In an article titled “Five Myths about Cancer Care in America” coming out in the policy journal Health Affairs today, Dana Goldman* and I take on five common misperceptions in the policy community about cancer care in the US today. Below I discuss some of the evidence and arguments contained in that piece.
Much has been made of late about the need to justify the cost of cancer treatments in the policy community. Yet, if you ask those who face a cancer diagnosis whether cancer care is valuable, their behavior speaks loudly that the answer is a resounding “yes.” Patients and their families are spending an enormous amount on cancer care, which is a direct indication of its perceived high value, at the same time that the policy community is often claiming the treatments are of low value. The mismatch between patient and bureaucratic valuations is perhaps the starkest in cancer care.
However, patients should be properly insured and not have financial distress when cancer hits. The outrage surrounding the high prices of oncology drugs is in large part due to the fact that the patient bears the cost burden at time of diagnosis, rather than sharing the cost through higher premiums with those lucky enough to not be diagnosed. Indeed, many health care services have higher daily and total costs than cancer treatments; for example, the cost of a stay in an intensive care unit may be more than $10,000 per day. Yet, because ICU patients are covered, no one is accusing the medical device industry for high ICU costs. The high costs of cancer care are an insurance failure, not a failure of ineffective and expensive therapies.
Further, the insidious belief that we are losing the war against cancer helps fuel questions about treatment costs. But the reality is that we have made tremendous gains in fighting cancer. The war on cancer has often been declared a loss but the evidence clearly indicates that it has been a tremendous victory. It is a victory in the sense that the research spending that took place since Nixon declared the war has been swamped by the monetary value of the gains in health that research generated. Today, patients once diagnosed with cancer live longer, healthier and happier lives than those in prior decades. Survival rates for all cancers increased by almost four years during the period 1988-2000, creating twenty-three million additional life-years and generating $1.9 trillion in additional value to society in terms of gains in health. Further, newer therapies often allow for a better quality of life as advancements have been made in managing the toxicities associated with chemotherapy and radiation regimens. For some cancers, e.g. breast cancer, patients even return to normal lives instead of dying. Oncology treatments, and not better detection, are the main driver of this dramatic payoff to cancer research. While early and better detection of cancer is much heralded, detection has little impact on health if effective treatments are not available. During 1988-2000, evidence suggests that almost 80 percent of the aforementioned survival gains were attributable to improvements in treatment, with the remaining 20 percent attributable to better detection. Catching cancers early matters, but being better at treating them when caught matters 4 times more.
It is the war on the cost of cancer care that is doing harm by obfuscating the full value of treatments. From a patient perspective, value may include attributes such as quality of life, ease of administration, reduction in disease and treatment complication – and hope. For many patients and their families, new treatments – even those that provide a modest benefit – provide hope to go on and fight. Many patients hope they will live on and have access to better treatments as they become available, as we actually have observed both outside of cancer and within it. For example, HIV patients that went on the modestly effective treatment AZT in the early 1990s lived to see the miracle treatments of HAART coming on the market in 1996. Likewise, many breast and leukemia patients have lived into better treatments while being on past innovations.
The policy community needs to re-evaluate the facts surrounding cancer care, as those facts often destroy the many false myths surrounding cancer care. Research and development has led to astounding discoveries and groundbreaking treatments that have prolonged life and quality of life more than the increase in spending. As we address the need to contain costs, we must do so in a responsible way that both adjusts coverage policies to take undue financial burden off of cancer patients and allows innovation to flourish so that we can meet the needs of patients today and in the future.
* Dana Goldman is the Leonard D. Schaeffer Chair and Director of the Schaeffer Center for Health Policy and Economics at the University of Southern California.
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Author: Tomas Philipson