare & Medicaid Services (CMS) from 2003 through 3006. Patients included in the study were Medicare beneficiaries with breast cancer, colorectal cancer, leukemia, lung cancer, or lymphoma who received chemotherapy in inpatient hospital, institutional outpatient, or physician office settings. The authors determined that there have not been major changes in travel distance and patient wait times for chemotherapy in the Medicare population since 2003—the year before MMA-related changes in reimbursement.

Tomorrow

According to a workforce study by the American Society of Clinical Oncology (ASCO), there will be a significant shortage of medical and gynecologic oncologists in the United States by the year 2020. In response to an aging and growing population, increasing numbers of cancer survivors, and a slower growth in the supply of oncologists, the US will have a shortage of between 2,550-4,080 oncologists by that time.

As reported in Medscape Today last week, part of the impending shortage may be attributed to an increasing need to address economic pressures on oncologists, mainly due to “a large price tag attached to many of the agents that have become available during the past few years, especially the biologics.”

Ultimately, the medical community must repair the damage that has been done both financially with respect to the oncologist community, as well as decrease the instance of cancer diagnosis. The cause-effect relationship is uncanny, and the burden is very real.