BOX 1-1
The Crisis in Cancer Care Delivery

Studies indicate that cancer care is often not as patient-centered, accessible, coordinated, or evidence-based as it could be, detrimentally impacting patients. The following trends amplify the problem:

•   The number of older adults is expected to double between 2010 and 2030, contributing to a 31 percent increase in the number of cancer survivors from 2012 to 2022 and a 45 percent increase in cancer incidence by 2030.

•   Workforce shortages among many of the professionals involved in providing care to cancer patients are growing and training programs lack the ability to rapidly expand. The care that is provided is often fragmented and poorly coordinated. In addition, family caregivers and direct care workers are administering a substantial amount of care with limited training and support.

•   The cost of cancer care is rising faster than are other sectors of medicine, having increased from $72 billion in 2004 to $125 billion in 2010; costs are expected to increase another 39 percent to $173 billion by 2020.

•   Advances in understanding the biology of cancer have increased the amount of information a clinician must master to treat cancer appropriately.

•   The few tools currently available for improving the quality of cancer care–– quality metrics, clinical practice guidelines, and information technology–– are not as widely used as they could be and all have serious limitations.

SOURCES: de Moor et al., 2013; He et al., 2005; IOM, 2008c, 2009b, 2011a; Mariotto et al., 2011; NCI, 2007; NRC, 2009; Reinhard and Levine, 2012; Smith et al., 2009; Spinks et al., 2012.

the United States that will place new demands on the cancer care delivery system, with the number of adults older than 65 rapidly increasing (He et al., 2005; Smith et al., 2009). The population of those 65 years and older comprises the majority of patients who are diagnosed with cancer and die from cancer, as well as the majority of cancer survivors (NCI, 2012, 2013; NVSS, 2012). In addition, there is a major structural crisis looming in cancer care delivery: the oncology workforce may soon be too small to care for the growing population of individuals diagnosed with cancer (IOM, 2009b). Meanwhile, the Centers for Medicare & Medicaid Services (CMS), the single largest insurer for this older population, is struggling with financial solvency (Goldberg, 2013; Medicare Trustees, 2013). In addition, the costs of cancer treatments are escalating unsustainably, making cancer care less affordable for patients and their families, and creating disparities in patients’ access to high-quality cancer care



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