ASCO Reflections: In the Fight Against Cancer, Health Coverage is Not Enough
The Annual Meeting of the American Society of Clinical Oncology (ASCO) serves as a platform for sharing groundbreaking cancer therapies and technologies, offering hope and addressing the significant unmet need in oncology. This year’s conference featured over 5,000 abstracts, showcasing cutting-edge research in the ongoing battle against the second-leading cause of death in the United States, affecting two million individuals annually.
Among the positive outcomes highlighted at ASCO was research indicating that Medicaid expansion correlates with a reduction in mortality rates and racial disparities among individuals with gastrointestinal cancers. These findings underscore the importance of improving health coverage as a crucial step in addressing disparities and eradicating cancer.
However, ASCO also reminds us of a more somber reality. Despite the remarkable progress made by researchers, which has contributed to a 33% decrease in the cancer death rate over the past three decades, many patients, especially the most vulnerable, still do not benefit from these innovations. This is primarily due to existing disparities based on race/ethnicity, socioeconomic status, insurance type, and geographical factors, such as ZIP code or proximity to a National Cancer Institute-Designated Comprehensive Cancer Center (NCI-CCC).
To make a substantial difference and bridge the gap between innovation and access, we need to establish a new paradigm for delivering cancer care. Expanding health coverage is a necessary starting point, but it is not sufficient on its own.
Data from California have revealed that Medicaid beneficiaries experience worse cancer outcomes compared to patients with other forms of insurance or even those without insurance at all. While social determinants of health and genetics also play significant roles in disparities, the complexity of our health system, particularly systemic barriers like insurance “narrow networks,” exacerbates the situation.
While narrow networks may be effective for less complex diseases or primary care, cancer care is distinct. It no longer operates as a single specialty but encompasses numerous sub-specialties defined by tumor origin and specific genetic or DNA characteristics, necessitating further specialization. By employing narrow networks in oncology, we are adding strain to a healthcare system already struggling to keep up with the pace of advancements, resulting in patients with complex cancers lacking access to the specialized expertise required to optimize their outcomes.
Denying beneficiaries the latest research and innovations has immediate consequences, as evidenced by concerning statistics on cancer surgeries when comparing Medicare Advantage (MA), which utilizes narrow networks, with traditional Medicare. Cancer patients with MA who underwent stomach or liver removal surgery were 1.5 times more likely to die within the first month after the procedure compared to members with traditional Medicare. Furthermore, MA beneficiaries who underwent oncologic surgery on the pancreas were twice as likely to die within the first month.
In the long term, this deprivation affects not only the current generation but also future ones, as it hampers the development of treatments that could benefit a larger population. The clinical research conducted at specialized cancer centers lays the groundwork for launching these new, more effective medications. By limiting access to trials, products with narrow network designs impede progress in discovering breakthrough treatments, similar to the advancements highlighted each year at ASCO. Moreover, minority populations are more likely to have narrow network products, exacerbating their disadvantage.
Reform is imperative.
At the state level, this could involve expanding access to optimal cancer care for Medicaid beneficiaries, as was done in California with the California Cancer Care Equity Act. On a federal level, redefining “network adequacy” to ensure access to more specialized cancer centers in MA plans could be a step forward. Regardless of the approach, stakeholders across the healthcare spectrum must collaborate. Community and academic centers, for instance, can work in partnership to ensure that patients receive care based on their needs rather than insurance product design.
Furthermore, we should explore digital innovations to help bridge the gap, such as initiatives like CancerX. This public-private partnership aims to enhance cancer care and research by fostering innovation in the fight against cancer, aligning with the national Cancer Moonshot initiative.
We must recognize that coverage does not equate to care. To keep pace with innovation, we need to modernize our system, and reforming narrow networks is a tangible starting point. Such measures will enable all patients to equally benefit from the latest advancements, bridging the gap between innovation and access.
