Cancer care doesn’t begin when someone sits down for chemotherapy or radiation treatment. It begins long before the first dose, with a diagnosis that arrives early enough to help the patient survive.

From there, cancer care also means providing transportation to the clinic week after week, and offering support to keep a steady paycheck. It means deciphering insurance paperwork, tracking follow-up appointments and reaching a clinician who will answer the phone when fear sets in. None of this appears on a treatment plan. But these factors determine who completes treatment and who may fall through the cracks.

Too often, needless barriers cause cancer to be diagnosed and treated late in medically underserved communities. Black Americans, for instance, experience the highest cancer mortality rates in the country for many types of cancer, driven by longstanding inequities in access to early diagnoses and timely care. The same challenges impact patients in rural communities, where long travel distances and limited transportation options can delay or interrupt care.

Community oncology — the localized, personalized and cost-effective practice of treating patients — helps address these challenges by absorbing the social and economic pressures that might otherwise pull a patient off treatment. The goal is to deliver high-quality treatment close to home through services that ease the burden of treatment: transportation assistance, care coordination, financial counseling and support for the family members doing the caregiving.

This is what closing the health equity gap actually looks like. It is not a slogan. It is a clinic 30 minutes away rather than three hours, with a staff member whose job is to make sure a patient can get there.

In many ways, access to cancer care was improved through the Inflation Reduction Act (IRA), one of the Biden administration’s signature accomplishments. The legislation delivered long-overdue reforms aimed at lowering prescription drug costs and strengthening protections for Medicare beneficiaries. Those gains are critical for patients, particularly seniors on fixed incomes. They should be preserved.

But no law of that scale arrives without consequences. A 2025 executive summary by Milliman reports that the IRA, as written, will shift the basis of provider reimbursements from Average Sales Price to Maximum Fair Prices for Part B drugs, including chemotherapy. Without action from Congress, this change is expected to result in a $26.9 billion payment reduction for oncologists over ten years.

A cut this deep would force independent oncologists to make tough decisions about how they can continue providing community-based treatment — if they can do so at all.

If community oncology practices close, patients will likely lose access to local care. That can mean longer drives, higher costs, fewer support services and the potential of not getting the critical care they need. Those burdens fall hardest on communities that already face disparities in health outcomes.

The infrastructure of community oncology is now at risk, but Congress has a chance to prevent the worst of the damage. That’s where the Protecting Patient Access to Cancer and Complex Therapies Act comes in.

This bipartisan bill doesn’t repeal Medicare drug price negotiations or roll back the IRA. Instead, it would shield physicians from harmful cuts while preserving the savings that patients gained under the IRA.

Congress has a responsibility to ensure laws work as intended. It can and should protect community-based care systems that patients depend on to access local care at a lower cost.

Policymakers have long discussed addressing social determinants of health and reducing disparities in care. Cancer patients need more than medicine. They need systems that make it possible to receive care with dignity and without unnecessary barriers.

I urge Congress to pass the Protecting Patient Access to Cancer and Complex Therapies Act to ensure those systems can safely stay in place.

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Julianne Malveaux, Ph.D., of Washington, D.C is an economist and leading scholar on the need to protect accessible, local cancer care in underserved communities. This column was produced for Progressive Perspectives, a project of The Progressive magazine, and distributed by Tribune News Service.

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