The cost of cancer treatment has risen dramatically in the last ten years. As a result, some people who need and deserve care are shut out. Those who do get care might find that the more expensive treatment is not the best.
The Fred Hutchinson Cancer Research Center is launching a new institute dedicated to health economics and reducing the economic burdens of cancer.
The 2011 President's Cancer Panel report found wide variations in cancer treatment, sometimes depending on a patient's race, income or choice of doctor.
"For example, a woman with stage one breast cancer might go to one doctor and get one recommended therapy and go to a different doctor and get a different therapy, and there's really no reason that should happen, but it does," said Dr. Scott Ramsey. He's been appointed the director of the Institute for Cancer Outcomes Research and Evaluation, or ICORE.
The institute hopes to develop information to improve the efficiency and effectiveness of cancer prevention and treatment.
"What I'm talking about is people with common cancers, the lung cancers, the breast cancers, the colon cancers where we actually have good evidence and good standards that are recommended but, unfortunately, not followed," Ramsey explained.
Sometimes a treatment decision is based in large part on the type of equipment a hospital owns. A good example might be robotic-assisted laproscopic surgery for prostate cancer. The daVinci machine can cost a million dollars and is now widely used, including here in Seattle.
"It was marketed very heavily by the company as a product that would lower a man's risk of having adverse effects from surgery and improve his recovery time [but] unfortunately there was no evidence that that was true. So, obviously when someone buys a machine like that, they're going to start using it and it certainly has pushed up the cost of care," argued Ramsey.
Study results from the University of Pittsburgh found the daVinci robot is significantly more costly than standard surgery with little scientific evidence of long-term improved patient outcomes. It's also true that the daVinci machine is credited with great success for many head and neck surgeries, among other procedures.
The cost of chemotherapy has risen from about $30,000 ten years ago to about $200,000 today. In some cases, Ramsey suggested, no treatment at all might be the best course.
"For example, there was a recent study showing that men with local stage prostate cancer, it was published in the New England Journal [of Medicine], who were randomized to watchful waiting versus surgery; The people who were in the waiting group did just as well as the surgical group," said Ramsey.
The new institute at the Fred Hutchinson Cancer Research Center will start by collecting information on every cancer patient in the region from various sources such as insurance claims, patient records and the cancer registry.
The goal and the belief is that reducing disparities in access and treatment and making sure that therapies are well selected for both cost and effectiveness will reduce the cost of cancer treatment while improving quality, saving "billions and billions of dollars."