In 2013, Nick Mulcahy reported for Medscape that oncologists at the Duke Cancer Center used the term “financial toxicity” to describe the high cost of cancer care and its effect on patients.
“Out-of-pocket expenses related to treatment are akin to physical toxicity, in that costs can diminish quality of life and impede delivery of the highest quality care,” Mulcahy wrote, citing a pair of articles in Oncology by S. Yousuf Zafar, M.D., a medical oncologist at the Duke Cancer Center, and Amy P. Abernethy, M.D., a medical oncologist at the Duke University School of Medicine.
Perhaps better than most, oncologists know that the average cost of new tumor-fighting medications is $10,000 per month and that cancer is the leading cause of bankruptcy in the United States. Therefore, they are among the first physicians to acknowledge the need to get patients more involved in making decisions about which options patients might prefer and which ones patients can afford.
For journalists reporting on how payers, providers and patients are promoting discussions about treatment options and costs, AHCJ will host a webcast on June 30 at 1 p.m. ET with Robert W. Carlson, M.D., a medical oncologist and chief executive officer of the National Comprehensive Cancer Network, a nonprofit alliance of 27 cancer centers.
NCCN is one of several organizations developing tools to help patients assess the value of various cancer treatments and to promote a larger decision-making role for patients. The network has developed what it calls the NCCN Evidence Blocks, a graphic showing how five key measures correspond to treatment recommendations in the NCCN Clinical Practice Guidelines in Oncology. These five measures are designed to provide the basis for discussion and address the efficacy, safety, and affordability of various treatment regimens and the quality and consistency of the evidence supporting those options.
This topic is important for health care journalists because the costs of all treatments, and cancer in particular, continue to rise. In two articles in Oncology (here and here) Zafar and Abernethy described how costs caused more than half of patients with cancer to limit adherence to treatment, that 24 percent of patients avoided filling prescriptions, 20 percent took less than their prescribed amount of medication and 19 percent partially filled prescriptions.
As these grim statistics show, it’s clearly time to get patients involved in making treatment decisions. What’s more, physicians and other providers recognize that different patients have vastly different treatment preferences.
Consider, for example, how two women with the same breast cancer diagnosis might weigh their options. A woman in her 30s may prefer a relatively expensive treatment shown to be highly effective, while a woman in her 70s might be more concerned about the cost and the side effects she could face.
Carlson will discuss how oncologists want to give patients a more prominent voice in treatment discussions, one that recognizes each patient’s values.