Imagine two patients are diagnosed with liver cancer on the same day. Both have similar tumors and overall health. The only difference? Their zip codes. While we’d like to believe that all patients in the United States receive standardized care regardless of location, the reality is far more complex. Where a patient lives—and more specifically, which health care system they can access—may fundamentally alter their treatment options and outcomes.
This disparity becomes particularly evident in emerging cancer treatments such as theragnostics. These innovative therapies combine diagnostic imaging with targeted treatment, often using radioactive particles to deliver radiation directly to tumors. While these treatments can offer hope to patients who previously had limited options, their availability and implementation vary dramatically across health care systems.
Consider transarterial radioembolization (TARE), a well-established treatment for liver cancer. The procedure seems straightforward: deliver radioactive particles directly to the tumor through its blood supply. But behind this simple concept lies a complex web of technical requirements, specialized expertise, and resource demands that many health care systems struggle to meet.
At the heart of TARE treatments is dosimetry—the precise calculation of radiation doses for each patient. Recently, remarkable advances in dosimetry methods have been made, leading to dramatically improved patient outcomes. Patients who once had few options are now living longer and, in some cases, achieving complete cures. However, these improvements come with increased complexity. Each advance requires new software, updated protocols, and continuous education for the entire treatment team. What was once a relatively straightforward calculation has evolved into a sophisticated process requiring specialized expertise and constant attention to emerging research.
The challenge isn’t just about having the right equipment—it’s about maintaining expertise in a rapidly evolving treatment environment. Medical knowledge doubles approximately every 73 days, making it nearly impossible for physicians to stay current across all aspects of care while maintaining busy clinical practices. Smaller health care systems face an even greater burden: they must somehow justify investing in cutting-edge technology and expertise while serving a smaller patient population.
European health care systems often address this challenge by establishing specialized centers of excellence, where patients with specific conditions are concentrated and often receive relatively standardized care. But this approach faces unique obstacles in the United States, where our vast geography and fragmented health care system create barriers to centralization.
As a result, we’ve seen several concerning patterns emerge as systems try to overcome the challenges discussed above. Often, health care systems resort to older treatment protocols—not because they’re optimal, but because they’re manageable with existing resources. Others invest in advanced technology but struggle to maintain the specialized staff needed to optimize its use. In many cases, physicians shoulder the burden, taking on additional complex work at the expense of other clinical responsibilities and overall well-being.
However, innovative solutions are emerging to bridge this gap as well, particularly in the form of specialized third-party services. These companies can centralize expertise across multiple health care systems, ensuring consistent, high-quality care while maintaining local delivery. In the case of TARE treatments, services like TeleDaaS provide specialized dosimetry expertise and protocol updates, allowing smaller systems to deliver cutting-edge care without overwhelming their resources. Remarkably, these services can sometimes pay for themselves through improved documentation and appropriate billing for complex care.
The fundamental question remains: shouldn’t patients receive optimal care regardless of their location or which physician they see first? While geographic disparities in health care delivery remain a significant challenge in the United States, solutions are emerging. Third-party specialty services represent one promising approach to democratizing access to advanced treatments. As medicine grows more complex, we must continue to innovate not just in treatment methods, but in how we deliver these treatments equitably across diverse health care systems.
The patient who walks into their local clinic deserving the best possible care shouldn’t have their options limited by geography. By embracing new models of care delivery, we can work toward making this ideal a reality.
Shamar Young is a physician executive.
