WASHINGTON (AP) - You've just been diagnosed with cancer, and the doctor is
discussing treatment options. Should the cost be a deciding factor?
Chemotherapy costs are rising so dramatically that later this year,
oncologists will get their first guidelines on how to have a straight talk with
patients about the affordability of treatment choices, a topic too often
sidestepped.
"These are awkward discussions," says Dr. Allen Lichter of the American
Society of Clinical Oncology, which is writing the guidelines. "At least we can
bring this out in the open."
It's a particular issue for patients whose cancer can't be cured but who are
seeking both the longest possible survival and the best quality of life -- and
may be acutely aware that gaining precious months could mean bankrupting their
families.
The prices can be staggering. Consider: There are two equally effective
options to battle metastatic colon cancer, the kind spreading through the body
-- but one costs $60,000 more than the other, says Dr. Leonard Saltz of Memorial
Sloan-Kettering Cancer Center.
What's the difference? The cheaper one, irinotecan, causes hair loss that
makes it impossible for people trying to keep a job to hide their cancer
treatment, he explains. The pricier oxaliplatin can cause nerve damage in hands
and feet that might make it a worse option for, say, a musician or computer
worker.
Saltz offers a tougher example: A drug for pancreatic cancer -- an
especially deadly cancer with few treatment options -- can cost $4,000 a month.
Yet while Tarceva has offered some people remarkable help, research suggests
that extra survival on average is a few weeks.
"Is it a good investment, a high-risk investment, or buying a lottery
ticket?" is how Saltz puts these choices.
Drug prices are a growing issue for every disease, especially for people who
are uninsured. But cancer sticker shock is hitting hard now, as a list of more
advanced biotech drugs have made treatment rounds costing $100,000, or even
more, no longer a rarity. Also, patients are living longer, good news but
meaning they need treatment for longer periods. The cost of cancer care is
rising 15 percent a year, Lichter notes.
Make no mistake: Some of these newer drugs have greatly helped some patients
-- Gleevec, for example, has revolutionized care for a type of leukemia -- and
the prices reflect manufacturers' years of research and development investment.
Also, drug companies do donate a certain amount of medication to
prescription-assistance programs that provide them for free to patients who
otherwise couldn't pay. Since 2005, nearly 5 million people -- cancer patients
and people with other diseases -- have been matched to such programs through the
drug industry's "Partnership for Prescription Assistance."
But few patients get a Gleevec-style home run, and there's very little
research that directly compares competing treatments to guide cancer patients on
which might offer the best shot at survival for the money.
"As long as a therapy provides a benefit, it will tend to be offered to
patients. Whether it's a small benefit or a moderate benefit, it may be offered
with the same level of enthusiasm," says Dr. Neal J. Meropol of Philadelphia's
Fox Chase Cancer Center, who is leading the panel writing ASCO's new guideline
on how to weigh treatment costs.
The idea: treat cost essentially as another side effect to weigh in choosing
a therapy. Meropol has watched patients do those calculations on their own, like
the colon cancer patient who asked to switch from oral chemo to cheaper but more
laborious intravenous chemo, or the woman who refused a pricey anti-nausea drug
that would make her chemo more bearable.
Even if doctors want to discuss cost, they may not know it -- it's not
included in treatment standards. At a meeting of the standard-setting National
Comprehensive Care Network earlier this month, Sloan-Kettering's Saltz and other
doctors urged adding chemo prices to those treatment guidelines.
"If there's a need to spend it, let's talk about it. If we can do it just as
well less expensively, I think doctors should know that and be able to make a
decision," Saltz says.
Even the well-insured are feeling the bite as patients are having to
shoulder a higher portion of the bill.
When Medicare began its Part D prescription coverage, retiree Helen Geiger
of Whiting, N.J., paid for a premium plan and put it to good use when she was
diagnosed with multiple myeloma, a blood cancer. She said the plan listed the
cost of her dose of Thalomid at $5,500 a month but her copay was $60 a month.
In renewing the prescription plan last year, the 71-year-old Geiger didn't
notice that Thalomid coverage had been changed. It now was classified a
specialty drug, costing a $1,051 monthly copay that she couldn't afford. She
went several months without the anti-cancer pills, as her doctors at
Philadelphia's Fox Chase Cancer Center and her family appealed to the insurer
and then scoured charities in hopes of finding her free or cheaper drug.
"You don't need this kind of stress when you're sick," says Geiger, who
finally stumbled onto a prescription assistance program that provided her free
medicine.
EDITOR'S NOTE -- Lauran Neergaard covers health and medical issues for The
Associated Press in Washington.
Copyright 2008 Associated Press. All rights reserved. This material may not be
published, broadcast, rewritten, or redistributed.
|