The rising cost of cancer research and care, which helped reduce death rates by 16 percent over 40 years, is straining the U.S. health system and needs to be restrained, commentators said in a special edition of the Journal of the American Medical Association.
Cancer research has cost the U.S. government $100 billion since 1971 and the price of care, accounting for inflation, has more than doubled to $90 billion since 1990, according to six journal reports that raise key questions about the past and future success of the U.S. “War on Cancer,” announced by then- President Richard Nixon in 1971.
The reduced death rates result from anti-smoking campaigns, early disease detection and new drugs, led by Roche Holding AG’s Avastin and Eli Lilly & Co.’s Erbitux, which can cost individual patients as much as $100,000 a year. The price of the drugs, and the care tied to their use, can be lowered by shifting to a system in which the cost of drugs, tests and other care are combined in a single provider payment, researchers said.
Such a system would push doctors to “shop carefully for the services” patients need, wrote the researchers from the Memorial Sloan-Kettering Cancer Center in New York, led by Elena Elkin in a commentary that was among those included in the special issue. “The expanding financial burden of cancer” including rising incidence rates “cannot be ignored,” the authors wrote.
The Sloan-Kettering researchers also suggested in their commentary that doctors and hospitals should be grouped into accountable-care organizations. That would nudge physicians to act more cohesively, and could be rewarded by payers for providing care that delivers good results.
Cancer remains the second-leading cause of death in the U.S., killing 562,000 people a year, according to the American Cancer Society in Atlanta. In one survey cited in the journal, almost a quarter of respondents with health insurance said they used most or all of their savings during treatment for the disease.
Avastin, the drug made by Roche of Basel, Switzerland, for breast, lung and colorectal cancer, can cost as much as $100,000 a year, according to UnitedHealth Group Inc. of Minnetonka, Minnesota, the biggest U.S. health insurer. Erbitux, the colon cancer treatment made by Indianapolis-based Lilly, can cost $40,000, said Les Funtleyder, a Miller Tabak & Co. LLC analyst in New York, in an e-mail today.
Not only do high bills cause financial hardship for patients, they influence the choices doctors make, the authors said. In a separate survey noted in the editorial, 84 percent of oncologists said that concerns about patients’ out-of-pocket payments influenced their treatment decisions.
The so-called war on cancer has led to $100 billion in cancer-research funding by U.S. agencies, according to a journal commentary written by Susan Gapstur, an epidemiologist at the American Cancer Society. These efforts resulted in a 1 percent annual drop in new cancer diagnoses between 1999 and 2006, her report said.
There has been “remarkable progress” in the treatment of certain types of cancer, the report said, including breast cancer, Hodgkin’s disease, and testicular cancer. Almost 80 percent of children and adolescents diagnosed with cancer now survive at least five years, Gapstur said in a phone interview yesterday.
The main driver of progress has been public-health messages about tobacco use. The decrease in cigarette smoking in the U.S. over the past half-century accounts for 40 percent of the drop in cancer deaths in men since 1990, the year when the lung- cancer mortality rate for men peaked, Gapstur’s commentary said.
“We’ve made progress, but people are still dying at too high a rate,” she said. “At the moment, we can’t put a dollar amount on when we stop. We have to continue our research efforts.”
Other noteworthy advances include vaccinations to protect against liver and cervical cancers and improvements in radiation therapy, Gapstur said in a press briefing today.
Early detection of colorectal and cervical cancers has reduced the mortality rates associated with those diseases. The challenge now, she said, is to improve early detection methods and enhance their usefulness.
“For society, it’s less expensive to screen hundreds of people than to treat a single patient with cancer,” said Bert Vogelstein, co-director of the Johns Hopkins Ludwig Center in Baltimore, who is working to develop diagnostics to detect the genetic alterations that are seen in cancers.
There are a number of other challenges ahead, according to the report. An aging population means the number of cancer cases is likely to increase in the future, it said. Some cancers, including those of the liver, pancreas, and brain, are still linked to high mortality rates despite research efforts.
As tobacco use wanes, the high rate of obesity in the U.S. could present a new public health challenge by raising cancer rates, Gapstur said.
“Most epidemiologic studies have shown that obesity is a risk factor for cancer,” said Vogelstein in an interview yesterday.
About 30 to 35 percent of all cancers can be attributed to nutrition, lack of physical activity, and obesity, Gapstur said. “Our concern is that, over time, that epidemic will have an impact on cancer mortality.”
Gapstur’s essay notes that many articles have been written that are critical of the pace of progress in battling cancers and finding cures, especially in light of the “immense” economic costs.
“We’ve been fighting this war on cancer since Nixon’s time, but we’ve only had the human genome for about a decade,” said Victor Velculescu, co-director of cancer biology at Johns Hopkins Kimmel Cancer Center. “It takes time to translate genetic information, but we’ve only just started getting it.”
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