Pa. faces growing cancer-rate challenge

Pennsylvania has relatively high cancer rates, many rural counties with no cancer specialists, rising cancer care costs, and shrinking reimbursements.

"We face a perfect storm of challenges," said Marilyn Heine, a hematologist-oncologist with a group practice in Langhorne.

Heine, a past president of the Pennsylvania Society of Oncology and Hematology, joined several colleagues this week in discussing two new reports on cancer - one national and the other focused on the Keystone State.

The national report, from the 35,000-member American Society of Clinical Oncology (ASCO), says advances in scientific understanding and treatment have raised five-year cancer survival rates from 50 percent in the 1970s to 66 percent now.

However, ASCO estimates the demand for oncology services will grow 42 percent by 2025, while the supply of oncologists will grow only 28 percent. "Financial instability" is driving many practices to close, sell, or merge operations, the national report says - particularly the small community practices that handle a disproportionate share of patient care.

ASCO recommends, among other things, reversing recent Medicare cuts and repealing the current formula used by federal regulators to control Medicare spending on physician services.

In Pennsylvania, demographic and financial challenges are particularly great, members of the state oncology society and the Pennsylvania Medical Society said Tuesday.

The state's 2013 health assessment, issued by the state Department of Health, shows Pennsylvania's incidence rate for all cancers was relatively steady between 2000 and 2010, finishing at 490 cases per 100,000 residents.

Over the same period, the national cancer incidence rate fell steadily, to 458 per 100,000 - 7 percent lower than Pennsylvania's rate.

Pennsylvania's death rate for all cancers fell steadily between 2000 and 2010, to 180 per 100,000 residents. But again, that rate was consistently higher than the U.S. average.

Compared with the national average, Pennsylvania has higher death rates for lung, colorectal, bladder, cervical, and breast cancer. The state's melanoma and prostate cancer death rates are lower than the U.S. average.

This disparity reflects the fact that cancer risk rises with age and that Pennsylvania's population is relatively old. About 16 percent of Pennsylvania's population is older than 65. In state rankings, Pennsylvania has the fourth-largest population over that age and is tied for third in the percentage of residents older than 85.

"We have fast-growing patient needs," Heine said.

In Pennsylvania, Heine noted, 13 out of 67 counties have no oncology practices, which adds a travel burden for patients battling cancer.

Across the river in New Jersey - a smaller, more urbanized state - the health department's most recent analysis (for 2006 through 2010) separates cancer rates for men and women. Both genders had higher total cancer incidence rates than comparable U.S. rates. But death rates for New Jersey men were slightly lower, and for women were slightly higher, than the national rates.

New Jersey men had lower lung cancer incidence rates, while women in the state had lower lung cancer death rates, than the rates for U.S. men and women, according to the report.

While the challenges are many, this week brought one major piece of good news for Pennsylvania's cancer doctors and patients: A Philadelphia Common Pleas Court judge ruled in favor of Pennsylvania in a case involving the 1998 tobacco settlement.

The ruling, which vacated the finding of an arbitration panel, means that annual payments to the state of nearly $300 million will be cut only by one-third of what had been feared. Unlike many other states, said Scot Chadwick, legislative counsel for the Pennsylvania Medical Society, Pennsylvania mandated that all the tobacco settlement funds be dedicated to health care and research.

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