DEVELOPING AND SUSTAINING
AN EFFECTIVE AND RESILIENT
ONCOLOGY CAREFORCE
PROCEEDINGS OF A WORKSHOP
Erin Balogh, Emily Zevon, Margie Patlak, and
Sharyl J. Nass, Rapporteurs
National Cancer Policy Forum
Board on Health Care Services
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by Contract No. 200-2011-38807 (Task Order No. 75D30118F00071) and Contract No. HHSN263201800029I (Task Order No. HHSN26300008) with the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health, respectively, and by the American Association for Cancer Research, American Cancer Society, American College of Radiology, American Society of Clinical Oncology, Association of American Cancer Institutes, Association of Community Cancer Centers, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, Flatiron Health, Helsinn Therapeutics (U.S.), Inc., LIVESTRONG Foundation, Merck, National Comprehensive Cancer Network, Novartis Oncology, Oncology Nursing Society, and Pfizer Inc. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-49604-9
International Standard Book Number-10: 0-309-49604-7
Digital Object Identifier: https://doi.org/10.17226/25533
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Developing and sustaining an effective and resilient oncology careforce: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/25533.
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WORKSHOP PLANNING COMMITTEE1
LISA KENNEDY SHELDON (Co-Chair), Chief Clinical Officer, Oncology Nursing Society
LAWRENCE N. SHULMAN (Co-Chair), Professor of Medicine, Deputy Director for Clinical Services, and Director, Center for Global Cancer Medicine, Abramson Cancer Center, University of Pennsylvania
AMY P. ABERNETHY, Chief Medical Officer, Chief Scientific Officer, and Senior Vice President, Oncology, Flatiron Health2
EDWARD J. BENZ, JR., President and Chief Executive Officer Emeritus, Dana-Farber Cancer Institute; Richard and Susan Smith Distinguished Professor of Medicine, Genetics and Pediatrics, Harvard Medical School
ROBERT W. CARLSON, Chief Executive Officer, National Comprehensive Cancer Network
CLESE ERIKSON, Deputy Director, Health Workforce Research Center, The George Washington University
STANTON L. GERSON, Director, Case Comprehensive Cancer Center, Professor of Hematological Oncology; Case Western Reserve University; Director, University Hospitals Seidman Cancer Center
LORI HOFFMAN HŌGG, Veterans Health Administration National Program Manager, Prevention Policy, National Center for Health Promotion and Disease Prevention; National Oncology Clinical Advisor, Office of Nursing Services, Department of Veterans Affairs
RUTH E. NEMIRE, President, ASK Educational Games, LLC
RANDALL A. OYER, Medical Director, Oncology, Ann B. Barshinger Cancer Institute, Penn Medicine Lancaster General Health
DAVID SIEGEL, LCDR, U.S. Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
2 As of February 2019, Dr. Abernethy’s affiliation is Principal Deputy Commissioner and Acting Chief Information Officer of Food and Drugs, Food and Drug Administration.
VIRGINIA L. VALENTIN, Assistant Professor and Associate Director, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah School of Medicine
ROBERT A. WINN, Associate Vice Chancellor, Community-Based Practice; Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Illinois at Chicago; Director, University of Illinois Cancer Center
Project Staff
ERIN BALOGH, Senior Program Officer
RUTH COOPER, Senior Program Assistant
ANNALEE GONZALES, Administrative Assistant
EMILY ZEVON, Associate Program Officer
SHARYL J. NASS, Forum Director and Director, Board on Health Care Services
NATIONAL CANCER POLICY FORUM1
EDWARD J. BENZ, JR. (Chair), President and Chief Executive Officer Emeritus, Dana-Farber Cancer Institute; Richard and Susan Smith Distinguished Professor of Medicine, Genetics and Pediatrics, Harvard Medical School
GARNET L. ANDERSON, Senior Vice President and Director, Public Health Sciences Division, Fred Hutchinson Cancer Research Center; Affiliate Professor, Department of Biostatistics, University of Washington
KENNETH ANDERSON, Kraft Family Professor of Medicine, American Cancer Society Clinical Research Director, Jerome Lipper Multiple Myeloma Center, Harvard Medical School, Dana-Farber Cancer Institute
WILLIAM L. BAILEY, Vice President, Medical & Scientific Affairs Research & Development, Helsinn Therapeutics (U.S.), Inc.
KAREN BASEN-ENGQUIST, Annie Laurie Howard Research Distinguished Professor, Professor of Behavioral Science, and Director, Center for Energy Balance in Cancer Prevention and Survivorship, The University of Texas MD Anderson Cancer Center
CHRIS BOSHOFF, Chief Development Officer, Oncology, Global Product Development, Pfizer Inc.
CATHY J. BRADLEY, Associate Dean for Research, Colorado School of Public Health, Professor and Deputy Director, University of Colorado Cancer Center
OTIS W. BRAWLEY, Bloomberg Distinguished Professor, Department of Epidemiology, Bloomberg School of Public Health, Department of Oncology, School of Medicine, Johns Hopkins University
ROBERT W. CARLSON, Chief Executive Officer, National Comprehensive Cancer Network
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
NANCY E. DAVIDSON, President and Executive Director, Seattle Cancer Care Alliance; Senior Vice President, Director, and Full Member, Clinical Research Division, Fred Hutchinson Cancer Research Center; Head, Department of Medicine, Division of Medical Oncology, University of Washington
GEORGE D. DEMETRI, Professor of Medicine and Director, Ludwig Center, Harvard Medical School; Senior Vice President for Experimental Therapeutics, Dana-Farber Cancer Institute; Associate Director for Clinical Sciences, Dana-Farber/Harvard Cancer Center
JAMES H. DOROSHOW, Deputy Director for Clinical and Translational Research, National Cancer Institute
NICOLE F. DOWLING, Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention
SCOT W. EBBINGHAUS, Vice President and Therapeutic Area Head, Oncology Clinical Research, Merck Research Laboratories
KOJO S. J. ELENITOBA-JOHNSON, Professor, Perelman School of Medicine; Director, Center for Personalized Diagnostics and Division of Precision and Computational Diagnostics, University of Pennsylvania
AWNY FARAJALLAH, Vice President, Head, US Medical Oncology, Bristol-Myers Squibb
STANTON L. GERSON, Director, Case Comprehensive Cancer Center; Professor of Hematological Oncology; Case Western Reserve University; Director, University Hospitals Seidman Cancer Center
LORI HOFFMAN HŌGG, Veterans Health Administration National Program Manager, Prevention Policy, National Center for Health Promotion and Disease Prevention; National Oncology Clinical Advisor, Office of Nursing Services, Department of Veterans Affairs
LINDA HOUSE, President, Cancer Support Community
HEDVIG HRICAK, Chair, Department of Radiology, Memorial Sloan Kettering Cancer Center
ROY A. JENSEN, President, Association of American Cancer Institutes; Director, The University of Kansas Cancer Center; William R. Jewell, M.D. Distinguished Masonic Professor, Kansas Masonic Cancer Research Institute
LISA KENNEDY SHELDON, Chief Clinical Officer, Oncology Nursing Society
SAMIR N. KHLEIF, Director, Jeannie and Tony Loop Immuno-Oncology Lab, Biomedical Scholar and Professor of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center
RONALD M. KLINE, Medical Officer, Patient Care Models Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services
MICHELLE M. LE BEAU, Arthur and Marian Edelstein Professor of Medicine and Director, The University of Chicago Comprehensive Cancer Center
MIA LEVY, Director, Rush University Cancer Center; Associate Professor of Medicine, Division of Hematology and Oncology; System Vice President, Cancer Services, Rush System for Health
J. LEONARD LICHTENFELD, Interim Chief Medical Officer, American Cancer Society
NEAL J. MEROPOL, Vice President, Research Oncology, Flatiron Health
MARTIN J. MURPHY, Chief Executive Officer, CEO Roundtable on Cancer
RANDALL A. OYER, Medical Director, Oncology, Ann B. Barshinger Cancer Institute, Penn Medicine Lancaster General Health
RICHARD PAZDUR, Director, Oncology Center of Excellence; Acting Director, Office of Hematology and Oncology Products, Food and Drug Administration
RICHARD L. SCHILSKY, Senior Vice President and Chief Medical Officer, American Society of Clinical Oncology
DEBORAH SCHRAG, Chief, Division of Population Sciences, Professor of Medicine, Department of Medical Oncology, Harvard Medical School, Dana-Farber Cancer Institute
LAWRENCE N. SHULMAN, Professor of Medicine, Deputy Director for Clinical Services, and Director, Center for Global Cancer Medicine, Abramson Cancer Center, University of Pennsylvania
DAN THEODORESCU, Director, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center
VERENA VOELTER, Head, United States Oncology Clinical Development & Medical Affairs, Novartis Pharmaceuticals Corporation
GEORGE J. WEINER, C.E. Block Chair of Cancer Research, Professor of Internal Medicine, and Director, Holden Comprehensive Cancer Center, The University of Iowa
ROBERT A. WINN, Associate Vice Chancellor, Community-Based Practice; Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Illinois at Chicago; Director, University of Illinois Cancer Center
National Cancer Policy Forum Staff
ERIN BALOGH, Senior Program Officer
RUTH COOPER, Senior Program Assistant
ANNALEE GONZALES, Administrative Assistant
NATALIE LUBIN, Research Assistant
MICAH WINOGRAD, Financial Officer
EMILY ZEVON, Associate Program Officer
SHARYL J. NASS, Forum Director and Director, Board on Health Care Services
Reviewers
This Proceedings of a Workshop was read in draft form by Lauren Shern and Taryn Young within the National Academies of Sciences, Engineering, and Medicine to ensure the proceedings meets institutional standards for quality and objectivity while accurately reflecting the purpose and focus of the workshop.
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Acknowledgments
Support from the many annual sponsors of the National Academies of Sciences, Engineering, and Medicine’s National Cancer Policy Forum is crucial to the work of the forum. Federal sponsors include the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health. Non-federal sponsors include the American Association for Cancer Research, American Cancer Society, American College of Radiology, American Society of Clinical Oncology, Association of American Cancer Institutes, Association of Community Cancer Centers, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, Flatiron Health, Helsinn Therapeutics (U.S.), Inc., LIVESTRONG Foundation, Merck, National Comprehensive Cancer Network, Novartis Oncology, Oncology Nursing Society, and Pfizer Inc.
The forum wishes to express its gratitude to the expert speakers whose presentations helped further the dialogue and advance progress to better support the oncology careforce and improve the delivery of high-quality cancer care. The forum also wishes to thank the members of the planning committee for their work in developing an excellent workshop agenda.
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Contents
CANCER CARE TRENDS AND CAREFORCE NEEDS
Epidemiological Trends in Cancer
Complex and Time-Consuming Cancer Care
OPPORTUNITIES TO ADDRESS ONCOLOGY CAREFORCE CHALLENGES
Fostering High-Functioning Oncology Teams
Including Caregivers on the Oncology Care Team
Expanding Patient Navigation Services
Integrating Palliative Care in Oncology Care
Collaborating with Primary Care Clinicians for Cancer Survivorship Care
Expanding Care Team Capacity with Advanced Practice Providers
Promoting Clinician Well-Being and Fostering a Supportive Work Environment
Reducing Administrative Burdens
Partnering with Community Resources
Implementing Workplace Changes
The Effect of New Technologies on Cancer Care
Challenges of Implementing New Technologies
Policies to Facilitate the Adoption of New Technologies in Cancer Care
Boxes and Figures
BOXES
2 Examples of Careforce Models for Cancer Care Programs and Organizations
3 Examples of Technologies to Facilitate Cancer Care
4 Aetna’s Oncology Medical Home
5 The Life-Sustaining Treatment Decisions Initiative of the Veterans Health Administration
FIGURES
1 Cancer mortality in breast, prostate, and colorectal cancer from 1990 to 2015 by race/ethnicity
2 Geographic distribution of oncology practices
3 Documentation volume for outpatient visits in the United States compared with other countries
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Acronyms and Abbreviations
ACA | Patient Protection and Affordable Care Act |
ACCC | Association of Community Cancer Centers |
AMA | American Medical Association |
AMIA | American Medical Informatics Association |
APP | advanced practice provider |
ASCO | American Society of Clinical Oncology |
CEO | chief executive officer |
CMS | Centers for Medicare & Medicaid Services |
CSC | Cancer Support Community |
EHR | electronic health record |
FDA | Food and Drug Administration |
HPV | human papillomavirus |
IOM | Institute of Medicine |
NP | nurse practitioner |
OMH | Oncology Medical Home |
ONS | Oncology Nursing Society |
PA | physician assistant |
PCORI | Patient-Centered Outcomes Research Institute |
PTSD | posttraumatic stress disorder |
SCH | Symptom Care at Home |
VA | Department of Veterans Affairs |
VHA | Veterans Health Administration |