Over the past two decades, cancer treatment has advanced at a remarkable pace. From immunotherapies and precision medicine to targeted oral agents offering new hope for patients, the complexity of care continues to grow, creating new challenges for providers. As oncology becomes increasingly specialized, many medical oncologists are narrowing their focus to specific cancer types in order to stay on top of rapidly evolving treatment standards.
A recent retrospective cohort study by Karadakic et al., published in the Annals of Internal Medicine and highlighted in the ASCO post, examined this trend of subspecialization in oncology using Medicare data from 2007 to 2021. The findings confirm what many in the field are already seeing: subspecialization is on the rise. But the study also revealed something more concerning—access to subspecialized care is not keeping pace across socioeconomic variables.
Subspecialization is growing, but unevenly
The study analyzed over 9 million chemotherapy episodes across nearly 19,000 oncologists. It found that the proportion of chemotherapy treatments managed by subspecialized oncologists doubled between 2008 and 2020. Subspecialization was defined as oncologists managing more than 80% of their chemotherapy episodes within a single cancer type.
While this shift reflects a positive step toward more personalized and informed cancer care, the benefits are not being felt equally. Utilization of subspecialized care was significantly higher in urban, high-income areas. In 2020, for example, 27.6% of chemotherapy episodes in the highest-income counties were managed by subspecialists, compared to just 8.8% in the lowest-income counties—even though cancer mortality rates are typically higher in lower-income regions.
What this means for patients and providers
For patients, access to subspecialized oncology care can make a meaningful difference, especially when dealing with complex or rare cancers. Subspecialists are more likely to be current with the latest guidelines, clinical trials, and biomarker-driven treatments. When care is coordinated well, the benefits are clear: more targeted treatments, fewer side effects, and potentially better outcomes.
However, the growing gap in access raises important equity questions. Patients in rural or underserved areas may have fewer opportunities to benefit from subspecialized care, particularly if they are unable to travel long distances for treatment. At the same time, general oncologists in these regions are tasked with staying up-to-date on a broad and ever-expanding range of treatment options—an increasingly difficult feat in today’s oncology landscape.
Bridging the gap
As noted in the study, addressing this imbalance will require systemic solutions. Key steps to bridging this divide include enhancing care coordination between general oncologists and subspecialists, improving telemedicine access, and investing in workforce development in underserved areas. Additionally, support services that facilitate patient navigation, transportation, and care planning can play a critical role in making high-quality, specialized cancer care more accessible to all.
As the cancer care community continues to innovate, equal attention must be given to ensuring that all patients—regardless of where they live or what they earn—can access the full benefits of modern oncology.
At AccessHope, we’re working to close the gap in equity in cancer care by bringing subspecialist expertise directly to those who need it most. Through our virtual cancer support services and remote second opinions from experts at NCI-Designated Comprehensive Cancer Centers, we enable collaboration between leading subspecialists and local oncologists. This model has led to updated diagnoses in 43% of cases, helping ensure patients receive the most accurate, effective treatment plans without having to travel far from home. More recently, a study published in the Journal of Clinical Oncology demonstrated how remote expert oncology opinions are bridging socioeconomic and geographic barriers to facilitate more equitable access to cancer care.
By partnering with employers, health plans, and health navigators to offer this forward-thinking cancer benefit, AccessHope is helping to foster more equitable access to cutting-edge care, improving outcomes while reducing the burden on patients and their families.
