December 22, 2021 at 5:00 am ET
Fifty years ago this month, the National Cancer Act was signed into law, helping pave the way to an era in which science has delivered innovations in cancer care that would have seemed like science fiction in 1971. We have treatments for more types of cancer, with better survival rates and fewer side effects, than ever before.
Unfortunately, outcome data shows systemic problems with how we pay for and deliver cancer care. There are too many barriers to groundbreaking treatments and optimal care for cancer patients — particularly those in underserved communities. The impact is devastating: Black American men are more than twice as likely to die from prostate cancer as white men, while Black American women are 40 percent more likely to die from breast cancer than white women.
The next cancer “moonshot” must democratize access to care by ensuring that patients — no matter their race, socioeconomic status or insurance provider — can access the appropriate specialized and personalized treatment most likely to save their lives.
Advances in cancer care, which include immunotherapy, precision medicine and treatments available through clinical trials, mean that a growing number of cancer diagnoses are no longer a death sentence. U.S. cancer deaths fell 31 percent between 1991 and 2018.
Delivering the best outcomes increasingly relies on precision genetic and genomic testing to enable cancer subspecialists to develop personalized courses of care for the particular subtype of cancer. For one type of blood cancer, patients receiving care from designated specialists saw a 53 percent reduction in the likelihood of short-term death. Similarly, for a form of lung cancer, targeted therapies can extend average life expectancy from 8 to 80 months.
But the war is not yet won. An estimated 1.8 million Americans were diagnosed with cancer in 2020. Many of them will die despite the fact we have the treatments to save them.
The nation’s health care system — the way we have designed payment, reimbursement and even value-based models — has not evolved as quickly as the science for treating and curing cancer. While we have pursued the laudable goal of expanding insurance coverage, too many cancer patients discover that their coverage doesn’t equate to access to personalized care.
Health plan tools that support affordability for chronic conditions like diabetes typically rely on “step therapy,” which require patients and physicians to use less expensive therapies first. For patients with life-threatening diseases like cancer, the best chance at a cure is often the first chance. Patients can’t afford to wait for initial treatments to fail to seek help from expert sub-specialists or access to safely administered, cutting-edge therapies. As more cures and diagnostic tools emerge, it will become more critical to remove the barriers that prevent patients from accessing these breakthrough discoveries.
I lead strategy at City of Hope, a comprehensive cancer care center in California. In my state, a patient’s health insurance coverage is correlated to drastic disparities in cancer survival rates. Californians insured with Medi-Cal suffered worse-than-average outcomes for several cancer diagnoses, including lung, rectal, colon and breast cancer. Less than half of California cancer patients received care aligned with national guidelines between 2004 and2016, and only about 8 percent of eligible cancer patients nationally enroll in clinical trials.
Cancer care is different and a moonshot for more equitable access is urgently needed.
At the federal level, the Centers for Medicare and Medicaid Services can amend oncology value-based payment models to better incorporate patient and caregiver perspectives. Research published in the Journal of Clinical Pathways shows the importance of incorporating patient outcomes, as well as patient-reported measurements of the physical, financial and psychological toll of cancer, when defining “value.” These tools are currently rarely used, and their expansion would help realign incentives in how we pay for cancer care.
Recently, California became the first state in the nation to pass a Cancer Patients Bill of Rights resolution that called for every California cancer patient to have access to the care most suitable for their diagnosis. City of Hope was proud to be the driver of a coalition supporting this resolution. This framework can inform the work of states and the federal government to ensure every cancer patient has access to the specialists, clinical trials or personalized treatments that are most likely to help them live and thrive.
There isn’t one simple fix to remove barriers to cancer care. Social determinants of health need to be addressed. And affordability remains essential to a sustainable health care ecosystem, though it should not shield us from the obligation to address the health inequity and outcome disparities that exist today.
Our ability to deliver advancements in cancer treatment and diagnostics should give us hope that — if we roll up our sleeves and work together — we can deliver the cancer care access moonshot too.
Harlan Levine, M.D., is president of strategy and business ventures for City of Hope.
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