About a month ago, we launched Just Ask, an initiative to encourage doctors and patients to talk more openly and frequently about the cost of medical care.
The thinking is: If doctors know their patients are cost-conscious, they can tailor their recommendations to meet patients' health and economic needs. That could mean that doctors more carefully consider which tests patients truly need or prescribe a less expensive alternative drug that's almost as good as their first choice.
These conversations get much stickier when it comes to conditions like cancer. Should doctors and patients address the cost of potentially life-saving medications during one of the most difficult and stressful periods of a patients' life?
The American Society of Clinical Oncology - which claims a membership of more than 35,000 cancer professionals from more than 120 countries - says: Yes.
In a June article in the Journal of Clinical Oncology, Dr. Peter Yu and others write that U.S. cancer costs are expected to increase from $125 billion in 2010 to $158 billion in 2020 – an increase of more than 25 percent. More of those costs are being passed on to patients through deductibles and co-pays, and that can have disastrous effects on people’s finances, a trend I've reported on here.
In response, the oncology society has developed a draft framework for assessing the value of new cancer treatment options.
New cancer treatments "often have a lot of toxicity, a lot of side effects, and there's always a question of, 'what is the real value of a treatment to a patient? What is the effect on quality of life, as well as longevity of life?'" says Dr. Yu, director of cancer research at Palo Alto Medical Foundation and immediate past president of the American Society of Clinical Oncology.
"These are very complex discussions that are not easy to have, especially in a time of emotional crisis," he notes.
'Is this a good decision to make?'
You or someone you know might be familiar with this situation: A doctor tells a person with cancer that there are several treatment options, including new therapies.
How do doctor and patient weigh the potential benefits of the treatment with possible side effects and costs? The oncology society's tool is intended to make these conversations easier and more effective, and better inform patients' decisions.
The oncology society suggests that these discussions follow one of two tracks: One for people with potentially curable disease, and the other for people with advanced cancer.
In both cases, the conversation would revolve around three themes:
- Clinical benefit: For some, this refers to the likelihood that a treatment will cure a patient. For those with advanced disease, this measures whether the treatment would improve someone's survival quality of life by helping them relieve symptoms, like less pain, less fatigue and improved appetite.
- Toxicity: This refers to clinical side effects of a treatment.
- Cost: This refers to the financial burden on a patient, society and insurers.
Yu describes the proposed approach in simple terms: Doctors and patients, working together, would use a point system to compare the standard treatment and the new option they're considering.
If the new option is more likely than the standard treatment to improve a patient's health or quality of life, it earns a certain number of points. The new treatment earns more points if it's less toxic than the standard one; it loses points if it's more toxic.
The new treatment's score is considered to be its "net health benefit." Doctors and patients then compare this number with their assessment of its cost.
The value of a treatment "is not rolled up into one number, where we're making judgments as to the cost of the therapy and its overall value," Yu explains. "We're putting the two elements side-by-side and letting the patients and physicians make their own judgment as to, 'is there value behind this, is this a good decision to make?'"
Considering treatment options with 'context'
Making decisions about treatment options is really hard. That's especially true when it comes to cancer, Yu says, because "every patient with cancer is a different situation."
He gives the example of a patient with cancer who's determined to attend her daughter's wedding in two months, and will "do anything to get to that two months." But once that goal has been achieved, he says, the patient may have different priorities when it comes to her care.
"Maybe they're putting a little less emphasis on longevity after that landmark has been achieved, and they're less willing to take toxicity," Yu explains.
He continues: "You really need to look at each patient's individual needs, goals, desires and help them understand the treatment options in that context, and that’s very different from the vast majority of medical decisions."
The Society of Clinical Oncology is taking comments online on the draft framework through August 21. Once it's finalized, Yu says the framework will be available to doctors and patients. He also envisions it being turned into an app.
Have you or someone you know had experience weighing the value of different cancer treatments? Do you think this sort of framework would help make such decisions? Add your voice below or e-mail me at Impatient@scpr.org.