What Has Impacted the Costs and Finances Associated With Cancer Care?

The high cost of cancer care is a mystery to nobody. While treatments have become more advanced and survival rates have increased, so too has the cost of these treatments. This is not the result of a single policy change or treatment, it is the culmination of many little decisions, policies, and advancements.

CancerNetwork® spoke with Loretta Nastoupil, MD, a practicing oncologist at Southwest Oncology in Durango, Colorado, an affiliate of CommonSpirit Oncology Mercy, about the finances and costs associated with cancer care from the perspective of a physician. While Nastoupil currently practices in a more rural, community center, her past history of working at MD Anderson Cancer Center, a large, institutional center, gives her a unique perspective into the reality and differences of both settings.

In her opinion, the consolidation of oncologists is one of the factors that has had the greatest impact on oncology over the last few years. As the prices associated with cancer care have risen, they have become “insurmountable” for many private practices; large academic groups have since begun purchasing community and private practices.

She also noted that the transition from traditional chemotherapy to newer, more expensive treatments like bispecific antibodies and CAR T-cell therapies has also led to changes, particularly in the payer mix.

What specific events have had a consequential effect on the economics of oncology?

For some background, I spent over a decade as an academic practicing oncologist at MD Anderson Cancer Center in Houston, Texas. I’m now a community oncologist in a rural community that’s a hospital-based practice. There are unique challenges in both settings. But what has really impacted the practice of oncology over the last few years is the consolidation of oncologists. The cost of drugs and the delivery of therapy in terms of supporting office staff have become insurmountable for most private practices. To address this, most have consolidated. You have these large academic groups that are buying up community or private practices. They have a better outreach into the community because we know that most patients in the US receive their care in community practice. [Additionally], you have these large hospital groups that are coming in and buying up smaller practices, and that’s currently where I practice.

Transitioning away from traditional chemotherapy to immune therapy, bispecific antibodies, and CAR T-cell therapies are major transition points. Married to that, because the cost of delivery of that care is so high, we’re seeing changes in the payer mix as well. This is going to [become] even more challenging over the next few years. For instance, where I practice, we provide care for patients who have Medicaid, Medicare, and even patients in the VA system, as there’s no VA hospital near us. We probably provide care for fewer privately insured patients, given that we have a large mix of retirees in this community. That’s also going to pose even greater challenges as we move forward.