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ASCO Reflections: In the Fight Against Cancer, Health Coverage is Not Enough

Although the revolutionary work of my colleagues has contributed to a 33% reduction in the cancer death rate over the last three decades, too many patients – particularly the most vulnerable – still never benefit from these innovations.

health insurance, Obamacare

Every year at the American Society of Clinical Oncology (ASCO) Annual Meeting, data highlighting groundbreaking therapies and innovative technologies to combat cancer are shared, addressing the significant unmet need in oncology and providing hope. This year’s conference has been no different; researchers presented more than 5,000 abstracts, showcasing leading-edge research in the race to end the country’s second-biggest killer which continues to disrupt the lives of two million people each year.

Perhaps one of the most encouraging takeaways from ASCO was research showing that Medicaid expansion was linked to a decrease in mortality and racial disparities for people with gastrointestinal cancers. These data show that improving health coverage is a critical step toward addressing disparities and eradicating cancer.

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However, despite these advancements, ASCO also serves as an annual reminder of a more sobering truth. Although the revolutionary work of my colleagues has contributed to a 33% reduction in the cancer death rate over the last three decades, too many patients – particularly the most vulnerable – still never benefit from these innovations. This is due to existing disparities by race/ethnicity, socioeconomic status, insurance type, and geography – such as by ZIP code or distance from a National Cancer Institute-Designated Comprehensive Cancer Center (NCI-CCC).

In order to begin to make a real difference and truly bridge the gap between innovation and access, we need to create a new cancer care delivery paradigm. Expanding health coverage is a start, but it is insufficient.

Data have demonstrated that in California, Medicaid beneficiaries have worse cancer outcomes compared to patients with other forms of insurance, or in some cases, with no insurance at all. We know social determinants of health and genetics are also important drivers of disparities, but the complexity of our health system – particularly systemic barriers like insurance “narrow networks” – makes matters worse.

Although narrow networks may work for less complex diseases or in primary care, cancer care is different from other conditions. The field no longer behaves as one specialty, but rather many sub-specialties defined by tumor origin and specific genetic or DNA blueprint, creating a need for more sub-specialization. By using narrow networks for oncology, we are adding stress to a delivery system that is already challenged to keep up with the pace of discovery and creating a situation where patients with complex cancers will lack access to the necessary expertise to optimize their outcome.

Depriving beneficiaries of the latest research and innovations has immediate impact, as evidenced by some worrying cancer surgery statistics when comparing Medicare Advantage (MA), which uses narrow networks, with traditional Medicare. Cancer patients with MA who had their stomach or liver removed were 1.5 times more likely to die within the first month after surgery compared to members with traditional Medicare. And MA beneficiaries who had oncologic surgery on the pancreas were two times as likely to die within the first month.

In the long term, we are depriving our children and grandchildren of treatments that will work for more people. The clinical research that takes place at specialty cancer centers paves the road to launching these new, more effective medications. By limiting access to trials, products with narrow network designs essentially slow our progress on new discoveries – the same kind of breakthroughs we hear about every year at ASCO. And given minorities are more likely to have narrow network products, they are disproportionately disadvantaged.

It is time for reform.

At the state level, this could mean expanding access to optimal cancer care for Medicaid beneficiaries, as was done in California with the California Cancer Care Equity Act. At the federal level, this could mean redefining “network adequacy” to expand access to more specialty cancer centers in MA. In all cases, stakeholders across the spectrum will need to work together; community and academic centers, for instance, can better work in partnership so patients receive care based on need, not insurance product design.

We should also look at digital innovation to help close the gap through initiatives such as CancerX, which supports better cancer care and research through a public-private partnership designed to boost innovation in the fight against cancer as part of the White House’s reignited national Cancer Moonshot initiative.

We must recognize that coverage is not care. We need to modernize the system to keep pace with innovation, and we can start by reforming narrow networks. Doing this will help all patients benefit equally from the latest advancements and begin bridging the gap between innovation and access.

Photo: BrianAJackson, Getty Images

Harlan Levine, M.D., is the president of health innovation and policy at City of Hope (COH), a National Cancer Institute-Designated Comprehensive Cancer Center dedicated to ensuring optimal cancer care through patient focused treatments. Dr. Levine also serves as the chair of the board of AccessHope™, a spinout company from COH that is focused on serving the employer market and making leading-edge cancer care available to all regardless of geographical location.

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