The Community Oncology Alliance (COA), a non-profit organization dedicated to preserving and fostering community cancer care, has released a new report (http://tiny.cc/9gw8bw) documenting cancer clinic closings and the stresses to the cancer delivery system.

This latest report comes on the heels of studies released by Avalere and Milliman documenting lower costs to patients and payers of cancer treatment provided in community clinics and widespread media reporting of the cancer drug shortage gripping the nation.

The COA report reveals the continuance of a dire negative trending: 241 community cancer clinic sites have closed during the past four and a half years, and 442 practices (often with multiple clinic locations) are struggling financially. Consolidation of cancer care is documented by 392 practices that have been purchased by hospitals, or formed a financial arrangement, and 132 practices that have merged or been acquired by a corporate entity.

“As a practicing oncologist, I am critically concerned about the adverse impact on patients of the dramatic changes in our delivery of cancer care,” said David Eagle, MD, president of COA and an oncologist in Lake Norman, NC. “Patients are falling through the treatment cracks and now we are struggling to find essential cancer care drugs. Forty years ago we declared the war on cancer, and I never thought I would see the day when we would be at risk of losing the war.”

In 2005, the Centers for Medicare & Medicaid Services (CMS) implemented significant Congress-mandated changes to the way Medicare, which accounts for close to half of all cancer treatment costs, reimburses for cancer care. Unlike other areas of medicine, Medicare has an inordinate influence on how private payers reimburse for cancer care.

This initiated a change in the cancer treatment landscape, as documented by the latest COA report just released. Recent studies by Avalere (http://tiny.cc/ejw8bw) and Milliman (http://tiny.cc/lkw8bw) have documented the lower costs to patients, Medicare, and private payers when care is delivered in oncologists’ community practices.

“Our practice has had to close a clinic in Wyoming because of unworkable changes to payment for cancer care,” said Patrick Cobb, M.D., an oncologist in Billings, MT, and immediate past president of COA. ”The overall crisis in cancer care is hurting patients and increasing costs for them and every American taxpayer. Congress has to act swiftly or we will end up with less access to quality cancer care and higher costs — the exact opposite of healthcare reform.”

“An imploding cancer delivery landscape and drug shortages, combined with the debacle of SGR-based physician Medicare payment cuts, are a recipe for disaster,” said Ted Okon, Executive Director of COA. “We have solutions but the Administration and Congress are more interested in political infighting and short-term patching than stabilizing and strengthening the cancer care delivery system, now and for generations of Americans to come.”

By 2020, there will be an estimated shortage of 4,080 oncologists, the equivalent of one in four cancer patients without an oncologist. National Analysts released a study reporting that 20% of oncologists would discourage a medical student/resident from pursuing a career in oncology, versus only 3% in 2003, prior to the problems caused by severe Medicare payment cuts.

About Community Oncology Alliance (COA)
Formed in 2003 by community oncologists, COA is a non-profit organization dedicated solely to community oncology, where four out of five Americans with cancer are treated.   COA advocates for patients’ access to quality, affordable cancer care in the community setting.  The organization is currently advocating for a solution to the nation’s drug shortage crisis.

COA Past President Dr. Patrick Cobb and COA Executive Director Ted Okon have both been asked to testify before Congress on the reasons for the shortages and their impact on cancer treatment.  COA also has a multi-stakeholder group involved with the implementation of the Oncology Medical Home, a cancer care model that fosters quality and value in cancer care.

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As the world’s largest professional society concerned with the causes and treatment of blood disorders, many of our more than 16,000 members are on the front lines of dealing with the country’s severe shortage of methotrexate, a drug critical in the treatment of children with acute lymphocytic leukemia (ALL).

The Food and Drug Administration (FDA) reported that two manufacturers plan additional releases within the week of February 20th, at the end of February, and continuing into March, which it anticipates will meet all patient needs.

While the Society is pleased with this announcement, we realize the shortage is still critical at many sites throughout the country and urge the FDA to ensure that once supplies are available, hematologists can have information on how to access this therapy for their critically ill patients.

ASH has been working hard to address the shortage, including reporting shortages to the FDA and Congress and urging the FDA to take immediate action to identify other manufacturers to meet demand, import supplies from overseas, and establish an emergency supply once there is a release so that supplies can be easily accessed.

Over the past year the Society has led collaborative efforts with the FDA, Congress, and senior health officials in the Administration to resolve not only this shortage, but also shortages of more than 200 other drugs, many of which are used to treat patients with hematologic diseases, that have become critical and life-threatening.

This week the Society sent a letter of support to Representatives Larry Buscon (D-IN) and John Carney (D-DE) who introduced bipartisan legislation (H.R. 3839, the Drug Shortage Prevention Act) that would provide expedite FDA review of drugs in shortage, improve communication within the agency and with stakeholders about possible shortages, and increase Drug Enforcement Administration (DEA) quotas for medications in short supply.

The Society is also submitting comments this week to the FDA concerning its Interim Final Rule, issued in response to the President’s Executive Order of Oct. 31, 2011, to enable the FDA to improve its collection and distribution of drug shortage information.

The steps the Society has taken over the past year have had impact. Following the introduction of bills in the House and Senate last year (S. 296/H.R.2245, the Preserving Access to Life-Saving Medications Act) mandating early notification by manufacturers of drugs in short supply, ASH was the first medical society to call on Congress to conduct hearings and has made recommendations on ways to prevent and mitigate drug shortages that are being incorporated into legislative and regulatory proposals.

ASH will continue to monitor all hematologic drug shortages closely and will continue to work with policy makers to protect the health of Americans.

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