Investment in Specialty Services
Studies have shown that academic cancer centers provide superior care for patients with rare, complex, or advanced cancers. Academic cancer centers provide comprehensive specialty care that is uniquely distinct from care in traditional physician office settings. Additionally, recent studies have shown academic cancer centers to have superior outcomes even in cancers considered common or high-volume. In order to ensure that people with cancer receive treatment at appropriate facilities, NCCN affirms that:
Please see relevant NCCN policy statements below
Network Adequacy
Intended to lower healthcare costs, narrow network plans limit patient access to advanced cancer care and result in burdensome travel times to access in-network providers, higher cost sharing for academic cancer centers, and out-of-network status for academic cancer centers. Network adequacy standards should assist health insurance companies with negotiating appropriate rates with all high quality, high value, providers to ensure patient access to appropriate care. In order to ensure networks provide adequate access to appropriate care for people with cancer, NCCN affirms that:
Please see relevant NCCN policy statements below:
Pain Management
Pain is one of the most common symptoms associated with cancer and pain management is an essential part of oncologic care. In recent years, the rise of opioid addiction and overdose in the United States has led to increased scrutiny of opioid prescribing practices. In the management of cancer, multiple reports indicate that a patchwork of regulatory and coverage policies, intended to curb inappropriate opioid use, has led to significant barriers for many cancer patients when opioid use is clinically indicated for pain management. The NCCN Guidelines for Adult Cancer Pain advises that cancer pain can be well managed in the vast majority of patients with appropriate techniques, careful monitoring, individualization, and safe prescription medicines. In order to ensure that people with cancer have access to appropriate pain management while reducing the potential for harm from opioid addiction, NCCN affirms:
Please see relevant NCCN policy statements below:
Patient Access to Care Planning and Coordination Services
As of January 2016, there were more than 15.5 million living Americans with a history of cancer, a number that is estimated to grow to more than 20 million by 2026. NCCN has long recognized the importance of patient/provider communication and education in cancer care. Over the last two decades, NCCN has developed a collection of resources and programs to support and educate stakeholders across the oncology spectrum, including physicians, researchers, nurses, policymakers, industry, payers, patients, and patient advocates. NCCN publishes a library of NCCN Guidelines for Patients® based directly on the information found in the NCCN Guidelines to provide patients with the same information their doctors’ use, but in easier-to-understand language. Additionally, the NCCN Guidelines for Survivorship are designed to provide a framework for the general survivorship care plus management for any potential long-term and/or late effects of cancer and its treatment that survivors may experience. In order to ensure optimal survivorship care for people with a history of cancer, NCCN affirms that:
Please see relevant NCCN policy statements below:
Patient Access to Clinical Trials
Years after the passage of the 21st Century Cures act, clinical trials still struggle with successful recruitment and retention of diverse patient populations. A 2019 study found that of the 230 clinical trials leading to FDA oncology drug approvals over the past decade, race was reported in only 145 (63%) trials. Of the studies that did report, people of color were significantly underrepresented. Additionally, the majority of clinical trials are restricted to adults between the ages of 18 and 64, resulting in an under-representation by children and older adults. In order to enable and encourage greater participation in clinical trials to further knowledge and extend access to the benefits from this mode of treatment, NCCN affirms that:
Please see relevant NCCN policy statements below:
Patient Access to Innovative Therapies
Cancer care is a field marked by multidisciplinary care and constant innovation, with rapid advancements in technologies and therapeutic interventions. Current reimbursement rates for novel, high-cost, therapies are hundreds of thousands of dollars below the actual cost per patient. In addition to the high acquisition cost, the administration of treatments like CAR T-cell therapy can be accompanied by significant toxicities including cytokine release syndrome (CRS), neurotoxicity, and prolonged cytopenia. The intensive and specialized services required to manage these toxicities adds significant additional cost, further compounding reimbursement challenges. Government reimbursement models must be modernized to match new methods of treatment. In order to preserve patient access to cutting-edge cancer management techniques, NCCN affirms that:
Please see relevant NCCN policy statements below: