Oncology in the era of managed care.

The field of oncology, both with regards to clinical care as well as research, is rapidly changing in response to the current changes in our health care delivery system. Cancer is the second leading cause of death in the United States, exceeded only by heart disease. Cancer care, including screening, diagnosis, treatment, and supportive care, consumes approximately 15% of all health care costs in the United States. The National Cancer Institute estimates the overall costs for cancer at $104 billion per year. Despite the increasing incidence of cancer, federal funding for cancer research has actually declined. Managed care's emphasis on cost reduction is threatening all aspects of the care of patients with cancer. Along these same lines, clinical research support has been dramatically affected by managed care. The major critical issues in the future will be guaranteed access of patients to high-quality cancer care, access to qualified clinical trials, promotion of cancer prevention programs, and support of professional education in oncology. The American Cancer Society estimates that in 1997, 1,382,400 new cases of cancer are expected to be diagnosed in the United States. This year alone, 560,000 Americans are expected to die of cancer. Cancer is the second leading cause of death in the United States, exceeded only by heart disease. One of every four deaths in the United States is due to cancer. The field of oncology, both with regards to clinical care as well as research, is rapidly changing in response to the current changes in our health care delivery system. This paper will address how these changes are having a major impact on the practice of cancer care in the United States.