Reports say cancer cost needs to be reined in

3/17/2010

NEW YORK - 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.

The reports raise questions about the past and future success of the U.S. "War on Cancer," as it was described in 1971 by then-President Richard Nixon.

The reduced death rates result from less smoking, early disease detection, and new drugs, 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.

"The expanding financial burden of cancer" including rising incidence rates "cannot be ignored," they wrote.

The Sloan-Kettering researchers also suggested in a commentary that doctors and hospitals should be grouped into accountable-care organizations.

That would nudge physicians to act more cohesively, and payers could reward them for providing care that delivers good results.

Cancer remains the second-leading cause of death in the United States, 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, a drug for breast, lung, and colorectal cancer, can cost as much as $100,000 a year.

Erbitux, a colon cancer treatment, can cost $40,000.

Not only do high bills cause financial hardship for patients, they also 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.

The report said "remarkable progress" has been made in the treatment of certain types of cancer, including breast cancer, Hodgkin's disease, and testicular cancer.

Almost 80 percent of children and adolescents who receive diagnoses of cancer now survive at least five years, Ms. Gapstur said.

The main driver of progress has been public-health messages about tobacco use. The decrease in cigarette smoking in the United States 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, Ms. Gapstur's commentary said.

And early detection of colorectal and cervical cancer has reduced mortality associated with them.

"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."