The Unsustainable Costs of Cancer Care: Guidelines to Alleviate the Burden of Cost for Patients

According to the proceedings, “the average monthly cost of cancer drug therapy has increased from $100 in 1965 to $10,000 in 2013.”¹ Much has been written about the high cost of cancer drugs, from Kantarjian et al on the “just price of agents” to the “financial toxicity” many patients experience when being treated for their cancers.²

At the recent 56^th Annual Meeting of the American Society of Hematology, for example, 183 abstracts had the word “cost” in their title, and a special symposium on the topic of quality concluded with a sometimes contentious discussion focusing, in part, on who should make decisions regarding cost and access: the patient, the physician, or the insurer?

During the symposium, S. Yousuf Zarar, MD, MHS, of Duke Cancer Institute in Durham, NC, reported on a survey of 300 patients with an 86% response rate in which patients who discussed costs with their doctors “believed the conversations helped reduce their expenses.”

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The survey identified two key research areas of barriers that need to be overcome “to deliver high-value, patient-centered care,” he said. The first is the need to “identify patients who might desire or benefit from a cost discussion,” and the second is to “validate practice-based interventions to reduce out-of-pocket costs.” He noted that in the United States and Europe, cancer treatment now costs more than $100 billion annually.³

Writing recently in the Journal of Clinical Oncology, Reshma Jagsi, MD, DPhil, of the University of Michigan in Ann Arbor, MI, agreed.

“As oncologists begin to appreciate how cancer care can cause substantial long-term financial burdens and deprivation among the very patients we intend to serve,” she stated.

“We may also begin to recognize that discussions of the costs of care and financial consequences of treatment decisions with patients can help us to fulfill our duty not only to society but also to the patients before us.”⁴

References

1. Nass SJ, Patlak M. National Cancer Policy Forum; Board on Health Care Services; Institute of Medicine. Ensuring Patient Access to Affordable Cancer Drugs: Workshop Summary. 2014. Available at: http://www.nap.edu/catalog.php?record_id=18956. Accessed December 2, 2014.
2. Kantarjian HM, Fojo T, Mathisen M, Zwelling LA. Cancer drugs in the United States: Justum Pretium – the just price. J Clin Oncol. 2013;31(28):3600-3604. Epub May 6, 2013.
3. Zafar SY. Financial toxicity: how the cost of medical care affects our patients. Presentation at the 56^th Annual Meeting of the American Society of Hematology. December 6, 2014. Available at: https://ash.confex.com/ash/2014/webprogram/Paper66432.html. Accessed December 11, 2014.
4. Jagsi R. Debating the oncologist’s role in defining the value of cancer care: we have a duty to society. J Clin Oncol. Published ahead of print on November 24, 2014.