Addressing the Unsustainable Growth of Metastatic Cancer Costs

Steps must be taken to address the unsustainable growth of health care costs for metastatic cancer in order to better serve patients while still acknowledging the limits of health care resources, claims a review published in the Journal of Surgical Oncology.

In 2016 alone, it is estimated that there will be 1,685,210 new cases of cancer, with 595,690 people succumbing to the disease. Many patients develop metastatic cancer during the course of their disease, which is incurable in almost all cases. However, recent advances have produced new ways to better identify, prevent, and treat metastatic cancer, although they have also significantly increased health care expenditures on an individual and societal level. 

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In 2015, US health care spending reached more than $3 trillion, a rate that is projected to grow by an average of 5.8% per year. Additionally, expenditures related to cancer care alone are expected to reach $173 billion in the United States by 2020. These extraordinary figures have translated to crippling financial hardships for American families, highlighting a need for greater understanding and management of the rising costs associated with cancer care. 

In an article published in the Journal of Surgical Oncology, researchers led by Muhammad Kashif Riaz, MD, University of Cincinnati Medical Center (Cincinnati, OH), discussed some of the ethical and financial challenges that oncologists and their patients face in the era of novel treatment strategies for metastatic cancer.

First, Dr Riaz and his colleagues discussed common practices for treating metastatic disease, which for many cancer types involves testing for certain genetic factors. These factors, authors continued, often guide oncologists about which treatments they should use to treat different diseases. However, all these tests lead to higher costs and there is much ambiguity about which treatment combinations would be best used to mange symptoms.

Next, the authors addressed the important issue of quality of life (QoL) during care, which can be the reason why patients adhere to or discontinue treatment plans. Chemotherapy-induced peripheral neuropathy is one major dose limiting toxicity of platinums, taxanes, and vinca alkaloids. This condition can be painful and adversely affect motor functions, resulting in major QoL implications. Clinical trials have demonstrated that drugs such as paclitaxel may be effective at helping to ease symptoms but can also lead to costs that are more than $17,000 higher than controls. The same can be said of neutropenia, a common side effect of cytotoxic chemotherapy, where management of symptoms can substantially increase costs. 

To address these issues and create a more equitable health care system, authors wrote that, “The medical community should be encouraged to discuss pharmacoeconomics with patients.”

They added that it might be surprising how many patients might choose to forgo treatment rather than spending significant amounts of money on the possibility of only marginal benefit. This would also provide patients with more control and autonomy over how their disease is treated, leading to care and outcomes that are more patient-centric. Additionally, drug approvals in the United States could also begin to include cost-effectiveness data that use incremental cost-effectiveness ratios to determine whether drugs adequately utilize resources, similar to other countries such as Canada and the United Kingdom. However, the authors do recognize that the use of quality-adjusted life-years as a standard measure for assessing drug efficacy and cost effectiveness is a controversial issue, as QoL is a subjective term. Thus, this measure should be viewed more as a guiding principle rather than a deciding factor when considering various interventions.

The authors concluded that drug pricing in the United States is unsustainable and not affordable for many patients. Steps to review and create awareness of this problem should be seen as admirable initiatives to curtail prices and better serve patients with limited resources.—Sean McGuire

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Riaz MK, Bal S, Wise-Draper T. The impending financial healthcare burden and ethical dilemma of systemic therapy in metastatic cancer [published online ahead of print July 4, 2016]. J Surg Oncol. doi:10.1002/jso.24333.