Since the passage of the Affordable Care Act (ACA), there has been a push by numerous stakeholders to reduce healthcare costs while enhancing value delivery to patients. In many areas of medicine, both goals can be achieved by reducing inter-physician variability in care delivery and giving providers incentives to consistently apply best practices on a population basis. The cancer care model, however, is different and far less amenable to this approach. For many patients with advanced- stage or high-risk cancers, there is no clear standard of care. For others, the emergence of genetic and molecular testing has shown that what was previously believed to be one type of cancer may represent dozens of molecular subtypes, each requiring a profoundly different therapeutic approach.

Additional factors that contribute to rising cancer care costs include the aging population, astronomical increases in pharmaceutical costs, increasingly complex multimodality care, and advances in surgical and radiotherapeutic technology. Costs are further inflated through non–value-added care delivery mismatches, and increasingly expensive end-of-life care. As a result, the National Cancer Institute projects that cancer care costs will increase by 27% between 2010 and 2020, rising to an estimated $158 billion annually.¹ The implications of these rising costs are beyond societal—they have an increasingly personal impact on patients. The rising burden of cancer care costs shouldered by patients and their families has led to the coining of the term “patient financial toxicity.”²

The tension between controlling rapidly-growing cancer care costs and the need to enhance oncology valuedelivery has, therefore, been escalating. Numerous stakeholders, including patients, families, physicians, payers, managed care plans, pharmacy benefits managers, employers, and the government, are deeply invested in trying to navigate this conundrum. Each has a unique perspective that may not be fully informed by that of the other stakeholders, and the task is rendered all the more difficult by 3 key factors:

• The standard of care for treating patients with cancer is a rapidly moving target.
• There is no clear consensus on what constitutes value in cancer care.
• Information is siloed and frequently inaccessible; as such existing metrics for cancer care performance and patient outcomes are very poor indicators of actual value delivery.

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