Findings from small pilot studies suggest that phase II and III clinical trials result in at most modest increases in cost over standard treatment costs. Also, an increasing number of policy makers have decided to support clinical trial reimbursement initiatives. It is hoped that economic data from large observational studies will facilitate widespread and permanent decisions that support reimbursement for phase I, II, and III clinical trial participation.

Changing economic circumstances have brought increased pressure to bear on the traditional revenue sources of oncologists. Practice standards and settings are being challenged to generate cost savings both for third-party payers and for oncology practices. Add to this the growing number of patients older than 65 years, and particularly older than 85 years, and the profession is facing a forced reconsideration of its approach to patient treatment. The current and future training of oncologists needs to incorporate both a multidisciplinary approach of cancer subspecialties and an enhanced ability to evaluate the use and cost-effectiveness of new therapies, second-line and third-line therapies, and palliative treatments.

The implementation of the Patient Protection and affordable care act will change oncology practice in many ways. Innovative payment models, new practice arrangements, and an increased focus on paying for quality and value will change the landscape for oncologists and people with cancer.

the traditional revenue sources of oncologists. Practice standards and settings Physician Reliance Network, Inc., Dallas, Texas.are being challenged to generate cost savings both for third-party payers and for oncology practices. Add to this the growing number of patients older than 65 years, and particularly older than 85 years, and the profession is facing a forced reconsideration of its approach to patient treatment. The current and future training of oncologists needs to incorporate both a multidisciplinary approach of cancer subspecialties and an enhanced ability to evaluate the use and cost-effectiveness of new therapies, second-line and third-line therapies, and palliative treatments.

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