In addition to the medical and emotional toll, the financial cost of cancer can be overwhelming.
On average, some of the newer drugs run to $10,000 a month, with some exceeding $30,000 a month, according to the American Society of Clinical Oncology, a group of about 35,000 cancer professionals.
ASCO and another group, the National Comprehensive Cancer Network (NCCN), have begun developing guidelines and tools to help physicians, patients, and their families assess efficacy, toxicity, and costs of the various treatment options.
Adam Dicker, a professor and chair of the Department of Radiation Oncology at Thomas Jefferson University's Sidney Kimmel Medical College, was a coauthor of the ASCO guidelines. His research at Jefferson's Sidney Kimmel Cancer Center focuses on novel drugs, immunotherapy, and the application of precision medicine for patients with cancer. He recently spoke to us about the cost of cancer care.
Is cancer one of our more expensive diseases?
Cancer has a big bull's-eye on it because more recent therapies have been quite expensive. But I don't think it's completely fair to focus on drug costs. For example, diabetes is a very expensive disease because in patients whose diabetes is not well-controlled, there's often subsequent heart disease, they have amputations, there is a great deal of hospitalization.
The good news in oncology is that . . . there are now a number of new drugs that have clinical benefit. When I trained at Memorial Sloan Kettering Cancer Center 20-something years ago, there was really nothing for patients with kidney cancer. Now, there are eight drugs approved for advanced kidney [renal cell] cancer.
And melanoma. Oncologists have flailed against melanoma for decades. And then, in the past decade, the whole immunology field blossomed. Physicians saw people's disease melt away. Currently, combinations of immunotherapy are being tested in clinical trials.
What prompted the medical field to take action?
Numerous people in the field of oncology realized that things were unsustainable. It was just spiraling out of control.
When the FDA approves a drug . . . the FDA doesn't get into the issue of cost effectiveness. That's not what the agency is mandated by Congress to do.
So you have incredibly expensive drugs. For some of these drugs, the cures were miraculous, and for others, the cures had marginal survival benefit.
What's happening now?
ASCO started to put together a group of people who were concerned about this over five years ago. Their approach was to look at the best-quality data available - often from randomized trials for a drug. That gives us unique survival data comparing two different approaches for the treatment of a specific cancer. From that information, we can calculate the cost, we can calculate . . . quality-of-life issues. The ASCO goal was to bring the conversation out in the open.
The NCCN is creating tools to be used by physicians and health-care providers with patients and their families when discussing a particular therapeutic approach for cancer. Five categories, each on a scale of one to five, look at the efficacy of the drug, the safety, the quality of the data, the consistency of the data, and the cost. The product is a very useful visual called "Evidence Blocks" that play a pivotal role when having a conversation with a patient and their family.
What does the future hold?
No one knows where this is headed. We are in uncharted waters right now. Everyone involved - the FDA, the pharmaceutical industry, insurance companies, physicians, patients and their families, others - everyone has to be part of the conversation of how we define value. Ultimately, value is defined by the patient. Does a particular treatment get them back to work? Does it provide quality time with their family? Does it reduce the symptoms that the cancer is causing? Is the toxicity acceptable?
A 25-year-old woman with breast cancer who has two young children might tolerate a more tough-love therapy for the trade-off of increased survival. An 85-year-old who has metastatic lung cancer might define value differently when his current quality of life is taken into account.
What makes you think this is achievable?
I am optimistic on multiple levels. I'm optimistic that we have incredible opportunities before us for curing a patient. The science in the field has never been better. I'm optimistic that everyone I've met acknowledges the financial toxicity. There's no one I've met who says, "Oh, this isn't a problem."
In order for everyone to win - for the patient to have new drugs, for the physician and health-care providers to be able to offer new opportunities for patients, for the industry to be able to make money - we have to figure out a solution so we can continue to be a leader in oncology for the rest of the world.
We've only started this conversation. It's not mature. We don't have all the answers. But it's real.