Is The Cost Of Cancer Care Killing Us?

In In The News by Barbara Jacoby

By: Peter Ubel


In 1987, my 3rd year of medical school, I sat in a morbidity and mortality conference listening to a senior oncologist explain that his patient “did not want to give up” despite suffering from incurable metastatic cancer. “So we offered him therapy with vinblastacancer and cytokilocure,” he said. (I’m paraphrasing here, and making up some pretty horrific sounding medication names, because I wasn’t taking notes at the time.) He then concluded by explaining that the patient’s tumor didn’t respond to further chemo, and he died in the hospital.

I raised my hand: “I’m just wondering why you thought you were doing this patient a favor by torturing him with useless treatments before he died.” The room let out a collective gasp at the temerity, the out and out rudeness, of my question. The oncologist, to his credit, remained calm, explaining that the patient wanted the treatment and that the treatment was his only hope for slowing down the cancer. The conference concluded, and I walked into the hall where the chief medical resident chewed me out, quite appropriately, for asking the question in a disrespectful manner.

Three years later, I was a medical resident (at a different institution: coincidence?). I remember finishing a month on the oncology service and wondering how anyone could survive as a practicing oncologist, when so many of their patients would not survive for very long. In my mind, cancer care was characterized by miserable treatments that yielded miserable results. So many patients suffered so much misery for so little chance of benefit.

My reaction was an overreaction. Even in the 80s and 90s, some cancer treatments brought substantial benefits to their patients. Lance Armstrong was cured of metastatic testicular cancer in the 90s even though, when diagnosed, the tumor had already spread to his abdomen, lungs, and brain. But cases like Armstrong’s were rare. Most adult cancers, once metastatic, were not curable at that time. And most treatments, treatments remember that were not expected to cure the cancer, were highly toxic – lose your hair; puke your guts out; and hope not to catch a life-threatening infection while your blood counts hover near indetectability.

My how times have changed. We are beginning to make major progress against many formerly hopeless cancers. And new therapies are usually far less toxic than old-fashioned treatments. These new targeting treatments are designed to be more selective – to target tumors while sparing normal body parts. We are beginning to see progress treating diseases like metastatic melanoma, an illness that took away my favorite aunt.

But this progress has come at a steep financial cost. According to experts, cancer care accounted for 5% of US healthcare spending in 2010 to the tune $125 billion. A decent chunk of that money went toward cancer drugs, especially toward wonderful new target-specific specialty drugs. Rena Conti, an economist at the University of Chicago estimates that the use of “oral oncologics” – basically cancer pills that people swallow rather than IV treatments like most of the chemo that Lance Armstrong received – grew 10% between 2006 and 2011, but the amount spent on specialty oncologics grew a whopping 37%.

At a time when overall healthcare spending rose about 3% per year, spending on specialty drugs grew three-fold faster. In fact, targeting agents have gone from accounting for 35% of oral oncologics in 2006 to 59% in 2010 and 2011.

If I were still a smart-mouthed judgmentally-challenged medical student, I would probably be disrespectfully asking some pharmaceutical executive why these drugs have to be so expensive: “You just want to torture our economy before killing it?”

I’m a bit wiser now (if still too smart-mouthed for my own good, at times). I recognize that we won’t make progress treating awful illnesses like metastatic melanoma if we are not willing to pay the price of developing and testing new treatments. I realize that pharmaceutical companies are not charitable organizations.

We need to scrutinize the cost of cancer care, however. We should push back at companies when their staggeringly expensive treatments yield only modest benefits. But we should also remember that progress and the fight against cancer doesn’t come cheap.