May 27, 2009 — When a cancer patient and his
or her doctor discuss the value of a treatment option, the conversation
usually centers on a consideration of the treatment’s medical benefits
versus its possible side effects for the patient. Increasingly,
however, as the already high costs of cancer care continue to rise, a
full view of the patient’s welfare must also take into account the
economic impact of the treatment on the patient and his or her family.
Additionally, beyond its clear impact on patients, the increasing
cost of cancer care also presents challenges to other stakeholders
involved in the development and delivery of care.
"Cancer care is one of the most expensive areas of health care
today, and the cost of that care is increasing steadily, for patients
and for society as a whole," says Neal J. Meropol, M.D., director of
the gastrointestinal cancer and gastrointestinal tumor risk assessment
programs at Fox Chase Cancer Center. Meropol, who is also a member of
the American Society of Clinical Oncology (ASCO) Cost of Care Task
Force and lead author on the upcoming ASCO Guidance Statement on the
Cost of Cancer Care, offered his analysis of the problem in a talk
presented at the ASCO annual meeting in Orlando today.
"As physicians, we have a responsibility to understand the impact
that the increasing cost of cancer care has on everyone involved,"
Meropol notes. "In particular, we need to be able to discuss with our
patients the impact that high out-of-pocket expenses might have on them
and their families, however difficult that conversation might be. More
and more, cost considerations have an appropriate role in the
assessment of treatment options."
According to Meropol, other stakeholders affected by the rising cost
of cancer care in addition to patients include employers who must
remain competitive while subsidizing their employees’ health care,
health insurance providers who must watch their bottom lines while
deciding which treatments to pay for and at what level, physicians who
must offer guidance for their patients in choosing among treatments,
including new drugs that might offer modest survival benefits but at
significant additional cost, and the pharmaceutical industry, which
hopes to earn a profit from the sale of innovative drugs that can cost
$1 billion to research and develop.
Meropol observes that many of the costly new cancer drugs now coming
to market are highly targeted in their action, often quite effective
but only in a subset of patients. While these drugs anticipate the
dream of personalized medicine, their high costs must be shared over a
smaller potential pool of patients, perhaps threatening the future of
this promising new direction in medicine.
Rising costs also have the potential to widen the disparities that
already exist in cancer outcomes among different populations, adding an
ethical dimension to the problem.
"Rising costs may be a key impediment to reaching our societal goal
of providing high quality cancer care to all citizens," Meropol says.
Going forward, the challenges in confronting the cost-of-cancer-care
issue are substantial. Patients and their physicians both feel
ill-equipped to consider treatment costs in the clinical setting, and
society has yet to address this multifaceted issue in a comprehensive
way. Still, Meropol says, we have no alternative but to begin the
search for answers now. The increasing economic burden posed by
cancer-care costs on patients and their families – and on society – is
too great to ignore.
Source : Fox Chase Cancer Center