TUESDAY, March 11, 2014 (HealthDay News) -- People fighting
cancer might have to wait longer to see a cancer specialist in the
coming decades, as demand for treatment outpaces the number of
oncologists entering the workforce, a new report released Tuesday
Demand for cancer treatments is expected to grow by 42 percent
or more by 2025, while the supply of oncologists will only increase
by 28 percent, experts found.
The mismatch between supply and demand could result in a
shortage of nearly 1,500 oncologists by 2025, according to the
American Society of Clinical Oncology (ASCO) report.
People living in rural areas will be hardest hit by the
shortage, the report predicted. Currently, only 3 percent of
oncologists are based in rural areas, even though that's where 20
percent of Americans live.
"We never want to have a cancer patient have to wait to get in
to see a cancer physician," said Dr. Richard Schilsky, ASCO's chief
medical officer. "Since we're aware of the issue, we are beginning
to think about how to mitigate it."
Schilsky said he believes oncologists will need to rely on
primary-care physicians, nurse practitioners and physician
assistants to handle basic cancer treatment and follow-up care as
demand for services grows. "That will leave the oncologists time to
deal with the more complex cancer patients," he explained.
Certain factors will likely combine to increase the number of
patients seeking cancer treatment in coming years, Schilsky said,
including: The aging of the baby boomer generation. "They are now all in
their 60s, and that's the age at the highest risk for getting
cancer," he said.Improved cancer treatment. A record 13.7 million cancer
survivors now live in the United States, Schilsky said, and many
want to maintain a relationship with their oncologist even though
they are cancer-free.Health care reform. "There are going to be millions of people
who didn't previously have health insurance and [who] will be
seeking care for cancer," Schilsky said.
The total annual cost of cancer care in the United States is
projected to reach $175 billion by 2020, an increase of 40 percent
from 2010, according to the report.
The ASCO report predicted that there won't be enough cancer
doctors on hand to meet this demand.
One expert not involved with the report agreed that a large gap
in specialists is looming.
"I personally think it's a topic we know is going on in the
oncology community, but when you're talking about the big picture
of health care these things can get overlooked," said Dr. Janna
Andrews, an attending physician in the department of radiation
medicine at the North Shore-LIJ Cancer Institute in Lake Success,
Andrews said people in rural areas already are feeling the
effects of a shortfall. "You probably see that now in the more
rural areas, where you are diagnosed with cancer and then you find
the closest center to treat you is over two hours away," she
Another issue is that the field has its own aging workforce, the
ASCO report noted.
"About 20 percent of currently practicing oncologists are now
approaching the retirement age of 65," Schilsky said. The number of
oncologists older than 64 exceeded those under 40 for the first
time in 2008, and the gap is expected to widen.
Dr. Steven Paulson, an oncologist and hematologist at Texas
Oncology, a US Oncology Network affiliate in Tyler, Texas, said
some oncology practices are struggling.
"The challenges facing practicing medical oncologists are making
it very difficult for small and even medium-sized oncology
practices to survive," Paulson said. "Many older physicians will
simply retire, worsening the shortages already projected."
And the supply of new graduates is not likely to keep pace with
demand, according to ASCO. As pressure builds, many cancer doctors
are likely to burn out and either reduce their clinical hours or
leave the field altogether, the report suggested.
"Oncology is a very, very demanding specialty where you have to
be available 24/7," Schilsky said. "You are dealing with people who
face life-threatening illnesses, many of whom will succumb to that
illness. There's this work-life balance we have to figure out how
to deal with."
Oncologists might be able to help the situation by shifting some
of their simpler cancer treatments to highly trained nurse
practitioners or physician assistants. "Once they are properly
trained, they have the skills to handle uncomplicated cancer
patients," Schilsky said.
Primary-care physicians also can play a role, by taking over the
care of cancer survivors. Oncologists can provide a "survivorship
care plan" that will note the potential long-term side effects of a
patient's cancer treatment, as well as their future cancer
"By leveraging all of the resources in the health care system,
we think we can mitigate a lot of this," Schilsky said.
The federal government also can help by steering more money
toward training new oncologists.
Most new doctors require two to three years in an oncology
fellowship before they are ready to practice, and Medicare pays for
the first year of this training in virtually all cancer teaching
programs, Schilsky said.
But Medicare funding for medical training has been ratcheting
down, he said, and that has constrained the number of doctors who
can seek out an oncology fellowship.
"It's limiting the availability of fellowship slots, even for
people who are interested in getting that training," Schilsky
To read the full report on the state of cancer care, visit the
American Society of Clinical Oncology.