By Jeff Elton, PhD, CEO and Robert Miller, MD, Chief Medical Science Officer
Over the course of the last two weeks, two research reports appeared, each of which highlighted the significance of the other. On January 16th, 2025, the American Cancer Society published Cancer Statistics, 2025, a summary of projected mortality and new cancers for the coming year. While the report had elements that were positive – such as an overall decline in mortality rates and avoidance of 4.5 million deaths since 1991 because of reduced overall rates of smoking, earlier detection, and improved treatment – the overall tone expressed concern around emerging trends. In 2025, the report forecasts more than 2 million new diagnoses with the rather astonishing observation that cancer incidences are growing in women, especially younger women who have an 82% higher incidence than men in the same age interval, with lung cancer rates now being higher in women than men. Rates of breast, uterine, melanoma, and liver cancer also are rising in women. Men are seeing increases in prostate and oral cancer incidences (human papillomavirus related). Pancreatic cancer is now the third leading cause of cancer deaths in the U.S. with both incidence and mortality on the rise with exceptionally low five-year survival rates. Altogether, the number of new diagnoses will increase over past years, along with the absolute number of cancer deaths. Adding to the overall workload is an increase in cancer survival five or more years post-treatment – increasing by 2 to 3 million survivors over five years, standing at just under 20M today. So, while progress in certain cancer incidence rates has been positive, there are new shifts and rather startling increases in rates of incidence that are leading to higher absolute rates, along with associated increases in the requirements associated with ongoing care of surviving patients and their unique needs.
On the same day, Medicus Healthcare Solutions, a source for third-party clinical talent to augment workforces, published their research in a report entitled Examining the Oncologist Shortage. Their report notes shortages of oncologists, hematologists, and radiation oncologists, where the demand for services is well above the supply of clinicians. This has progressed to the point where 32 million Americans live in counties with no local oncology services. Their estimates indicate that the two smallest groups are gynecological oncologists and pediatric hematologist-oncologists where the shifts in incidence are highest.
Overall, they see a continued net decline in radiation oncology and an increasing gap between the supply of clinical oncologists and the demand for medical oncology services for at least five more years. With more than 20% being age 64 or older and a median age of 53, there is no scenario where the 15% of oncologists who are age 40 or below can assume the clinical workload of those retiring or taking reduced clinical workloads. And for the first time, more than 40% report severe burnout or a desire to take reduced duties for lower compensation.
This is a systemic problem. More patients and declining reimbursement increase the financial pressures on oncology practices and providers – which in turn increases requirements to care for more patients in order to hold income constant (or slow the decline) and to ensure that the community can be responsibly served. This, in turn, makes oncology less attractive to younger clinicians, disincentivizing them to go into oncology clinical practice. And the cycle repeats. The more limited cancer care access and the more limited clinical practice capacity, the more limited the size of clinical research programs – making trials less accessible to increasing numbers of patients. Less access to care and fewer trials lead to delayed timing for diagnoses and fewer treatment options, both of which gate against the best possible outcomes for patients.
There are immediate and longer-term solutions available to us. Reimbursement of community oncologists and other providers continues to be a challenge. In past perspectives, we have examined how recent changes essentially provide oncologists lower payments in real terms. Supply and demand are real principles of markets – if payments fall below a level that can sustain careers, practices, and an acceptable quality of life, it will be patients who ultimately bear the adverse consequences.
Also, medical education is expensive and time-consuming. We need to make sure that the institutions that train physicians and other care personnel are strong and that the future for oncology careers is bright and attractive. While groups such as the American Society of Clinical Oncology and American Society of Hematology create blueprints for training and examinations, they are dependent on earlier training programs for the flow of prospective specialist physicians.
Cancer care is complex and requires many inputs to make an effective assessment and treatment or clinical trial selection. This can require multiple clinical personnel to spend hours sifting through lab results, radiological interpretations, pathologist reports, molecular diagnostic reports, and prior history notes. This is where the latest Generative AI solutions can be an effective augmentation of oncologist effort, preparing the information required for specific decisions at a specific time, assuring that evidence-based and potentially beneficial clinical trials are all presented and contextualized. ConcertAI and others are actively working on these solutions and are committed to ongoing development and innovation in clinical research and standard-of-care solutions that relieve burden, provide quality of care assurance, and present information in a timely and workflow-aligned manner. As an example, earlier this week we announced a broad partnership with one of the leading oncology networks in the U.S., ONCare Alliance, and their research entity, Exigent Research.
All in all, the trends indicate increasing challenges ahead. The systemic elements of payments, technologies, and supply need to come together in a coherent plan that assures the long-term health and well-being of patients.
