Goal: Support access to high quality, affordable cancer care for all Nevadans.
Access to healthcare and rapid progression from cancer diagnosis to treatment represent two of the most critical factors influencing cancer survival rates. Evidence increasingly demonstrates that even short delays in treatment initiation can significantly impact patient outcomes, while barriers to healthcare access continue to create profound inequalities in cancer care delivery.
While there’s no standard setting a specific time from diagnosis to treatment, researchers have confirmed that the risk of death for several types of cancer—including breast, colorectal, lung, cervical, head and neck, and bladder cancers—increases with delays in treatment, regardless of the type of treatment. A one-month delay in treatment can increase mortality risk by 6-13%. Longer delays can increase that risk even more.lxix Conversely, shorter time to treatment has shown to decrease mortalitylxx and timely treatment has the potential to reduce the need for aggressive treatment and improve quality of life.
There are a number of factors that impact time to treatment, including financial barriers, health system complexity, geographical disparities, low health literacy, and lack of supports including for transportation and caregiving responsibilities. Greater travel distance to oncology services has been shown to often result in later stage diagnosis, lower likelihood of receiving adjuvant chemotherapylxxi, less guideline-concordant treatment, worse prognosis, and lower quality of life for survivors.lxxii Patient navigation, both in the clinical and community settings, has emerged as an evidence-based intervention that can guide patients through complex healthcare and insurance systems and help to address barriers to care by providing individualized support. However, navigation services must be combined with other interventions, including policies to reduce barriers that delay or prevent access to treatment, and be paired with a greater availability of oncology care across the state overall.
Objectives
Objective: Reduce time between diagnosis and treatment.
Strategies:
- Support development of designated National Cancer Institute cancer center(s) in Nevada.
- Support navigation services to streamline patient access to cancer care.
- Support policies reducing healthcare barriers that delay or prevent access to provider-recommended treatments, imaging, lab testing, and other procedures and services.
Objective: Increase Nevada’s physician workforce with an emphasis on oncology-related fields.
Strategies:
- Support development and expansion of oncology/hematology training programs at Nevada’s medical schools.
- Support efforts to secure additional graduate medical education residency and fellowship slots in Nevada.
- Support access to trauma-informed and culturally affirming care for people who identify as LGBTQ+ including through professional education and provider listings/registries.
- Support policies to attract and retain healthcare providers in Nevada.
- Support policies to expand the legal practice of physician assistants in Nevada.
Indicators
Number of state policy changes
Baseline: 0
Target: 2
Active Licensed MDs/DOs per 100,000
Baseline: 230.0
Target: 245
U.S. (2023): 282.3
Active Licensed MDs/DOs per 100,000 in rural/frontier communities
Baseline: 89.3
Target: 110
Annual GME graduates
Baseline: 272
Target: 300
Physician assistants per 100,000
Baseline: 38.5
Target: 51
U.S., 2022lxxiii: 51
Source: Nevada Health Workforce Research Center/Nevada Instant Atlas
References
lxix Hanna, T. P., W. D. King, S. Thibodeau, M. Jalink, G. A. Paulin, E. Harvey-Jones, et al. "Mortality due to cancer treatment delay: systematic review and meta-analysis." BMJ, vol. 371, 2020, m4087, doi:10.1136/bmj.m4087.
lxx Cone, E. B., M. Marchese, M. Paciotti, et al. "Assessment of Time-to-Treatment Initiation and Survival in a Cohort of Patients With Common Cancers." JAMA Network Open, vol. 3, no. 12, 2020, e2030072, doi:10.1001/jamanetworkopen.2020.30072.
lxxi Lin, C. C., S. S. Bruinooge, M. K. Kirkwood, C. Olsen, A. Jemal, D. Bajorin, S. H. Giordano, M. Goldstein, B. A. Guadagnolo, M. Kosty, S. Hopkins, J. B. Yu, A. Arnone, A. Hanley, S. Stevens, D. L. Hershman. "Association Between Geographic Access to Cancer Care, Insurance, and Receipt of Chemotherapy: Geographic Distribution of Oncologists and Travel Distance." Journal of Clinical Oncology, vol. 33, no. 28, 2015, pp. 3177-3185, doi:10.1200/JCO.2015.61.1558.
lxxiii National Commission on Certification of Physician Assistants, Inc. 2022 Statistical Profile of Board Certified PAs, Annual Report. Apr. 2023, www.nccpa.net/resources/nccpa-research/.