In the war on cancer, oncologists report that financial concerns are increasingly altering certain aspects of treatment and may be narrowing patient options. While six in ten (59%) oncologists express optimism about the future of oncology care in the US, 74% believe rising costs will eventually exceed society’s collective ability to pay for optimal oncology care.

A new study by National Analysts Worldwide entitled “Oncologists Look at Oncology: The Prognosis of US Cancer Care” surveyed practicing oncologists about the current state and future outlook of their profession, including implications for patient care.

The findings from this inaugural study demonstrate that shrinking insurance reimbursement and rising costs are affecting the practice of oncology: survey participants estimate that discussions of therapy options with patients are shaped by finances 40% of the time and expect that figure will increase to 50% over the next five years.

“While most oncologists are optimistic about medical advances in their field, many report mounting apprehensions about the way that financial considerations may influence quality of care and individual access to therapy innovation,” said Susan Schwartz McDonald, Ph.D., President & CEO, National Analysts Worldwide. “Oncologists tell us that, now more than ever, their presentation of therapy options is influenced by patients’ ability to pay.”

In particular, a patient’s insurance status frequently impacts the dialogue: survey findings show that cost influences discussions about therapy options 52% of the time for patients who are uninsured, compared with 44% of the time for patients with Medicare only and 35% for patients with private insurance. Nearly three in ten oncologists (28%) predict that they will refuse Medicare-only patients in the next few years, and roughly one-third (35%) expect to refuse uninsured patients.

On the other hand, the consequences of financial constraints are not necessarily negative in all respects: 57% of oncologists agree that high out-of-pocket costs have led them to be more explicit about likely treatment outcomes so patients can fully weigh the return on their investment in care.

“This shift to a more consumer-driven model is an important step toward patient empowerment,” said Debra Kossman, Ph.D., Senior Vice President, National Analysts Worldwide. “It’s an open question as to how having more information will change consumer priorities and choices, but as patients assume more financial responsibility for their own cancer care, many expect to be treated like informed consumers.”

When it comes to delivery of care, private practice oncologists report that financial concerns are directly influencing where patients receive their care and how far they must travel to receive it: 73% are forced to send more of their patients to hospital centers for costly IV therapies due to inadequate insurance reimbursement, often requiring patients to travel farther for care. More than two-thirds (69%) said the burden of seeking pre-authorization is reducing the time they spend interacting with patients.

Time spent untangling red tape is also having a direct impact on oncologists’ level of personal satisfaction with the work they do. Three in ten oncologists reported finding oncology less personally rewarding than expected, and reduced time spent with patients due to pre-authorization requirements was cited as a major cause of that dissatisfaction. When the question turns to financial satisfaction, fully half of the survey participants described oncology as less financially rewarding than expected.

“The study shows that finances are playing a prominent role in the current and future state of cancer care,” noted McDonald. “Cancer treatment in particular has always reflected certain cultural values that suggest no price is too high to pay for life extension, but that equation seems to be changing. In the war against cancer, we are now waging battle not just on medical fronts, but on financial fronts as well.”

If left unaddressed, oncologists’ financial and administrative concerns are likely to have a corrosive impact on the profession. Currently, less than half of survey participants indicated that they would encourage a young person to pursue a career in oncology today, compared with two-thirds five years ago.