Date:
03/24/2008 04:52 PM HEALTHBEAT: Cancer doctors may see cost as 'side effect'
to weigh in choosing treatment
By LAURAN NEERGAARD
AP Medical Writer
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.
