Penn Medicine Finds Support for Cancer Care Rationing

June 2013, Vol 3, No 4 - ASCO Meeting Highlights

Philadelphia, PA—A majority of oncologists, patients with cancer, and members of the general public support cutting healthcare costs by refusing to pay for drugs that do not improve survival rates or quality of life. This is according to the results of a new study that were presented by researchers from the Perelman School of Medicine at the University of Pennsylvania during the annual meeting of the American Society of Clinical Oncology in Chicago.

In 2012, the team from Penn Medicine surveyed 326 adult patients with cancer who were receiving treatment at Penn’s Abramson Cancer Center, a random sample of 891 adults in the general public, and 250 oncologists across the United States to ask their opinions about tactics for controlling the costs that are associated with cancer care.

“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, an instructor in the division of Hematology-Oncology in Penn’s Abramson Cancer Center. “We know that cancer patients and their doctors face decisions every day that stand to raise healthcare 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 3 groups 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 of those surveyed (69% of the patients with cancer, 81% of the general public, and 70% of the oncologists) also thought that hospitals and doctors conducted unnecessary tests and provided unnecessary treatments.

The research team, including senior author Ezekiel J. Emanuel, MD, PhD, Chairman of the Department of Medical Ethics and Health Policy at Penn, presented a variety of potential cost-lowering options to each group and asked whether they supported the idea. Patients with cancer, members of the general public, and oncologists tended to be in agreement with the idea that patients with cancer who can afford to pay more for care should be asked to pay more (56%, 58%, and 52%, respectively).

Large numbers of all 3 groups also favored not paying for more expensive drugs when cheaper alternatives are equally as effective (78% of the patients with cancer, 86% of the general public, and 90% of the oncologists). The majority of those surveyed also supported refusing to cover drugs that do not improve survival or quality of life, although the physicians were more likely to refuse payment under those circumstances (79% of oncologists compared with 52% of patients with cancer and 57% of the general public).

However, drugs that confer only incremental gains in survival were found to be worth covering in the eyes of all of the groups surveyed­­— just 12% of the oncologists were willing to refuse payment for a drug that would extend life by 4 months, compared with 20% of the patients with cancer and 28% 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,” Dr Gogineni said. “Patients with cancer have a much broader set of concerns, from the cost of their doctor’s visits to the side effects of their treatment and the emotional toll of their illness.” (Source: Perelman School of Medicine, University of Pennsylvania, May 15, 2013.)