The Community Oncology Alliance (COA) today announced that due to severe year after year cuts to Medicare reimbursement for cancer care, community oncologists around the U.S. are closing offices at a rate rapidly increasing since January 2010. Reductions in staff, services and facilities are also on the rise.

Specifically, 39 community cancer clinics in 15 states across the U.S. have closed or are in the process of closing since this January 2010 date due to financial pressures from severe cuts in Medicare reimbursement for cancer care. If this trend continues, the number of closures could double by the end of this year. A recent casualty is the cancer clinic serving Selma, Alabama for nearly 25 years that was forced to shut its doors to patients. In total, 166 clinics have closed over the past three years.

“As a practicing oncologist, I am extremely concerned about the impact these closings have on patients. Many are simply falling through the cracks as providers are being forced to cut staff and close clinics, forcing patients to seek treatments outside of their communities,” said David Eagle, MD, newly elected President of the Community Oncology Alliance (COA).

In the past few years, more than 850 clinics nationwide have experienced severe negative impacts from annual cuts to cancer care by Medicare. This number includes clinics that have closed their doors; continue struggling financially to pay bills to operate; are forced to send all of their Medicare patients elsewhere for treatment; or have been acquired by hospitals or other entities.

As a result, a growing number of cancer patients are unable to receive care in their communities, and many cannot travel the distances required to get treatment. Rural practices and those with higher proportions of Medicare and Medicaid patients are particularly hard hit. Four out of five U.S. cancer patients are treated in the community setting, and approximately half of all U.S. cancer patients are Medicare patients.

“Delays in resolving major Medicare cuts to all physicians have compounded the very serious problems already facing community oncology practices due to continued payment cuts to cancer care,” said Ted Okon, Executive Director of COA. “We are seeing community oncology offices cutting staff, services, and ultimately closing at a much faster pace since the beginning of 2010. The economic reality is that practices cannot continue to operate when their costs are greater than revenues. This country has the best, most efficient cancer care delivery system in the world, yet unrealistic payment policies are pushing it off a cliff. This is nothing less than a national crisis.”

Compounding the problem, the nation is losing oncologists relative to the mandate for cancer care. By 2020, there will be a shortage of 4,080 oncologists, causing cancer patient demand to outstrip the supply. It is estimated that by 2020, one in four cancer patients will be short an oncologist. Additionally, as oncologists retire, fewer physicians are choosing to treat cancer. National Analysts reported that one in five (20 percent) oncologists would discourage a medical student/resident from pursuing a career in oncology, versus only 3 percent who would have done so in 2003, prior to the problems caused by year-over-year Medicare cuts.

The cancer mortality rate in the U.S. has declined due to earlier detection, the quality of treatment, and the accessibility of cancer care. The American Cancer Society’s just-released Cancer Statistics 2010 estimates that 767,000 U.S. lives were saved from 1990-2006 by reducing the cancer death rate. Yet, cancer is still the number one killer of Americans under age 85.

“The government has to act now to stop Medicare cuts in order to preserve our nation’s cancer care delivery system before it’s too late,” said Okon.

About Medicare Cuts to Cancer Care

Medicare has already severely cut payments for cancer care, dramatically impacting doctors’ ability to treat patients. For example, Medicare payment for the administration of chemotherapy has been cut by 35 percent since 2004, which is an effective cut of 47 percent when factoring in the increase in the Medical Economic Index (MEI). Medicare will make additional payment cuts in 2011, 2012, and 2013. A study completed by Avalere Health shows that Medicare covers only 57 percent of the cost of providing this critical component of cancer care. Payment cuts are also being made to imaging tests — such as PET and CT scans — and there will be a 23.5 percent payment cut for all physicians’ services effective December 2010 and a 6.1% cut effective January 2011, if Congress does not act to stop these cuts.

About Community Oncology Alliance (COA)

Formed in 2003 in response to the Medicare Modernization Act, COA is a non-profit organization dedicated solely to community oncology. COA was founded by community oncologists to advocate for patients and providers in the community oncology setting, where four out of five Americans with cancer are treated.

Currently, COA is working with Congress in providing proactive solutions designed to protect the viability of the nation’s cancer care delivery system and patients’ access to quality, affordable cancer care. The cancer death rate in the U.S. has declined due to earlier detection, the quality of treatment, and the accessibility of cancer care. However, according to the American Cancer Society, men still have an approximately one in two lifetime risk of developing cancer, with a risk of one in three for women. For more information, please visit www.communityoncology.org.

Nearly two-thirds of Americans

The AMA claims to speak for doctors, and the media often echo that assertion, yet barely a quarter of the nation’s physicians are AMA members. Many medical and public health organizations have policies that support aid in dying, including the American Medical Women’s Association, the American Medical Student Association, the American College of Legal Medicine and the American Public Health Association. Still, according to a study recently conducted by Georgetown University Hospital, nurses, doctors and patients all feel some frustration, fear and abandonment during the end-of-life cycle for a patient in a hospital setting.

Nurses, in particular, who completed an End-of-Life Nurse Consortium Course, were asked about their training. Surprisingly, about 52 percent of nurses in the study said they never received this training, yet 43 percent reported they had been involved in one to three end-of-life situations within the previous six months.

Over 100 nurses attended the course, and while survey results are still pending, there have been some changes. All newly-hired nurses at the hospital now receive the training, and all of inpatient oncology and hematology nurses are required to take the end-of-life training course. The study found nurses that receive end-of-life education and training can positively impact the lives of patients and families facing difficult times, according to the report at WFTV. According to the news story:

Another study shows patients who are dying and their families report that feelings of abandonment by their physicians at the end-of-life have two components: a loss of continuity of care before death and a lack of closure near death or afterward. “Early on, patients and family caregivers fear that their physician, whose expertise and caring they have come to depend on, will become unavailable,” the authors write. Most physicians are not consciously aware of having abandoned their patients. Instead, they report lack of closure or a feeling of unfinished business. The report could help physicians structure care to maintain the professional value of non-abandonment, including use of non-hospice palliative care or closure-promoting communication strategies involving nurses and other members of the health care team. As end-of-life approaches, physicians should offer assurances that they’ll still be available and should maintain contact with the patient and caregiver, according to Anthony Back, M.D., of the Seattle Cancer Care Alliance, and colleagues.

Interestingly, patients with advanced cancer who discuss end-of-life care with their physicians appear to have lower health care costs in the final week of life than those who do not, according to a report in the Archives of Internal Medicine. Formal and informal caregivers who were interviewed after the patients’ deaths reported that those with higher costs also had a worse quality of death in their final week.

But, not everyone who develops heart disease or cancer or who suffers a stroke die immediately. Often, these victims need help, and palliative care, or hospice care, is one route to take for this help. Here are a few reasons for heart disease, cancer and stroke patients to choose hospice services:

Heart Disease: Patients who suffer heart disease often suffer through cycles of treatment. They experience extreme pain, get treated, go home and then experience extreme pain again. Sometimes, a little help on the home front can increase the time between extreme episodes. However, patients would need to meet certain criteria for hospice care, including the prognosis of six months or less left to live.

Cancer: When cancer treatment no longer is viable or a cancer patient cannot tolerate treatment, then hospice care becomes appropriate. Opting for palliative care does not mean that the cancer patient is giving up. Instead, the patient is opting for an alternative to learning how manage symptoms and to improve quality of life while living with this disease.

Stroke: The severity of the effects of a stroke will help determine if a patient needs hospice care. The criteria for hospice care includes a coma, persistent vegetative state, and/or severely reduced level of consciousness and abnormal muscle contractions. Usually, the patient’s prognosis after the first three days following a stroke will determine the need for palliative care.

Remember that Medicare and many private insurance plans won’t cover hospice care and hospital admissions for the same diagnosis at the same time in any disease. With that said, when a patient has exhausted all resources and the end of life seems imminent, hospice services can make the end-of-life transition more comfortable for patients and their loved ones.

Hospice care workers who visit the home to care for heart disease, cancer and stroke victims patients can:

• Help with pain and symptom management.
• Help to avoid hospital admissions.
• Help to gain access to community resources and assist with emotional and spiritual needs.
• Can help with death care management.

These services can help family members spend more time with the patient as the hospice worker takes on the responsibilities of keeping the patient comfortable and at ease. If you’re interested in using hospice care, you can find many resources here .