In the Zone | Our Investment in OncoveryCare

The progress in cancer treatment over the past few decades is truly remarkable. Groundbreaking targeted therapies and immunotherapies have led to a sea change in the effectiveness of treatment for many types of cancer. At the same time, an effort to improve and standardize screening has resulted in diagnosis at earlier stages of disease, when it is far more treatable. Taken together, these advancements have meaningfully improved cancer survival rates and created a rapidly growing population of “survivors.”

Despite (and in many ways because of) these advances, a large gap in patient care has emerged after active treatment ends. Informed by our own thesis work on the cancer survivorship space starting in 2019, .406 gained conviction that addressing this gap was as an opportunity to improve care and lower costs in the system.

The concept of cancer “survivorship” was born in the 1980s and alludes to not just completing treatment, but also to the health and well-being of a cancer patient from the time of diagnosis until the end of life, which can now extend for decades. Advocates for cancer survivors have been vocal that treatment is separate and distinct from the ongoing healthcare needs that come after. The movement highlights the challenges patients face both during and long after treatment. Patients are often left with several medical and mental health issues after cancer treatments, including treatment toxicity, comorbid medical diagnoses, sexual health challenges, and fear and anxiety related to cancer recurrence.

Many of these conditions fall into a ‘no man’s land’ of care. Oncologists are already stretched thin with large panels and waitlists of patients with active cancer diagnoses. Primary care doctors often have little training or background in dealing with the unique medical and behavioral needs of these patients. This means that cancer survivors often have nowhere to turn for reliable, convenient, and compassionate care, resulting in poor outcomes and greater costs for the system.

Growing number of survivors

According to the American Cancer Society’s 2024 publication, the five-year survival rate across all cancers is 69%, up from 49% in the mid-1970s. Two of the most common cancer types (breast and prostate) now have five-year survival rates above 90%. Targeted therapies and immunotherapies have transformed the outlook for certain diagnoses, with particularly impressive progress made across the blood cancers (leukemia, myeloma, and lymphomas). 

While survival rates are improving, a worrying trend is the growing rate of ‘early onset’ cancer diagnoses, defined as diagnoses occurring in adults under the age of 50. Between 2010 and 2019, rates of early onset breast and GI cancers increased by 8% and 15%, respectively. Oncologists attribute this increase to better early detection (good news) along with an increase in lifestyle risk factors that have grown the overall disease burden (bad news).

The combination of these factors, along with an aging population, has led to massive growth in the cancer survivor population. As of January 2022, there were an estimated 18 million cancer survivors in the U.S., and this number is expected to grow to 26 million by 2040.

Medical Complexity of Survivorship

According to a Livestrong survey, 91% of cancer survivors reported experiencing one or more physical health concerns and 96% experienced at least one emotional concern after treatment. 70% indicated that their oncologist did not offer support in dealing with non-medical needs, and the remaining 30% indicated that their oncologist was willing to talk about their needs but did not have the resources to address them.

The lack of resources and care for cancer survivors’ complex needs puts these patients at risk for worse outcomes while driving increased medical utilization and spend:

• 70% of cancer survivors have some sort of comorbid condition (e.g. cardiovascular, lymphedema, diabetes, metabolic issues, infertility, or premature menopause)
• Women with a history of breast cancer are at a 8x higher risk of cardiovascular disease
• 42% of breast cancer survivors develop lymphedema, which has an average treatment cost of $3,300 per patient per year
• Cancer survivors are 3x more likely to exhibit clinical levels of depression and 1.5x more likely to exhibit signs of anxiety
• The direct medical costs of cancer survivors, after the first year of diagnosis, is estimated to be 1.8x higher than people without a history of cancer.

In the Founder’s Words from Hil Moss, Founder and CEO: