State of Cancer Care in America

ASCO’s State of Cancer Care in America™ initiative explores challenges and opportunities in today’s oncology delivery system, with the ultimate goal of improving the quality of care for all patients with cancer. Through a series of timely, in-depth articles published in JCO Oncology Practice, infographics, and interactive tools, the State of Cancer Care in America examines emerging issues and trends in oncology practice that impact the delivery of efficient, cost-effective, equitable, and high-quality cancer care.

Find a full list of articles, graphics, and commentaries published in the JCO Oncology Practice as part of the State of Cancer Care in America initiative.

Interactive Maps

Through its oncology workforce, rural cancer care, and health equity initiatives, ASCO has been exploring the geographic distribution of systemic and socioeconomic factors that potentially influence cancer care delivery in the United States. Drawing on a number of data sources, the ASCO Interactive Map of Oncology help put U.S. COVID-19, workforce, and equity data into perspective.

This data visualization tool explores the geographic distribution of systemic and socioeconomic factors that influence cancer care delivery in the United States. It includes state-level data from the ASCO COVID-19 Registry and population-based data maintained by the US government and other authoritative sources on the oncology workforce, population demographics, disease epidemiology, and factors related to social determinants of health. Please review this User Guide before visiting the tool.  


Each year, ASCO releases a snapshot of the state of the oncology workforce in America. The snapshot features highlights from the ASCO Workforce Information System, which provides ASCO with an ongoing method for data collection and reporting on the current status of the oncologist workforce.

State of Oncology Workforce in America

2022 Snapshot – Includes a focus on the participation of Hispanic/Latinx people in the US oncology workforce.

2021 Snapshot – Includes a focus on the participation of Black/African American people in the US oncology workforce.

2020 Snapshot – Includes a focus on the rural oncology workforce.

Advanced practice providers (APPS) are playing an increasingly important role in the cancer care delivery team. In 2018, ASCO also examined the availability and role of APPs (e.g., nurse practitioners and physician assistants) to meet the treatment needs of patients with cancer. ASCO’s 2018 study estimated that there are between 5,350 to 7,000 advanced practice providers in oncology. A 2016 study found that oncology patients are aware when care is provided by a non-physician provider and are very satisfied with the care they receive in a collaborative practice model.

Another article looks at several initiatives ASCO established to support medical students and oncology trainees so that they have access to information and resources as they consider entering the field.

Commentaries looked at the composition of the current academic radiation oncology workforce in comprehensive cancer centers and the state of the physician and oncology workforce in the US.

Practice Pressures

Practices identified payer pressures as their top concern and prior authorization as their top payer pressure in a survey conducted by ASCO in 2017. In written commentaries, providers expressed concern that prior authorization has negative effects on treatment outcomes, timeliness of care, patient stress, clinician burnout, and administrative costs. Oncology practices reported needing an average of 6.1 full-time employees to manage payer prior authorization requirements. Learn more about the Association for Clinical Oncology’s work to improve the prior authorization process.

2020 Pharmacy Benefit Managers infographic

Oncology practices are also still struggling to efficiently incorporate EHRs into clinical practice. They are utilizing systems that are only partially interoperable; many cannot electronically integrate patient information from other practices, and few can share information with patients. Current EHR limitations largely stem from the fact they were designed for billing and coding, not for improving care delivery.

Pharmacy benefit managers (PBMs) develop and manage prescription drug benefits for insurers and act as an intermediary in the prescription drug supply chain. As the role of PBMs has expanded, their opaque business practices and impact on drug prices make it difficult to know if the cost-saving measures they promise to translate to reduced costs for patients. Data collected during the 2018 ASCO Practice Survey showed PBMs may reduce access and quality of care while increasing burdens on providers. For example, three-quarters of practices surveyed said PBMs interfered with patient care and/or made it difficult to deliver care, and 56% say that PBMs disrupted practice workflow. An article and infographic from 2020 in JCO Oncology Practice summarize these effects.

Practice Landscape

The oncology practice landscape continues to be in flux. In a 2017 ASCO survey, one-third (34%) of practices reported some change in organizational structure, including opening a new practice (18%), experiencing a merger/joint venture (9%), or closing a practice (7%). A quarter of practices increased their number of oncologists from 2016-2017, while 18% had fewer oncologists in the same period.

Despite this consolidation, most practices remain small, with 76% of practices employing 1-5 oncologists, and 72% reporting only one site.

These and other data points from the 2017 ASCO Practice Census are included in the infographic to the left.

Opioids for Managing Cancer Pain

In the wake of policies intended to address the opioid crisis, it has become harder for cancer patients to access the pain treatment they need. According to ASCO’s 2017 Practice Census, 40% of U.S. oncology practices say their patients had trouble filling their opioid prescriptions and 92% of U.S oncology practices say they are concerned that restrictions on opioid prescribing will result in undertreating cancer pain. ASCO’s infographic (see left) highlights some of the barriers to accessing opioids for cancer pain management.

In a related commentary, a survivor of cancer describes some of the barriers she and other patients have experienced when trying to access opioids and writes that “anti-opioid sentiment can be pervasive and hurtful” for patients and survivors of cancer. In another commentary, two oncologists describe some of the policies that have been enacted at the state and federal levels and how those policies have impacted patients and oncologists. Officials from U.S. Food and Drug Administration (FDA) also outline the role of the FDA in ensuring access to pain management therapies for patients with cancer.

Rural Health

In 2020, a State of Cancer Care in America special series published in JCO Oncology Practice with six commentaries covering a variety of topics including the importance of using local expertise to improve rural cancer care outcomes, multilevel approaches throughout the United States to handle rural cancer care disparities, and the important role telehealth has played in rural areas. The JCO Oncology Practice rural cancer care package is available online.

Precision Medicine

Precision medicine is rapidly becoming the standard of care for patients with advanced cancer, however administrative, clinical, and financial challenges make it difficult for non-academic practices to implement precision medicine. A February 2019 article delves deeper into these challenges and highlights how practices can use clinical decision support and administrative support for prior authorization and clinical trial matching to successfully implement precision medicine.

The article is accompanied by a series of commentaries focused on precision medicine, how to implement it in oncology practices, and precision medicine’s impact on patients. ASCO also developed a new visual guide for clinicians to help determine whether a targeted therapy is a viable treatment option for an individual patient.

In January 2018, ASCO hosted the inaugural State of Cancer Care in America event, Precision Medicine: Expanding Opportunities, which focused on the country’s most urgent challenges in precision medicine and strategies to ensure new therapies are available to individuals with cancer.

Past Reports

ASCO published a series of State of Cancer Care in America reports to examine trends in the cancer care delivery system. Read past reports from 2014 – 2017.

Random Quote

"I value the broad exposure ASCO affords my specialty throughout the oncology world. All of us have the opportunity to learn about the latest advances in our field and to broadly share our own research."
Clifford Hudis, MD, FASCO