Cancer Care Trends in Community Cancer Centers, 2009-2010

Fifty-seven percent of survey respondents report putting a freeze on hiring, while 29 percent have reduced staff and 10 percent have reduced services. Still, despite an economic downturn, most respondents (78 percent) characterize their cancer program’s financial status as good or very good. Just 7 percent report poor financial health.

Expansion and replacement plans for some clinical technology appear to be limited. Sixty-one percent report delaying equipment purchases. The numbers of linear accelerators, ultrasound imaging machines, computed tomography scanners, magnetic resonance machines, and PET or PET/CT machines budgeted for purchase in the next fiscal year are down. But some equipment and cancer service line offerings are on the upswing: more programs this year than last are offering digital mammography, prostate brachytherapy, image-guided radiation therapy, intensity-modulated radiation therapy, and robotic surgical systems.

In the past year 17 percent of responding programs reported consolidation of programs within their market area. In the next one to two years, one in three hospital respondents expect consolidation within their primary market area. That compares to less than one in five in Year 1 of the survey. Consolidation is defined as a merger or affiliation with another cancer program or the acquisition of another cancer program or part of another program.

Respondents were asked about consolidation of community oncology practices within their primary market area. Physician oncology practices are consolidating even faster than cancer programs. In the past year, 29 percent of respondents report consolidation of physician oncology practices in their primary market area. In the next one to two years, almost half of respondents expect consolidation of physician oncology practices in their area, up from 30 percent in Year 1 of the survey.

Community relationships between cancer programs and private practice physicians continue to be pivotal. Most cancer programs rely heavily on private practice physicians, but less so than in last year's survey results. Compared with last year’s survey, there is a significant decrease in mean number of FTE medical/hematological oncologists and radiation oncologists in a contractual relationship with the cancer program and an increase in those employed by the cancer program. As oncologists in private offices struggle with declining reimbursements and seek financial stability, many are opting for employment at hospitals. A major shift in site of care may loom ahead.

Cancer programs report seeing more patients who need help affording their medication, co-pays or co-insurance, prescription drug expenses, and transportation expenses. In addition, 73 percent of respondents report an increase in the number of uninsured/underinsured patients for whom they provide chemotherapy infusions.

The use of electronic medical records (EMRs) is increasing, but is still not universal in community cancer programs. In 2009, 84 percent of respondents report utilization of EMRs versus 65 percent in 2008. More than half (54 percent) of respondents that do use EMRs report using more than one software.

Just 24 percent of programs dispense oral anti-cancer drugs at the infusion center. These numbers are up only slightly from last year’s 21 percent. We expect the numbers will continue to increase as more and more oral agents come to the market and patients demand their greater convenience. Hospitals are well-positioned, since they already have in-house pharmacies. Of those programs that dispense oral anti-cancer drugs, just 40 percent report having quality initiatives related to the use of oral agents in place.