Rationing some cancer care has broad support

Cutting health care costs by refusing to pay for drugs that do not improve survival or quality of life has the support of the majority of cancer doctors, patients, and members of the general public, according to a new study. Its results and details will be presented at the annual meeting of the American Society for Clinical Oncology in Chicago, Illinois, in early June.

Opinions about tactics to control costs associated with cancer care were studied by surveying 326 adult cancer patients who were receiving treatment, a random sample of 891 adults from the general public, and 250 oncologists across the United States during 2012.

"We found that the majority of respondents considered Medicare spending a big or moderate problem, and many suggested that Medicare could spend less without causing harm," said the study's lead author, Keerthi Gogineni, MD, MSHP, of the Abramson Cancer Center at the University of Pennsylvania in Philadelphia, where the study was conducted. "We know that cancer patients and their doctors face decisions every day that stand to raise health care costs without conferring much benefit to patients, and our survey has identified some common themes in how these groups of stakeholders might propose to lower costs of care while still protecting patients."

More than 90% of all three groups surveyed attributed rising costs to drug companies charging too much, and more than 80% of each group cited insurance company profits as a driver of rising costs. Many also thought hospitals and doctors conducted unnecessary tests and provided unnecessary treatments (69% of patients, 81% of the general public, and 70% of doctors).

The research team presented a variety of potential cost-lowering options to each group and asked whether they supported the idea. Cancer patients, members of the general public, and oncologists tended to be about as likely to say patients who can afford to pay more for care should be asked to pay more (56, 58, and 52%, respectively). Large numbers favored not paying for more expensive drugs when cheaper alternatives are equally as effective (78% of patients, 86% of the general public, and 90% of physicians). The majority also supported refusing to cover drugs that do not improve survival or quality of life, though physicians were more apt to refuse payment under those circumstances (79% compared to 52% of patients and 57% of the general public).

"These results suggest that patients and the lay public prioritize quality of life, while oncologists appear focused on controlling disease and increasing length of life," Gogineni said. "Patients have a much broader set of concerns, from the cost of their doctor's visits to the side effects of treatment and the emotional toll of their illness."
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