Introduction

There is currently a crisis in cancer care that experts predict will worsen in the near future due to a rapidly growing population of Americans requiring cancer care combined with an aging/retiring oncology workforce, and inadequate numbers of replacement workers. By 2020, the American Society of Clinical Oncology (ASCO) predicts a 48 percent increase in cancer incidence and an 81 percent increase in people living with or surviving cancer (Erikson et al., 2007). For the same time period, ASCO predicts only a 14 percent increase in the number of practicing oncologists. Expected shortages in other health care workers who are involved in cancer care, including nurses, physician assistants, laboratory and radiology technicians, social workers, radiologists, surgeons, pharmacists, public health workers, and cancer registrars, also will affect both the quantity and the quality of cancer care in the 21st century. In addition, achieving improvements in any aspect of cancer care—including research, clinical trials, health disparities, access to care, patient navigation, survivorship, palliative care, etc.—will be difficult if not impossible without a sufficiently staffed general health care workforce. This is particularly true, since the majority of cancer care is not delivered in major cancer centers, but rather, is provided by primary care physicians and community practices.

Although other health care fields are also expected to face severe shortages in their workforces, there are factors in oncology that make its workforce issues particularly challenging, including the wide range of treatment



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Introduction T here is currently a crisis in cancer care that experts predict will worsen in the near future due to a rapidly growing population of Americans requiring cancer care combined with an aging/retiring oncology workforce, and inadequate numbers of replacement workers. By 2020, the American Society of Clinical Oncology (ASCO) predicts a 48 percent increase in cancer incidence and an 81 percent increase in people living with or surviving cancer (Erikson et al., 2007). For the same time period, ASCO predicts only a 14 percent increase in the number of practicing oncologists. Expected shortages in other health care workers who are involved in cancer care, including nurses, physician assistants, laboratory and radiology technicians, social workers, radiologists, surgeons, pharmacists, public health workers, and cancer registrars, also will affect both the quantity and the quality of cancer care in the 21st century. In addition, achieving improvements in any aspect of cancer care—including research, clinical trials, health disparities, access to care, patient navigation, survivorship, palliative care, etc.—will be difficult if not impossible without a sufficiently staffed general health care workforce. This is particularly true, since the majority of cancer care is not delivered in major cancer centers, but rather, is provided by primary care physicians and community practices. Although other health care fields are also expected to face severe short- ages in their workforces, there are factors in oncology that make its work- force issues particularly challenging, including the wide range of treatment 1

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2 ENSURING QUALITY CANCER CARE options employed, the multiple health specialists involved in treating each cancer patient, the ongoing medical monitoring required after treatment is complete, the important role of family caregivers, and the availability of clinical trials and experimental treatments. As potential reforms are pro- posed for the health care delivery system, it is important for policy makers to consider the needs of quality cancer care To help address the challenges in meeting the public’s oncology health care needs, the National Cancer Policy Forum of the Institute of Medicine (IOM) convened the workshop Ensuring Quality Cancer Care through the Oncology Workforce: Sustaining Care in the 21st Century on October 20 and 21, 2008, in Washington, DC (see Appendix A for the agenda and Appendix B for a list of workshop speakers). The workshop covered issues relevant to the entire spectrum of cancer care, from prevention and diag- nosis to treatment, monitoring, survivorship, and palliative care. This docu- ment presents a summary of the ideas presented at the workshop. The first section of this summary outlines the evidence for the current and expected workforce shortages in health care professions in general, as well as evidence specific to the oncology professions. As stated above, any improvements in the oncology workforce will require a well staffed overall health care work- force. It is impossible to completely separate oncology from other areas of health care. The second half of this summary focuses on the solutions to the workforce shortage proposed by the various speakers, including system- based solutions, such as policy initiatives, innovative team approaches to the care of patients, and greater use of electronic medical records. Also explored were providing more innovative education and training, offering more incentives to recruit and retain cancer care workers, and enabling profes- sionals to return to the workforce after raising children or taking time off for other reasons. There was no effort to prioritize the proposed solutions, or make conclusions and recommendations.