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In March 2007, results of a study commissioned by the American Society of Clinical Oncology (ASCO) Board of Directors on supply and demand for oncology services through 2020 were released. The study indicated that that the United States is likely to face a nearly 50% increase in demand for oncology services by 2020, largely because of the expected increases in both cancer survivorship and cancer incidence caused by the aging population. The anticipated increase in the supply of oncologists during that timeframe will not meet the growing demand.

Results from the 2007 ASCO study were likely conservative with regard to predictions. As the general population gets older, it’s likely to seek more healthcare services than those who are currently 65 or older. Furthermore, improvements in cancer treatments are enabling patients to living longer. In turn, these individuals may eventually be faced with other cancer diagnoses and/or chronic illnesses later in life. Oncology workforce shortages can affect the entire medical community. Unless actions are taken, it’s likely that we’ll face a crisis in our ability to provide quality cancer care for patients.

New Initiatives

In the November 2008 Journal of Oncology Practice, ASCO’s Workforce Advisory Group issued a strategic plan to address projections indicating that demand for oncology services will surpass the supply of practicing oncologists in the years to come. While no single action will fulfill the supply and demand gap completely, efforts are being made to develop multifaceted approaches that address oncology workforce shortages so that future demands can be met.

One of the major actions that ASCO (as well as other associations) are currently undertaking is to develop an information database that tracks real-time trends in the oncology workforce. The goal of this database is to monitor the oncology workforce supply. It will gather actual figures on the number of practicing oncologists in the U.S. and compare these data to benchmarks established in 2007. We’re anticipating our first report on this data sometime near the end of 2009.

Important Recommendations

ASCO also recommends evaluating in greater detail the delivery of oncology care by collaborating with other physicians and non-physicians. Most oncologists already work with non-physician practitioners (eg, nurse practitioners and physician assistants), but only about half of these providers perform advanced activities like helping with new patient consults or ordering routine chemotherapy. Identifying the most productive elements of innovative practice models is necessary to improve delivery of care.

Another area where improvements can be made to increase the oncology workforce supply is to expand the number of oncology training slots in residency and fellowship programs. Currently, the number of these positions in oncology is limited. Efforts are also needed to increase medical student and resident exposure to oncology. In addition, ASCO is examining the use of “survivorship clinics.” These clinics have developed paradigms to optimally manage patients once their cancer is in remission and they no longer require active treatment. Survivorship clinics can provide ongoing, integrated long-term follow-up care. In the U.S., some practices have established these clinics with non-physician practitioners, so integrated collaboration with the oncology workforce is paramount.

Our primary goal with each of these recommendations is to ensure that patients continue to have access to high-quality cancer care. We’ve made extraordinary developments, but our progress is at risk if we don’t identify future patient needs in a comprehensive manner and address them using evidenced-based approaches.

Dean F. Bajorin, MD, FACP, has indicated to Physician’s Weekly that he has worked as a consultant for Eli Lilly and Company, Bristol-Myers Squibb, and GPC Biotech. He has also received grants/research aid from Eli Lilly and Company, Bristol-Myers Squibb, GPC Biotech, Genentech, and Pfizer.