Even as cancer rates decline, changing demographics and treatments are expected to dramatically increase costs in the US by 2020. A public discussion will aid the public in determining priorities—absent this discussion, very expensive treatments will be used despite their poor record, just because that’s what doctors do when nothing else has worked for the patient in front of them.
US cancer rates are changing, for a variety of reasons. From the March 25, 2011 Science, pp 1540-1 (subscription needed):
Lung and bronchus Lung cancer incidence began declining among men in the early 1980s and the death rate decline began in the early 1990s. Deaths for women continue to increase. Mortality rate overall decreasing. The death rate among African-American men is far higher than for white men. The trend lags changes in smoking habits. 2010 estimated deaths: 157,300
Colon and rectum Incidence per 100,000 peaked in mid-80s, while death rate has been declining since at least 1975. Improved diet and colonoscopies are helping; mortality may drop by half by 2020. 2010 estimated deaths: 51,370
Breast (female): Rate dramatically increased in the 1980s due to efforts to detect and treat invasive breast cancer, peaking in 1999 for all races. Death rates have been decreasing steadily since 1989-90. The survival rate is far higher for whites than African-Americans. 2010 estimated deaths: 39,840
Pancreas Incidence and mortality remain constant because detection is difficult. The average patient diagnosed with advanced disease lives only 6 months. 2010 estimated deaths: 36,800
Prostrate The incidence spiked in the early 1990s with the prostrate-specific antigen (PSA) screening test, although most tumors detected by this test are non-lethal. Death rate began declining about the same time. 2010 estimated deaths: 32,050
Leukemia Incidence has remained about constant, but death rates are slowly declining due to treatments combining chemotherapy drugs. Survival rate for childhood acute lymphoblastic leukemia is now 80%. 2010 estimated deaths: 21,840
Liver The incidence and mortality from liver and bile duct cancers have been rising steadily for decades, due to increases in hepatitis B and C and alcohol abuse. Tumors usually can’t be removed with surgery, so post-diagnosis survival is short. 2010 estimated deaths: 18,910
Brain (included because of concerns about cell phones; information comes from NCI surveillance program) Incidence increased through the late 1980s (because of increased testing?) Incidence began decreasing in the late 1980s and mortality in the early 1990s. Both incidence and mortality are much higher in whites than in African-Americans (greater testing? longer life expectancy since median age at diagnosis is 56?) 2010 estimated deaths: 13,000
Can Treatment Costs Be Tamed? (March 25, 2011 Science, subscription needed) addresses the costs of cancer treatment which are increasing much faster than the population.
Over the past 3 decades, total U.S. spending on cancer care has more than quadrupled, reaching $125 billion last year, or 5% of the nation’s medical bill, according to a recent estimate. By 2020, it could grow by as much as 66%, to $207 billion. Multiple forces are driving the spiral: a growing and aging population, more people living longer with cancer, and new “personalized,” or “targeted,” therapies that can come with sticker-shock prices of $50,000 or more per patient.
Outpatient treatments are helping costs per patient decline, but these savings are swamped by the increasing number of older people, more likely to get cancer. Medicare predicts that its rolls will almost double from by 2020, from 40 million to 70 million. If all other costs stay the same, demographic changes will increase national cancer costs by 27%.
Increasing survival rates also pushes up cancer rates: the number receiving “continuing care” for breast and prostrate cancer are expected to increase 41% by 2020, adding $18 billion.
Targeted therapies may be important for society to address. Personalized therapies can be expensive, but some only extend life for a few weeks or months. One treatment for lung cancer extends life a year at a cost of more than $1.2 million. Drug costs are currently less than 15% of treatment costs, but new, costly drugs may increase their share.
Some argue that drugs that cost more/”quality-adjusted life year” than dialysis ($129,090, which would make the US still more generous than the United Kingdom, Canada, and Australia) should not be funded by Medicare and insurance, and shouldn’t be funded off-label (for cancers other than originally approved). Others argue that preventing off-label use would
hobble the proven practice of freeing doctors to find promising new uses for existing drugs. And it would stand “in stark contrast with clinical practice.” Studies, for instance, suggest that up to 75% of anticancer drugs are already used off-label. And price controls would, they argue, ultimately cause investors to reduce funding for research into new drugs because they couldn’t be sure of recouping their costs.
Both sides agree on the need for better, more organized studies.
One idea gaining favor is the idea that insurance companies would provide “coverage with evidence development”, provide coverage in order to get the data to compare effectiveness, with the aim of discontinuing coverage if drugs don’t work. “Risk-sharing arrangements” between insurers and manufacturers could link drug prices to performance.
Other topics (subscription needed):
Celebrating an Anniversary
Video: Sequencing Cancer Genomes–Targeted Cancer Therapies
Cancer Research and the $90 Billion Metaphor with Infographic (cancer information on rates)
40 Years of the War on Cancer
Combining Target Drugs to Stop Resistant Tumors
Can Treatment Costs Be Tamed?
A Push to Fight Cancer in the Developing World
Making Her Life an Open Book to Promote Expanded Care
Brothers in Arms Against Cancer (siblings of p53, the tumor-blocking protein)
Exploring the Genomes of Cancer Cells: Progress and Promise
A Perspective on Cancer Cell Metastasis
Cancer Immunoediting: Integrating Immunity’s Roles in Cancer Suppression and Promotion