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Can we afford the cancer care of the future?

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.

Fox Chase Cancer Center