Despite the fact that my colleagues’ pioneering work has contributed to a 33% reduction in cancer mortality over the last three decades, far too many patients, particularly the most vulnerable, are yet to benefit from these improvements
Every year, data detailing revolutionary medications and novel technology to battle cancer are given at the American Society of Clinical Oncology (ASCO) Annual Meeting, addressing the substantial unmet need in oncology and bringing hope. This year’s conference was no exception; academics presented over 5,000 presentations, highlighting cutting-edge research in the quest to eliminate the country’s second-leading killer, which continues to disturb the lives of two million people each year.
One of the most encouraging discoveries at ASCO was that Medicaid expansion was linked to a reduction in mortality and racial disparities among people with gastrointestinal cancer. These findings indicate that increasing health coverage is a vital step towards reducing inequities and eliminating cancer.
Regardless of these advancements, ASCO serves as a yearly reminder of a sad reality. Although my colleagues’ groundbreaking work has contributed to a 33% drop in cancer mortality over the last three decades, far too many patients, particularly the most vulnerable, have yet to benefit from these advances. This is due to existing disparities depending on race/ethnicity, socioeconomic status, insurance types, and geographies, such as ZIP code or distance from a National Cancer Institute-Designated Comprehensive Cancer Centre (NCI-CCC).
We need to create a new cancer care delivery paradigm to make a difference and bridge the gap between innovation and access. Increasing healthcare coverage is a good start, but it is insufficient.
Data show that Medicaid recipients in California had poorer cancer results than those with other types of insurance, or in some circumstances, no insurance at all. We know that socioeconomic determinants of health and genetics play a role in inequities, but the complexity of our healthcare system – notably institutional impediments like insurance “narrow networks” – exacerbates the problem.
Tight networks may exist for less complex diseases or in primary care, but cancer treatment is distinct. The discipline no longer functions as a single speciality, but rather as a collection of sub-specialities characterised by tumour origin and distinct genetic or DNA blueprint, necessitating additional sub-specialization. By using restricted networks for cancer, we are adding stress to a delivery system that is already trying to keep up with the pace of discovery, and we are creating a situation in which patients with severe conditions may lack access to the necessary expertise to maximise their outcomes.
Depriving beneficiaries of the most recent research and advancements has an immediate impact, as indicated by certain concerning cancer surgery statistics when comparing Medicare Advantage (MA) with regular Medicare. Cancer patients on MA who had their stomach or liver removed were 1.5 times more likely to die during the first month of surgery than standard Medicare participants. Furthermore, MA recipients who underwent pancreatic cancer surgery were twice as likely to die within the first month.
In the long run, we are denying our children and grandkids therapies that will benefit a greater number of people. Clinical research at speciality cancer centres lays the way for the introduction of these new, more effective treatments. Products with restricted network designs fundamentally hinder our progress on discoveries – the same kinds of achievements we read about at ASCO every year. Minorities are disproportionately disadvantaged since they are more likely to have limited network products.
It is past time for a change.
This might entail extending access to appropriate cancer care for Medicaid patients, as California did with the California Cancer Care Equity Act. At the federal level, this might imply redefining “network adequacy” to increase access to additional speciality cancer centres in Massachusetts. In all circumstances, stakeholders from across the spectrum will need to collaborate; for example, community and academic centres can better collaborate so that patients receive care based on need rather than insurance product design.
We should also consider digital innovation to help close the gap, such as CancerX, a public-private partnership aimed at encouraging innovation in the fight against cancer as part of the White House’s relaunched national Cancer Moonshot initiative.
We must recognise that coverage is not the same as caring. To stay up with innovation, we need to modernise the system, and we can start by reforming narrow networks. This will allow all patients to benefit equally from the most recent breakthroughs, closing the gap between innovation and access.
