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January 23, 2020

The Future of Cancer Care in the United States—Overcoming Workforce Capacity Limitations

Author Affiliations
  • 1Abramson Cancer Center, University of Pennsylvania, Philadelphia
  • 2Oncology Nursing Society, Pittsburgh, Pennsylvania
  • 3The Cancer Center, St Joseph Hospital, Nashua, New Hampshire
  • 4Dana-Farber Cancer Institute, Boston, Massachusetts
  • 5Departments of Medical Oncology, Medicine, Pediatrics, and Genetics, Harvard Medical School, Boston, Massachusetts
JAMA Oncol. Published online January 23, 2020. doi:10.1001/jamaoncol.2019.5358

The growth in the number of patients with cancer and cancer survivors in the United States is greatly outpacing the number of clinicians available to care for them. Although age-adjusted cancer incidences and mortality rates are decreasing in the United States, population growth and aging have contributed to a substantial increase in patients requiring cancer care and survivorship care. According to the American Association for Cancer Research, approximately 1.76 million people were expected to receive a cancer diagnosis in the United States in 2019, and the number is estimated to increase to 2.3 million by 2035.1 The number of cancer survivors in the United States was estimated to be 15.5 million in 2016 and is predicted to be 20.3 million by 2026.2 However, the number of oncology clinicians is increasing at a much slower rate, and the first generation of oncologists and oncology nurses trained in the 1970s is beginning to retire.3 In some geographic areas, this disparity is exacerbated by the known maldistribution of oncologists, with greater shortages observed in rural areas.4

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    1 Comment for this article
    Regional Partnerships in Cancer Prevention and Treatment
    Fu Jin, Ph.D. | Department of Radiation Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital
    During the past decades, cancer prevention has borne fruit. The latest statistics showed that the cancer incidence rate was stable in women and declined annually by about 2% in men in the United States. Timely and effective treatment has also achieved remarkable results. The cancer death rate among women and men both declined annually by 1•4% and 1•8%, respectively.1 The number of patients with cancer and cancer survivors is growing steadily, but the number of oncologists is increasing slowly. As Shulman LN and colleagues said, in order to solve this contradiction, increasing efficiencies may be the only available solution.2
    this viewpoint, they proposed two broad strategies to optimize care delivery, practice level (enhanced team–based inter–professional practice, etc.) and system level (advanced technology, etc.). These strategies are indeed effective to some extent, but we should also pay attention to other factors. In fact, partly due to different degree of socioeconomic development besides demographic traits, the cancer profiles vary widely among regions. Meanwhile, oncologists are unevenly distributed particularly in some rural areas. Therefore, the death rate was approximately 20% higher among the poorest residents compared with the most affluent counties during 2012–2016.1 How can we reduce the impacts of these inequalities on cancer prevention and treatment?
    On the one hand, there is no doubt that oncologists should focus on various new cancer therapies and bio–marker tests to improve survival rates. Moreover, they need specialize in special cancer treatment based on incidence and death rates of states where they live, because these rates are different among regions. Once this becomes a reality, it will no longer be difficult to streamline management of routine medical and administrative issues for these cancers. Additionally, it is notable that 71% of cases in the United States are potentially preventable due to modifiable risk factors. Wanqin Chen and colleagues also showed that 45•2% of cancer deaths could be prevented if regionally–tailored strategies were adopted based on modifiable risk factors.3 All of them make oncologists focus on regional precision cancer medicine to improve efficiencies.
    On the other hand, cancer treatment largely depends on high–tech therapeutic equipments besides skilled human resources. But as an Editorial reflected, "for most patients living with cancer in low–income and middle–income countries, access to these remains a utopia."4 A broader sharing of regional resources would undoubtedly reduce regional inequalities (workforce and equipment shortages, knowledge gaps, etc.). Oncologists should gather information through the advanced technologies (Cloud, Mist, etc.) within and across regions, and perform intra– and inter–disciplinary collaborative medicine to make the optimal choice for individual patient, in the hopes of making clinical practice faster, more accurate, comfortable, and economic (i.e. "FACE" principle).
    The changes in national policies usually lag behind changes in individual practices. Regional adoption of effective strategies has vast potential to improve efficiency and productivity of oncologists.
    1. Siegel RL, Miller KD, A J. CA Cancer J Clin. 2019;69:7-34.
    2. Shulman LN, Sheldon LK, Benz EJ. JAMA Oncol. 2020. doi:10.1001/jamaoncol.2019.5358
    3. Chen W, Xia C, Zheng R, et al. Lancet Glob Health. 2019;7(2):e257-e269.
    4. The Lancet Global Health. Lancet Glob Health. 2019;7(3):e281.