Guest Update by Dr. Martin Brown
NCI Surveillance Program Helped Project Oncologist Shortage
The leadership of ASCO should be commended for sponsoring the AAMC report on the U.S. oncology work force. The conclusions they reach are clearly concerning: A potential shortage of 2,550 to 4,080 oncologists in the United States by 2020.
In many respects, the fact that a shortage is being projected is not surprising. We have known for some time that the population is aging and that, as a result, cancer incidence and prevalence are likely to increase. Using data from SEER and the SEER-Medicare Linked Database, NCI was able to generate specific projections of cancer prevalence and of the demand for oncology services through 2020. These data, combined with information on medical school graduation rates and reports from other specialty medicine groups about work force availability, raise concerns that there may be a shortage of oncologists over the next two decades.
With this new report, we now have a credible analysis from which the cancer and medical communities can begin to work together to address a serious situation, something ASCO is already doing with the assembly of an expert Workforce Implementation Group.
NCI’s contribution to this report was important, because it helped to quantify in the most accurate way possible the demand component of the analysis. We were able to do this because of NCI’s commitment to cancer surveillance research resources and personnel.
Dr. Angela Mariotto and colleagues from the Statistical Research Applications Branch in DCCPS used SEER data from 2000 to 2002 and applied it to the most recent U.S. Census Bureau population projections to develop a rigorous method for projecting incidence and prevalence for all cancers from 2000 through 2020. That work led to a forecast of a 48-percent increase in cancer incidence and an 81-percent increase in people living with or surviving cancer over this time period.
Dr. Joan Warren and colleagues from the Health Services and Economics Branch in DCCPS used data from the SEER-Medicare database to construct a model that separated out oncologist visit rates by patient sex, age, and time of diagnosis during patients’ first 12 months after diagnosis, last 12 months of life, and the period in between.
These analyses made it possible for the ASCO/AAMC study team to develop a clearer picture of important trends in cancer care, particularly the influence of increased cancer survivorship. These analyses revealed that two-thirds of the projected visits to oncologists in 2020 will be made by patients who are more than 1 year post-diagnosis.
That is likely due, in part, to the benefits being seen with adjuvant chemotherapy in breast and other cancers, and it means that, moving forward, oncologists will be involved in direct patient care with individual patients over longer periods of time. As a result, they may need to depend more on physician assistants and nurse practitioners and consult more closely with patients’ primary care physicians. Physician-patient communication and coordination of care, already topics of concern for U.S. health care delivery, will become even more important. Surveillance of such trends will be critical to a better understanding of the quality of cancer care and where, perhaps, efficiencies in care can be gained.
NCI staff are currently working on a paper for publication that will provide the technical details of how the demand projections that contributed to this important work force study were generated. In the interim, it’s gratifying to yet again witness the power of our surveillance program and contribute to an important new study that will help shape cancer care.