Recently, the recommended screening age for two cancers dropped, which could impact oncologist workloads.
In March, the Prostate Cancer Foundation released new guidelines for prostate-specific antigen-based screening in Black men, recommending screening to start between ages 40 and 45 and continue until age 70.
In May, the U.S. Preventive Services Task Force lowered the age for breast cancer screenings for women with an average risk from 50 to 40.
These guideline changes — along with a nationwide push to increase screening among adults, and the release of new screening tools like blood tests — have changed the burden on oncologists and the healthcare system.
The short-term impact
The number of screenings will increase patient loads in the short-term, leaders told Becker's. That burden will be distributed across the medical ecosystem and several specialties, including primary care, radiologists, gastroenterologists, pulmonologists and others, can expect to see higher patient loads, Steven Artandi, MD, PhD, director of the Stanford (Calif.) Cancer Institute, told Becker's.
"There may be a modest effect on the oncology workforce, but for the entire medical system, there's going to be additional work to follow up on the test results of these screening tests," Dr. Artandi said.
For oncologists specifically, patient loads are also predicted to go up — but some leaders are excited about that prospect.
"This will change the field, allowing oncologists to help patients by detecting more cancers at a curable stage," Chris Flowers, MD, division head of cancer medicine at University of Texas's MD Anderson Cancer Center in Houston, told Becker's. "Overall, this will be good for patients and oncologists."
The point of expanding screening programs is to identify patients earlier and treat them sooner, David Rivadeneira, MD, physician-in-chief of clinical strategic initiatives for eastern Long Island at New York City-based Northwell Health and director of Northwell Health Cancer Institute at Huntington (N.Y.), told Becker's. Catching cancers earlier could prevent the need for chemotherapy and radiation treatment.
Dr. Artandi said his system is already seeing the benefits of early detection.
"Anecdotally, we are seeing patients who have had the blood tests for cancer through liquid biopsy," he said. "We're also seeing patients now who are getting whole body MRIs. Both of these techniques are finding cancers that would otherwise not be found until later."
Although, in the short-term, increased screenings create more work for oncologists and the rest of the medical ecosystem, leaders predict these changes will reduce burnout and workload for physicians long term.
The long-term gains
Patients who discover their disease at the pre-cancerous or early stages will have a better prognosis and require less chemotherapy and radiation.
"In the long run, this will lead to less burnout for physicians because oncologists will see fewer advanced-stage cancers. That, I think, is the bigger picture," Dr. Rivadeneira told Becker's.
The shift to more screenings could also change the way cancer care is delivered. More targeted treatments may be used for early stage cancers, and may not involve the same drugs historically given to cancer patients, meaning that patients could experience less toxic side effects, Dr. Flowers said.
Cancer mortality is also expected to decline as shifts in care continue. However, this could lead to a different issue: more cancer survivors needing care.
"Cancer survivorship is a challenge for the system," Dr. Artandi said. "The question is, how do we manage cancer survivorship most effectively for the patients? It can't fall entirely on the oncologists, because they are dealing with many new cases and active cases. It depends on the cancer, the circumstances of patients, and the risk of recurrence to determine the extent to which the oncologist manages that survivor versus the entire health system and the primary care physician."
Compounding the growing need for cancer survivorship is a decrease in the number of oncologists.
"There is an oncologist workforce crisis," Sara Jo Grethlein, MD, executive director of the Swedish Cancer Institute in Seattle, told Becker's. "About 20% to 22% of currently practicing medical oncologists are 65 or older. The number of people graduating from fellowships has decreased, while the need for cancer care is rising."
Stanford is addressing this crisis by providing a mixed-care model that leverages oncologists and its primary care network.
At Swedish Cancer Institute, advanced practice clinicians are undergoing additional education and training so they can practice at the top of their license within cancer care.
"We are working to create those opportunities to enhance their skills and comfort with care across the spectrum," Dr. Grethlein said. "We want to support our APC colleagues in partnering with us to provide excellence in care."