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Competing for Cancer Patients in CNY

The market just became more competitive with the entry of St. Joseph’s Health: Does Central New York have enough cancer patients?

By Aaron Gifford

For years, Roswell Park Comprehensive Cancer Center advertised in Central New York, confident that prospective cancer parents would decide against selecting a closer provider if they spent just one day on the Buffalo campus.

“Most patients that get cancer feel that they needed to be treated yesterday,” the television and radio ad said. “The most important thing is not to do surgery tomorrow. To have the right treatment plan, even if it takes a week, is so much more important than doing something now.”

Roswell Park has enjoyed a strong reputation in Western New York and across other regions of the state. Subsequently, when St. Joseph’s Hospital in Syracuse revealed it was adding a “Cancer Care Service Line” in collaboration with Roswell Park, existing oncology practices in this region were livid.

“Central New York does not need more hospital cancer centers,” Maryann Roefaro, CEO of Hematology-Oncology Associates (HOA) of CNY, wrote in a 2022 guest opinion piece for a local newspaper.

“When a hospital that was previously never interested in providing cancer care because it was too labor-intensive, extremely complex, and would result in small operating margins now wants to get in the cancer business because they hit the 340B (federal subsidized drug program for underserved communities) targets for eligibility and they see dollar signs, they will do and say whatever they need to achieve that objective — even if it includes fooling the general public,” Roefaro wrote.

St. Joseph’s began serving cancer patients last year, and yet business still appears to be increasing for all of the major providers in that space. Upstate Hospital recently opened cancer centers in Verona and at Auburn Community Hospital, and HOA is scheduled to open a new facility in Camillus this fall.

According to state data, it appears there’s more than enough cancer to go around.

A 2023 report from the Health Care Workforce in New York State listed the cancer death rate for Central New York at 200.8 per 100,000 people, compared to the state rate of 175.5 per 100,000.

In the Finger Lakes region, the cancer death rate last year was 212.4 per 100,000.  For the Mohawk Valley, the rate was 229.2. For the north country, it was 206.2. And for the Southern Tier, it was 216.2.

All of those regions presumably send residents to the Syracuse area for some specialized health care services.

The New York State Department of Health’s Community Health Indicator Results (CHIR) dashboard breaks down the rates of some specific cancer types by county and region for the period of 2018-2020. It includes cancer incident rates based on diagnosis, not deaths.

Cayuga County reported the highest incident rate in the four-county region, at 712.1 per 100,000 people, followed by Oswego (682.7), Onondaga (658.3), and Madison (615.9).

By diagnosis, lung and bronchus cancer was far more common in the four counties than any other cancer type. Oswego led that category at 127.1 per 100,000 people, followed by Cayuga (119.8), Onondaga (96.3), and Madison (86.6).

The CHIR dashboard also lists concern levels by county and cancer type. Oswego shows high concern levels for oral, colon and lung cancers. Cayuga County showed lung, breast, and prostate cancers. Onondaga County showed lung and prostate cancers. Madison County did not show high concern levels, but several cancer types were listed as moderate concern levels.

Sarah Bonzo, an associate professor at SUNY Oswego, said one of the reasons for higher cancer rates in Central New York compared to the rest of the state is the aging population. As people get older, the risk for most cancer types increases. “And if you predict five, 10, 20 years out, it’s particularly worse in our region,” she said. “We really should be planning to meet the needs of this region.”

Sarah Bonzo, an associate professor at SUNY Oswego’s health care administration Master of Business Administration (MBA) program, said one of the reasons for higher cancer rates in this region and neighboring regions compared to the rest of the state is our aging population. As people get older, the risk for most cancer types increases.

“And if you predict five, 10, 20 years out, it’s particularly worse in our region,” she said. “We really should be planning to meet the needs of this region.”

Cornell University’s program on applied demographics, a public website that allows users to sort county and New York state demographic data, projects the population of those over 60 in the four-county region will exceed 203,000 people by 2040. That number for Onondaga County was 126,884, followed by Oswego County at 30,397, Madison at 24,377, and Cayuga at 21,466.

Given those trend lines, the influx of oncologists here in recent years, even if the competition between them appears fierce, is no surprise. Likewise, with an aging population and the projected population that the Micron semiconductor plant project will bring, more medical specialists of all types will be needed in the Central New York region.

“This is a time to make strategic choices. Staffing challenges continue to be an issue across all caregiving professions,” Bonzo said, adding that anesthesiologists and nurses who specialize in that area are particularly in short supply here.

As illustrated by the mergers or acquisitions of hospitals throughout this region in recent years, and partnerships like the one with Roswell Park and St. Joseph’s, health systems across the country are simply getting larger. That brings challenges as well as benefits, Bonzo said.

“It does reduce competition, which has implications,” she said. “But it also reduces wait times and brings comprehensive care without having to leave the region.”

Based on U.S. Department of Labor statistics, physicians of all specialties are needed throughout the country.  There are about 817,000 medical doctors in the United States right now, and that number is expected to increase by at least 24,000 by 2032. The national agency lists the 2023 median pay for physicians as $239,200, or $115 per hour.

According to the National Cancer Institute (NCI), the risk of cancer increases from less than 25 cases per 100,000 people for those under 20, to about 350 per 100,000 in the aged 45 to 49 category. For those over 60, the rate is more than 1,000 per 100,000.

NCI also reports that the median age for a cancer diagnosis is 66. Regarding specific types of that disease, the median age for breast cancer is 62; 67 for colorectal; 71 for lung; and 66 for prostate.

“But cancer can be diagnosed at any age,” the NCI report said. “For example, bone cancer is most frequently diagnosed in children and adolescents [people under age 20], with about one fourth of cases occurring in this age group. And 12 percent of brain and other nervous system cancers are diagnosed in children and adolescents, whereas only 1 percent of cancer overall is diagnosed in this age group.”

The rest of the world is also bracing for more cancer. Global Market Insights (GMI) forecasts the value of the oncology market will more than double from $280 billion in 2022 to $690.4 billion in 2032.

GMI lists the growth drivers in this space as rising incidence of cancer globally; government and agency initiatives to spread more awareness of the disease; the growing number of diagnostic labs in developing countries; and technological advancements in developed countries.

GMI reports that the pitfalls and challenges to growth in the cancer treatment industry range from the dearth of skilled and well-trained oncologists and radiologists to the high costs associated with diagnostic imaging systems and the high risks of side effects associated with cancer treatment.

“Thriving cancer burden worldwide will drive industry growth,” the GMI website notes. “The rising administrative support along with the surging funding toward cancer prevention research will play a key role in the market expansion.”

At the local level, cancer center administrators acknowledge the need for more services while emphasizing the competitive nature of their specialty.

“We felt a strong need to provide comprehensive services to patients in our network, which included making cancer care available to them regardless of their payer source,” said Meredith Price, senior vice president of St. Joseph’s Acute Operations. “The utilization of our cancer care center is exceeding our expectations six months in, which indicates that we made the right decision to provide personalized, patient-centric cancer care close to home.”

Physician Haider Khadim, medical director of oncology at St. Joseph’s Health, said his new center was in response “to a delay in patient care among existing practices, especially for under-insured patients, which proves there is a need for another hospital-based oncology practice in Central New York.”

Physician Tarek Sousou, HOA of CNY board president and an oncologist, noted that with his organization’s continued growth, patients can be seen within a week and are eligible for additional services like social work, dietitian services and financial counseling.

“There is a great need for cancer care in Upstate New York that continues to grow. Within each of our three comprehensive cancer centers, we are able to deliver high-quality care using the latest FDA-approved chemotherapy, immunotherapy, radiation, and clinical trials, all close to home,” he said. “We are delighted to be where the patients are and provide high-quality services with minimal disruption to the lives of our patients and their families.”

 

Older Population Means Higher Incidence of Cancer

According to the National Cancer Institute (NCI), the risk of cancer increases from less than 25 cases per 100,000 people for those under 20, to about 350 per 100,000 in the aged 45 to 49 category. For those over 60, the rate is more than 1,000 per 100,000.