Who is REALLY Determining Your Cancer Treatment Options

In Breast Cancer, Recent Posts by Barbara Jacoby

From my earliest days after being diagnosed with cancer, I became very interested in learning about my course of treatment and understanding the purpose for each step selected. It was this concern that resulted in my getting a second opinion after my first appointment with my oncologist that resulted in a complete reversal in my treatment after an actual test was done on the cancer itself with the second oncologist. And it was also our follow-up discussion where my options were discussed with me and where I became a part of the decision making that resulted in my desire to become a patient advocate that would encourage patients to learn about their choices and to have that doctor/patient communication. This really made me become vested in following this course of treatment in order to produce the best outcome possible for me. Therefore, when I learned that my choices might not be the only ones available but actually the only ones to which I have access, I wanted to share something with you that I recently found.

Our doctors are truly the only ones who know their patients’ full medical situation and are in the best position to determine a treatment path.Barbara Jacoby

I recently came across an article that explains how a Boston-based organization is making decisions about which patients should have access to certain medical care that they need. It reads, in part, as follows:

“The Institute for Clinical and Economic Review (ICER) is a research organization and medical review board that makes recommendations about whether new medications are “cost-effective” and whether insurance companies should cover those treatments. To arrive at its recommendations, ICER uses a complicated mathematical formula called a “value framework,” which determines how much an insurance company should spend on any given person.”

This is no different than my first oncologist who determined what my treatment would be based upon the type of breast cancer that I had, the size of the tumor and my age. These were the guidelines that he printed out for me from WebMD that he decided would direct my treatment. This was very uncomfortable to me as my first thoughts were why do I need an oncologist to decide my treatment path if all that was needed was to follow what I found on the Internet rather than getting advice from a medical professional who has spent years learning about breast cancer and all of the options available for their patients based upon their actual cancer which is different in every single individual.

The even bigger problem that I have with the decision making that is being done by ICER is that it is placing a value on a person’s life based upon economics solely for the insurance companies and/or others that have a vested interest in such financial decisions. Therefore, if you are in an underserved community of any kind and can’t afford the best treatments because you do not have expensive insurance coverage or the financial means to pay for the treatment, your life is apparently not as valuable as others. As the article further explains, such guidelines that have been mapped out by ICER are now also affecting pharmacy drug management and even caps on Medicaid spending in the State of New York.

Perhaps it is time to reassess what is actually happening in the medical communities in this country as we have now taken away the treatment decisions from our doctors. Our doctors are truly the only ones who know their patients’ full medical situation and are in the best position to determine a treatment path. I can’t help but think about all of the proponents who are fighting for medical insurance coverage for everyone in this country who don’t know about ICER and other private groups that are deciding who should be eligible for certain medical treatments. After all, what good is it to have insurance for everyone if you can’t even receive the actual medical treatment that may need to save your life?