ASCO Reflections: Health Insurance Isn’t Enough in the Fight Against Cancer

ASCO Reflections: Health Insurance Isn't Enough in the Fight Against Cancer
ASCO Reflections: Health Insurance Isn't Enough in the Fight Against Cancer

Despite the fact that my colleagues’ groundbreaking work has contributed to a 33% drop in cancer mortality over the last three decades, far too many patients, particularly the most vulnerable, have yet to benefit from these advances.

Every year, data detailing revolutionary medications and novel technology to battle cancer are given at the American Society of Clinical Oncology (ASCO) Annual Meeting, addressing the substantial unmet need in oncology and bringing hope. This year’s conference was no exception; academics presented over 5,000 presentations, highlighting cutting-edge research in the quest to eliminate the country’s second-leading killer, which continues to disturb the lives of two million people each year.

One of the most hopeful findings at ASCO was that Medicaid expansion was associated with a reduction in mortality and racial inequalities among persons with gastrointestinal malignancies. These findings indicate that increasing health coverage is a vital step toward reducing inequities and eliminating cancer.

Despite these advances, ASCO serves as an annual reminder of a more depressing reality. Despite the fact that my colleagues’ groundbreaking work has contributed to a 33% drop in cancer mortality over the last three decades, far too many patients, particularly the most vulnerable, have yet to benefit from these advances. This is because of existing differences based on race/ethnicity, socioeconomic position, insurance type, and location – for example, ZIP code or distance from a National Cancer Institute-Designated Comprehensive Cancer Center (NCI-CCC).

To actually make a difference and bridge the gap between innovation and access, we must develop a new cancer care delivery paradigm. Increasing health-care coverage is a good start, but it is insufficient.

Data show that Medicaid recipients in California had poorer cancer results than those with other types of insurance, or in some circumstances, no insurance at all. We know that socioeconomic determinants of health and genetics play a role in inequities, but the complexity of our health-care system – notably institutional impediments like insurance “narrow networks” – exacerbates the problem.

Although tight networks may operate for less complex diseases or in primary care, cancer care is unique. The discipline no longer functions as a single speciality, but rather as a collection of sub-specialties characterized by tumor origin and distinct genetic or DNA blueprint, necessitating additional sub-specialization. We are adding stress to a delivery system that is already struggling to keep up with the speed of discovery by employing narrow networks for oncology, and we are creating a situation in which patients with complicated malignancies will lack access to the requisite expertise to maximize their result.

In the long run, we are denying our children and grandkids of therapies that will benefit a greater number of people. Clinical research at speciality cancer centers lays the way for the introduction of these new, more effective drugs. Products with restricted network designs fundamentally hinder our progress on new discoveries – the same kinds of achievements we read about at ASCO every year. Minorities are disproportionately disadvantaged since they are more likely to have limited network products.

It is past time for change.

This might entail extending access to appropriate cancer care for Medicaid patients, as California did with the California Cancer Care Equity Act. This might imply redefining “network” at the federal level.

This might entail extending access to appropriate cancer care for Medicaid patients, as California did with the California Cancer Care Equity Act. At the federal level, this might imply redefining “network adequacy” in order to increase access to additional specialized cancer centers in Massachusetts. In all circumstances, stakeholders from across the spectrum will need to collaborate; for example, community and academic centers can better collaborate so that patients receive care based on need rather than insurance product design.

We can also consider digital innovation to help reduce the gap, such as CancerX, which promotes improved cancer treatment and research through a public-private collaboration meant to increase innovation in the fight against cancer as part of the White House’s Cancer Innovation Initiative.

relaunched the national Cancer Moonshot project.

We must know that coverage is not the same as care. To stay up with innovation, we need to update the system, and we may start by changing narrow networks. This will allow all patients to benefit equally from the most recent breakthroughs, closing the gap between innovation and access.

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