Financial Toxicity of Cancer Care
From American Medical News (find it here):
The toxicity of chemotherapy and other drug treatments for cancer has extended beyond side effects such as nausea and nerve pain. It has now extended to a patient's ability to pay the mortgage and buy groceries while undergoing care, said the author of a study looking at the financial impact of cancer treatment.
Amy Abernethy, MD, associate professor in the Division of Medical Oncology at Duke University Medical Center, helped write one of a handful of studies presented at the June meeting of the American Society of Clinical Oncology that found the rising cost of cancer care could impact treatment decisions and even lead to patients forgoing treatment because they cannot afford it.
The growing financial burden on those undergoing cancer treatment could put physicians in the position of prescribing treatments that could save their patients' lives but force them into bankruptcy, poverty or even homelessness -- if they could scrape up the money to receive the treatment in the first place. This is especially troubling given the fact that advancements are being made in cancer treatments that could lead to much higher survival rates.
Another study presented at the ASCO meeting was published online June 5 in The New England Journal of Medicine. It found that the experimental drug vemurafenib and the newly approved Yervoy (ipilimumab) can improve survival rates for patients with advanced melanoma, a population that hasn't had many treatment options in the past. Yervoy will cost $120,000 for a four-dose treatment at $30,000 per dose.
"The move toward increased cost-sharing in high-deductible health plans, increased premiums and tiered formularies all shift the cost burden to patients and force them to make day-to-day decisions on how to integrate health care costs with other discretionary spending," said (Neal Meropol, MD, chief of the Division of Hematology and Oncology at Case Western Reserve University School of Medicine).
A study conducted by researchers at the Fred Hutchinson Cancer Research Center in Seattle found that as cancer patients' survival time increases, so do the chances they will declare bankruptcy. Researchers compared U.S. Bankruptcy Court records to cancer registry data from nearly 232,000 adult cancer survivors in western Washington over 14 years. They found that, on average, bankruptcy rates quadrupled within five years of a cancer diagnosis.
From the Agency for Healthcare Research and Quality (find it here):
The Effective Health Care (EHC) Program partners with networks of researchers and clinical teams across North America, using input from stakeholders throughout the process of comparative effectiveness research, translation, dissemination, and implementation of research findings.
In 2010, AHRQ used funding from the American Recovery and Reinvestment Act of 2009 (ARRA) to establish two important Program initiatives:
* Community Forum to improve and expand public and stakeholder engagement in AHRQ’s comparative effectiveness research and EHC Program.
* Healthcare Horizon Scanning System to identify new and emerging issues for comparative effectiveness review investments.
These initiatives contribute to the work of these Program components:
* Individual investigators and their research groups at academic institutions and other research centers generate new evidence from original research.
* The Evidence-based Practice Centers (EPCs) perform in depth reviews of existing evidence.
* The DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) Research Network gathers new knowledge on specific treatments and health care services.
* The Centers for Education & Research on Therapeutics (CERTs) conduct research and educate clinicians and consumers about drugs, biologicals, and medical devices.
* The Scientific Resource Center provides scientific support for the EHC Program.
* The John M. Eisenberg Center for Clinical Decisions and Communications Science organizes the research results into guides and tools that are useful to clinicians, health care policymakers, and patients.
* The Stakeholder Group provides different perspectives on the EHC Program from individual members of the Group.
Dr. McCanne's comment:
Having cancer and facing the agony of treatment is bad enough without also having to face the financial burdens of treatment. As this and many other reports show, "financial toxicity" can seriously impair the ability to meet other basic needs, and may even result in personal bankruptcy.
We do need some reassurance that the costs and adverse effects of the treatments are worth the benefits provided. We shouldn't use as our sole source of information an industry that might be reluctant to communicate the full downside of their treatments when that information might reduce their very lucrative profits.
Fortunately, we do have a good start on becoming more informed in our choices for health care. The Effective Health Care Program of the Agency for Healthcare Research and Quality (AHRQ) is providing us with comparative effectiveness and evidence-based research that can be very useful in our clinical decision making. However, we do need to move further forward and use this information to make coverage decisions, certainly to eliminate coverage of detrimental health care, and also to eliminate coverage of care that the overwhelming preponderance of information reveals is not beneficial.
We also need to negotiate the best pricing based on legitimate costs and fair profits, and begin to make decisions on tolerance thresholds for health care payments. Everyone would agree that we can't use our collective funds to pay say $10 million for a treatment program that would extend the life of one person by three weeks, but with the very high prices that are being introduced, we will have to begin to struggle with cost-effectiveness determinations at levels that we find to be tolerable.
Once we are armed with the very best information, we should use that to obtain the highest quality care that's feasible for each and every individual with health care needs. We should eliminate "financial toxicity" by providing first dollar coverage for not just cancer patients but for all patients who already have enough burdens heaped upon them without having to face onerous financial burdens as well.
The Utah Healthcare Initiative has long argued that decisions about what is included in the health benefit paid for by all of us, whether through premiums or taxes, should be driven by clinical science. The lowest cost effective treatment should be covered. It is sheer folly to declare that each of us individually should have 'skin in the game' when it comes to health care costs when we are all paying the world's highest taxes for health care (on a per capita basis) and those unfortunate enough to have life threatening illness (such as cancer) not only have skin in the game, but everything else as well. Why do we allow illness and injury to cause personal and family bankruptcy in the United States? We are the only first world country where people hold bake sales for their friends and family with serious illness. We are already paying enough to have best quality care for every American. What we can not afford is health care profiteering through the perverse incentives of health care driven by dollars not clinical science.
Dr. Joe Jarvis