Cancer cuts would hit minority patients hardest

With each passing year, health outcomes and life expectancies in America continue to improve because of technological advances in medicine.  Yet, as the Centers for Disease Control (CDC) report, the benefits of enhanced medical knowledge and advanced treatments have not been shared equally. In fact, even in the midst of sweeping reform, health disparities persist, especially among traditionally underserved minority populations. 

As a radiation oncologist, this fact is dangerously clear to me.  Cancer incidence and mortality rates are markedly higher for black Americans compared to other ethnic groups.  Health officials consistently discuss ways to eliminate racial disparities, however, several new proposals raise concerns that government is now taking steps that may very well do the opposite. 

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Recently, the Centers for Medicare & Medicaid Services (CMS) suggested a new way of paying for cancer care services delivered to American seniors.  Within the complicated language of the proposed physician fee schedule (PFS), the agency included a six percent payment cut to freestanding radiation facilities.  This would be on top of cuts to freestanding centers that have totaled almost 20 percent over the last decade. 

While the majority of freestanding radiation oncology centers – which now serve more than 40 percent of all cancer patients – have been able to withstand past cuts, CMS’ recent proposal to further compromise these centers may prove to be the “straw that broke the camel’s back.”  Indeed, 30 percent of freestanding practices indicated that they would have to close their doors if subjected to additional reimbursement cuts, according to research from the American Society for Radiation Oncology (ASTRO).  

Clearly these cuts threaten the consistency of care for all Americans, potentially forcing cancer patients from convenient, community-based radiation oncology centers to expensive hospital outpatient settings, negatively impacting quality of life, and adding to financial toxicity for individual patients who may need to travel further for care.  Moreover, patients may potentially forego treatment all together as the commute for daily radiation therapy treatments, which can require as many as 35 to 45 sessions, may become too burdensome.  These cuts will have a truly devastating impact on at-risk African Americans specifically because black Americans are disproportionately affected by breast and prostate cancer, two of the diseases for which CMS has proposed significant reimbursement cuts.   

Specifically, African American women make up 33 percent of all new breast cancer victims, but have significantly poorer rates of survival than women from other racial and ethnic groups, according to the Susan G. Komen Foundation.  Moreover, black men in America are 1.5 times more likely to develop prostate cancer and are 2 to 3 times more likely to die of the disease.   Clearly, these well-established public health data indicate that black men and women will be disproportionately impacted by the proposed rules. 

Almost universally, physicians believe we should extend access to life-saving care for breast and prostate cancer. But if the proposed PFS changes are approved, payments for a course of radiation for breast and prostate cancer will be 32 percent and 36 percent less than the same care provided in the hospital setting, respectively.  The discrepancy will understandably make it hard for freestanding facilities – which deliver the exact same care as hospitals – to keep their doors open.  From a public health perspective, it is impossible to understand why we would want to incentivize such a detrimental trend. 

Reputable, peer-reviewed research has uncovered two key findings with regards to community-based cancer care, which should instead guide policymakers’ decisions.  First, limited access to radiation oncology in less populated areas is associated with increased rates of prostate cancer mortality.  Second, limited access to oncology care for breast cancer is associated with delays and missed treatment, which negatively impacts outcome. 

Therefore, as a link between access to freestanding facilities and improved health outcomes for cancer patients becomes ever clearer, we must ask: should we now turn our backs on our nation’s most at-risk cancer patients?  And more importantly, should we really cut off a critical resource for those who benefit most from freestanding facilities – traditionally underserved minority populations? 

The answer is a resounding “no.”  Ultimately, as policymakers attempt to end health disparities, they must preserve the institutions and physicians that are helping to win the fight.  This begins with reconsidering proposed cuts to freestanding oncology facilities and protecting access to the critical care they deliver.

Brown is a radiation oncologist with 21st Century Oncology, the largest global, physician-led provider of integrated cancer care services.