How much is cancer treatment worth?
It’s a difficult question. One the American Society of Clinical Oncology (ASCO) wants to make easier to answer.
That’s why the organization has developed a framework to help doctors and patients compare before deciding on a treatment plan.
The goal is to create a user-friendly, standardized way to evaluate available cancer treatments.
The conceptual ASCO Value Framework was published in the Journal of Clinical Oncology. ASCO is accepting comments from interested parties through August 21.
How Treatment Programs Are Rated
The ASCO Value in Cancer Care Task Force came up with a scale to rate treatments on three critical elements: benefit, safety (toxicity), and cost. Treatments are rated on a scale of 0-130 to come up with a net health benefit score.
For benefits, the treatments are graded on whether they improve health and prolong life while preserving quality of life.
Cancer treatments can be harsh and lead to other health problems. It’s something doctors call “toxicity” of treatment. Physical and emotional toxicities have a powerful effect on quality of life.
Then there’s financial toxicity. Whether you have health insurance or not, cost matters, too.
It matters to the patient and to the total cost of healthcare spending in the United States.
Cancer is only one part of our healthcare spending. But costs for cancer care are rising faster than those in other areas of medical services. The aging of our population means more of us are getting cancer. We’re also spending a lot more on diagnostic testing.
New cancer drugs are costly – even if some of them do little to improve outcomes. That’s the kind of information ASCO officials say patients need to see.
New cancer drugs average between $10,000 and $30,000 a month. Prices like that can lead to bankruptcy. For some patients, high out-of-pocket costs translate into reduced quality of life.
Some may have to choose between paying health costs and buying food or clothing. Others skip physician appointments, procedures, or having their prescriptions filled. All that can lead to worse health outcomes.
When putting the framework together, ASCO considered out-of-pocket costs for the individual, as well as the cost to the health system in general. That’s because even if insurers pick up the tab, it impacts rates for everyone.
The Doctor-Patient Relationship: It’s Complicated
Cancer treatment can mean having a team of doctors.
You may see a general physician, a surgeon, and a radiologist. It’s usually an oncologist who takes the lead in explaining the potential benefits and harms of various cancer treatments.
People want to make informed decisions. But when it’s a matter of life and death, those decisions can be overwhelming.
Cost complicates the relationship between oncologists and patients. It’s difficult, if not impossible, for an oncologist to get a handle on a patient’s total financial picture. Each patient has different out-of-pocket costs for individual treatments, depending on their health insurance.
Just as patients want to concentrate on staying alive, doctors want to concentrate on keeping them alive. But those money matters can’t be ignored.
At the same time, oncologists must also try to understand a patient’s point of view about the potential value of a treatment.
Cancer Patients Discuss Costs
Cancer survivor Charles Alan Livingston of Las Vegas, Nevada, said his doctors discussed the pros and cons of treatment but never spoke about cost. While he does believe oncologists should explain expenses, he told Healthline it’s secondary to fighting the cancer.
“The cost involved was life. Do it, you
live. Don’t do it, you die. It was simple,” he said.
Susan Reif of Tuxedo Park, New York, is a seven-year breast cancer survivor. She doesn’t recall any discussion of cost with her oncologist.
“I was fortunate to have very good health insurance that the oncologist and the hospital accepted,” she said. “My surgeon did not take my insurance, but whether he accepted my insurance or not, I was going with him.”
It worked out for Reif. She managed to negotiate acceptable payment terms with her surgeon. But she understands that cost is an issue for many people.
“It breaks my heart to hear about people who delay or bypass treatment due to financial concerns,” Reif told Healthline. “That is a terrible statement about our society and it maddens me to no end.”