While cancer death rates in the U.S. have declined due to earlier detection, the quality of treatment, and the accessibility of cancer care, the American Cancer Society reports that men still have an approximately one in two lifetime risk of developing cancer, with a risk of one in three for women. According to the American Society of Clinical Oncology (ASCO) advances have come with significant increases in the cost of cancer care, which, in the United States, are growing more rapidly than the overall economy. The considerable financial burden for patients and family members is a major concern noted my healthcare professionals.
To address the concerns, the American Society of Clinical Oncology (ASCO) established a Cost of Care Task Force. The Task Force has developed a Guidance Statement on the Cost of Cancer Care which provides a concise overview of the economic issues facing stakeholders in the cancer community. It also recommends that steps be taken to address immediate needs, including recognition that patient-physician discussions regarding the cost of care are an important component of high-quality care, the design of educational and support tools for oncology providers to promote effective communication about costs with patients, and the development of resources to help educate patients about the high cost of cancer care to help guide their decision making regarding treatment options.
Public Concern
The Community Oncology Alliance announced results of a national survey that reveals the inability to pay for cancer care is among the top fears about the disease. Seven out of ten reports being very concerned about paying for cancer treatment if they developed the disease (69%), the same proportion who are very concerned about dying of it (68%). Only the cancer consequences of having a poor quality of life (75%) and being in pain (72%) evoke slightly more concern.
COA commissioned Opinion Research Corporation to survey a statistically representative sample of 1,022 adult Americans 18 years of age or older. The survey was conducted June 26-30, 2009.
The participant speak from experience: 79% of the survey respondents reported having a family member or friend diagnosed with cancer. Other top concerns regarding a cancer diagnosis include being unable to work (61%) and leaving their families in debt (59%).
Lack of confidence
"The need for healthcare reform is especially critical for cancer care," explained Patrick Cobb, M.D., president of COA and managing partner of Hematology-Oncology Centers of the Northern Rockies in Billings, Montana. "The increasing cost of drugs, declining Medicare reimbursement, and current financial crisis have created a 'perfect storm' that jeopardizes community cancer clinics, where most Americans with cancer are treated."
The survey reveals a lack of confidence in the cancer healthcare payment system, including both private insurance plans and the Medicare system. Less than half (45%) believe their private insurance plans would cover the full cost of cancer treatment, while only 25% believe Medicare would cover treatment costs. Only 41% believe they would be covered for care in a community cancer clinic, where 84% of cancer treatment actually occurs.
Cobb continued, "Though the U.S. has the best cancer care delivery system in the world, the system is now in first-stage crisis because Medicare has substantially cut payments for cancer drugs and essential services. Oncologists are spending an inordinate amount of time dealing with patient financial issues, including trying to find ways of navigating the insurance maze and identifying drug and co-payment assistance for patients in need. Community cancer clinics have had to close satellite facilities and cut staff. Smaller clinics are struggling to operate and more will close."
Inability to cover the costs
The survey found that most Americans say they could not afford the typical monthly cost of cancer treatment not covered by insurance plans. Only a third (37%) say they could pay up to $1,000 per month towards their cancer care not covered by insurance plans. And only 16% say they could pay up to $2,500 per month towards cancer care.
"Monthly out-of-pocket costs for cancer care and treatment, not covered by private insurance plans or Medicare, can easily run to $1,000 or more," explained Dr. Cobb. "For many cancer patients, the costs of diagnostic imaging, surgery and expensive cancer medications, especially in the first few months of treatment, can add up to well beyond $2,500 per month."
To pay for cancer care, Americans report they would take a variety of dire steps. Nearly seven out of ten (66%) report they would go on government assistance to pay the cost of cancer treatment. Four out of ten or more would sell their cars (48%) or their homes (38%), would borrow the money (44%) or declare bankruptcy (40%). Fully one third (33%) say they would simply stop the cancer treatment.
Most (85%) of Americans believe a government-run health plan would have significant disadvantages for cancer care, compared to their own current insurance plans. They see higher taxes as the mostly likely disadvantage of a government-run health plan (74%), while more than half cite negative impacts on treatment and quality of care: longer wait for medical appointments (62%), less coverage of expensive cancer medications or treatments (60%), less coverage of cancer detection and diagnostic tests (54%) and lower quality of care in general (56%).
"The need for healthcare reform is especially critical to cancer care," said Ted Okon, executive director of COA. "However, the proposals currently under consideration by Congress and the Administration to reform the healthcare payment system do not take into account the special circumstances and requirements of cancer care. What is needed is a substantive program developed with the involvement of oncologists to enhance the delivery of quality cancer care."
Aggressive Solutions Needed
Recently, H.R. 2872, the "Medicare Quality Cancer Care Demonstration Act of 2009," was introduced into the House of Representatives by U.S. Representatives Artur Davis (D-AL), Steve Israel (D-NY) and Mary Jo Kilroy (D-OH). H.R. 2872 is a bill that will authorize Congress to direct the Centers for Medicare & Medicaid Services (CMS) to implement the Quality Cancer Care Demonstration (QCCD) project. The QCCD, a landmark initiative to transform the payment system for cancer care, will focus on patients covered by Medicare (approximately 45% of cancer patients), involving the collection of data and implementation of a patient-centric program that enhances quality cancer care while controlling costs.
"The Quality Cancer Care Demonstration project offers a means of moving forward immediately, and an architecture for a solution to the current crisis in cancer care," Cobb noted.
Earlier this year, Sen. Arlen Specter (D-PA) introduced into the U.S. Senate S. 1221, "The Medicare Prompt Pay Correction Act," as the companion to the H.R. 1392. Both seek to address problems with Medicare reimbursement for cancer drugs and help alleviate a national problem affecting the delivery of cancer care treatment to patients, almost all of whom are treated in community oncology clinics close to their homes.
In addition to these developments, the Guidance Statement developed by ASCO’s Cost of Care Task Force recommends that the organization will be more involved in the development of policy positions to address the underlying factors contributing to the increased cost of cancer care. Doing so will require a clear understanding of the factors that drive these costs, as well as potential modifications to the current cancer care system to ensure that all Americans have access to high-quality, cost-effective care.
For more information:
- The Community Oncology Alliance (COA)
- American Society of Clinical Oncology (ASCO)
- Oncology Europe: Topic Review: Cost of Cancer
Physician Resources:
- Costs and Cost-Effectiveness of New Cancer Technologies (2009 ASCO Annual Meeting)
- Defining Goals of Care: Financial and Quality-of-Care Impact (2009 ASCO Annual Meeting)
- Economics of Cancer Care: It's Everyone's Problem (2009 ASCO Annual Meeting)
- Health Care Economics and Quality (2009 ASCO Annual meeting)
- Discussing the Cost of Care with Patients with Cancer: What Can We Tell Them? What Is the Goal? (2009 ASCO Annual Meeting)
- Costs and Care from Treatment to Survivorship (2007 ASCO Annual Meeting)
- Oncology Business Management Issues in the Changing Reimbursement Environment (2006 ASCO Annual Meeting)
Also read the following PubMed abstracts:
- Meropol NJ, Schrag D, Smith TJ, Mulvey TM, Langdon RM Jr, et al. American Society of Clinical Oncology Guidance Statement: The Cost of Cancer Care. J Clin Oncol. 2009 Jul 6. [Epub ahead of print]
- Ricciardi A, Largeron N, Giorgi Rossi P, Raffaele M, Cohet C, et al. Incidence of invasive cervical cancer and direct costs associated with its management in Italy. Tumori. 2009 Mar-Apr;95(2):146-52.
- Thompson MR, Heath I, Swarbrick ET, Wood LF, Ellis BG. Earlier diagnosis and treatment of symptomatic bowel cancer: can it be achieved and how much will it improve survival? Colorectal Dis. 2009 Jul 3. [Epub ahead of print]
- Sharma K, Das S, Mukhopadhyay A, Rath GK, Mohanti BK. Economic cost analysis in cancer management and its relevance today. Indian J Cancer. 2009 Jul-Sep;46(3):184-9.
- Fojo T, Grady C. How Much Is Life Worth: Cetuximab, Non-Small Cell Lung Cancer, and the $440 Billion Question. J Natl Cancer Inst. 2009 Jun 29. [Epub ahead of print]
- Engel RP, Witjes JA. Perioperative instillation therapy in superficial bladder cancer: is it effective regarding outcome and costs? Curr Opin Urol. 2009 Jun 23. [Epub ahead of print]
- Konski A, James J, Hartsell W, Leibenhaut MH, Janjan N, et al. Economic Analysis of Radiation Therapy Oncology Group 97-14: Multiple Versus Single Fraction Radiation Treatment of Patients With Bone Metastases. Am J Clin Oncol. 2009 Jun 19. [Epub ahead of print]
- Munshi A. Resource-sparing and cost-effective strategies in current management of breast cancer. J Cancer Res Ther. 2009 Apr-Jun;5(2):116-20.
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