The American Society for Radiation Oncology (ASTRO) has released alarming findings from its latest nationwide survey, highlighting the severe consequences of prior authorization delays in cancer treatment. The comprehensive study, conducted in fall 2024, gathered responses from over 750 radiation oncologists across academic and private practices, revealing a growing crisis in cancer care delivery.
Severe Patient Impact and Treatment Delays
The survey uncovered disturbing statistics about patient harm. Thirty percent of radiation oncologists reported that prior authorization delays resulted in emergency department visits, hospitalizations, or permanent disability for their patients. More critically, 7% of respondents indicated that these delays contributed to patient deaths.
Treatment delays have become nearly universal, affecting 92% of physicians' practices and impacting more than one-third of patients on average. The situation has deteriorated significantly since 2020, with 68% of physicians now reporting delays of five days or longer, compared to 52% four years ago.
Compromised Care and Treatment Abandonment
"Prior authorization policies are failing people with cancer, causing avoidable delays that are dangerous and, in too many cases, deadly," stated Dr. Howard M. Sandler, chair of the ASTRO board of directors. The survey revealed that one-third of physicians have witnessed patients abandoning radiation treatment altogether, with approximately 10% of patients discontinuing care due to authorization hurdles.
The impact extends beyond radiation therapy, affecting crucial supportive care medications. Physicians reported significant difficulties obtaining authorization for various treatments, including pain management medications (40% for opiates), anti-nausea drugs (23%), and other essential supportive care medications.
Increasing Administrative Burden and System Inefficiencies
The bureaucratic burden has intensified dramatically, with 85% of radiation oncologists reporting increased prior authorization requirements over the past three years. This has led to significant operational challenges:
- 94% report increased staff burnout
- 80% needed to reallocate staff time
- 60% required additional staff hiring
- 54% now need prior authorization for more than half their cases
The system's inefficiency is further highlighted by the fact that while 71% of requests are initially approved, 73% of denied cases are eventually overturned on appeal, suggesting a fundamentally flawed process.
Push for Legislative Reform
ASTRO is advocating for the Improving Seniors' Timely Access to Care Act of 2024 (S.4532, H.R.8702) to reform prior authorization processes in Medicare Advantage plans. The proposed legislation aims to establish real-time coverage decisions and increase transparency and accountability in the authorization process.
"We encourage Congress to act now to help end these life-threatening delays and put Medicare Advantage on a path toward transparency and accountability by passing this legislation before the current session ends," urged Dr. Sandler.
