By Lee N. Newcomer
VIEWPOINT
Myths And Realities In Cancer Care: Another Point Of View
ABSTRACT Cancer care is advancing, and the cancer community is right to celebrate that progress. Simultaneously, however, the cost of cancer therapy is rising along with all medical costs. In a matter of just a few years, the cost of health coverage is projected to reach heights that are simply unsustainable for most American families, overshadowing every other daily expense. Such an overwhelming burden will continue to undermine the progress made in developing new, more effective treatment and care for cancer patients. There cannot be a celebration of discoveries if there is no way to pay for them. It is from that perspective that I react and respond here to the commentary of Dana Goldman and Tomas Philipson, who debunk five myths in cancer care. I concur with the authors’ assessment of the value and impact of progress in cancer care. However, I also argue that researchers and policy makers must pay more attention to the impact of cost on patients’ adherence and experience and the speed with which new treatment and care are being developed.
B ased on current trends, econo- mists predict that in less than three years a family’s typical health in- surance premium and out-of-pock- et costs will equal 50 percent of the
average US-household income.1 The same study notes that fourteen years later the cost of health care coverage will equal 100 percent of house- hold income. As costs continue to rise, health care providers and researchers must discover methods to reduce the cost of care while advanc- ing the progress that has beenmade against can- cer. In this commentary I take the same five myths that Dana Goldman and Tomas Philipson have sought to debunk2 and, in reverse order, offer add
itional considerations that policy mak- ers should take into account.
Myth 5: Supportive Care Is Overused Goldman and Philipson are correct: It is a myth that supportive care is overused. However, sup-
portive care is undermined bymisuse. A study of 1,849 lung and colon cancer patients treated at multiple centers demonstrated underuse of sup- portive care,withonly 17percent of patientswith high-risk chemotherapy regimens receiving granulocyte colony stimulating factors (G-CSFs) to prevent low blood counts.4 The same study also showed significant overuse. Overall, for thesepatients, 97percentof theG-CSFs thatwere administered were not recommended by evi- dence-based guidelines. Palliative care offers one pathway to the dis-
cussions of patient goals that are critical for as- suring the appropriate use of supportive care. A trial of all lung cancer patients in an academic oncology clinic randomized patients to standard oncology careor to standardoncology carewitha palliative care consultation. The palliative care group had better quality-of-life scores, lived 2.7 months longer, used less chemotherapy, and had less aggressive end-of-life care.4 The palliative care patients established clear goals
doi: 10.1377/hlthaff.2014.0893 HEALTH AFFAIRS 33, NO. 10 (2014): 1805–1807 ©2014 Project HOPE— The People-to-People Health Foundation, Inc.
Lee N. Newcomer (lee_ [email protected]) is senior vice president in Oncology Services at UnitedHealthcare, in Edina, Minnesota.
October 2014 33: 10 Health Affairs 1805
Cancer Care
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