August 2013 Vol 6, No 6 Special Issue - Health Economics
Wayne Kuznar

Chicago, IL—“Building Bridges to Conquer Cancer” was the theme of the 2013 American Society of Clinical Oncology (ASCO) annual meeting, as well as of the address of ASCO’s outgoing President Sandra M. Swain, MD.

Dr Swain’s address focused on 3 pillars of the theme: (1) ensuring global health equity, (2) the need to strengthen future generations of leaders and providers, and (3) the vision for a rapid learning system in oncology. These 3 issues “belong squarely on our personal and professional radar screens,” she said.

Disparity in Access to Care
Gaps in connecting proven treatments and preventive measures with underserved populations are linked to increased mortality from cancer and more suffering as a result of later disease stages at initial presentation.

These gaps occur in various parts of the United States, and not just in low- and middle-income countries, said Dr Swain. The 48 million uninsured Americans—and those joining the Medicaid rolls—are all part of this picture. One area of concern is the wide variability in Medicaid programs.

“On the plus side, a recent study showed that in states where Medicaid programs have been expanded to cover more individuals, there has been a reduction in overall mortality,” she said. “While this is an encouraging sign for the general population, cancer-specific outcomes for patients covered by Medicaid have been associated with no better outcomes than for those who are uninsured.”

A key predictor of whether an adult will survive cancer is income. This outcome gap is largely a result of differences in access to care. One innovative effort to bridge equity gaps is a screening program for colon cancer that is available to every citizen in Delaware. The program’s success is exemplified by screening rates in blacks, which rose from 48% to 74%. The number of blacks presenting with regional and distant colorectal cancer was reduced by 39%. The decline in mortality rates for blacks was 42%, bringing it closer to that of whites.

“Not only did the program help patients avoid the pain and suffering associated with aggressive treatment of late-stage illness, it saved millions of dollars in treatment costs,” said Dr Swain.

Although advances in vaccines and screening large populations for breast cancer and cervical cancer have been made, many of these methods are not available globally. And even if the cancer is diagnosed, there are wide gaps in the availability of affordable treatments.

In response to the global cancer crisis, ASCO has started a program called ASCO International, which aims to increase support for existing programs and to invest in new programs aimed at global cancer control. One important strategy will be to use digital resources (ie, virtual meetings and mentoring) “to knit the world closer together.”

Supporting the Next Generation of Leaders and Providers
Supporting the next generation of clinical cancer researchers is a priority, said Dr Swain. Although 98% of past winners of ASCO’s Young Investigator Award and Career Development Award programs are still involved in cancer research, donations to support the program are declining, an unwelcome occurrence at a time when federal research dollars are dwindling.

ASCO is continuing its successful and popular Leadership Development Program in an effort to develop the next generation of leaders, but potential shortfalls in practicing oncologists are a concern. “Will we be able to meet the projected increase in cancer cases? To better understand and monitor these trends, ASCO has established a workforce information system,” she said.

The number of oncologists aged ≥64 years is growing rapidly, and outnumbers those aged <40 years. Furthermore, only 3% of oncology fellows are black and 8% are Hispanic. To address disparities in which populations receive access to cancer care, a diverse professional workforce is necessary.

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