Across the past year there's been more and more discussion about the cost of cancer care. ASCO has made it a top priority, even going so far as to provide guidance on how oncologists should discuss the cost of care with patients. New data released earlier this year in Health Affairs provide evidence that oncologists are increasingly accounting for the cost of cancer care, although they might not be proactively discussing costs with patients.
The survey is the largest to date to assess oncologists' attitudes about the cost of treatment and was conducted by researchers at both Tufts Medical Center and the University of Michigan. They found that 84% of oncologists consider patient's out-of-pocket costs when recommending cancer treatment, but less than half of surveyed physicians actually discuss costs with patients. Undoubtedly, as cost data becomes more readily available to physicians, this conversations will be easier to have. We actually looked extensively at how to help estimate costs up front to engage in these conversations - you can access that research here. Notably, the survey also asked about comparative effectiveness, and found that 79% of oncologists support more government research into comparative effectiveness.
A study released in last week's New England Journal of Medicine provides additional data supporting the potential role of shorter, hypofractionated radiation therapy treatment courses for breast cancer patients. The goal of the study was to determine whether a 3 week course of therapy was as effective as a 5 week course in women who had undergone breast conserving surgery, with clear resection margins and negative axillary nodes. They were assigned randomely to two groups: the control group received a standard dose of 50.0 Gy in 25 fractions over 35 days and the hypofractioned group received a dose of 42.5 Gy in 16 fractions over 22 days.
Results Indicate Hypofractionation Not Inferior To Standard Treatment
The women were followed for 10 years and the risk of recurrence was 6.7% in the control group compared to 6.2% in the hypofractionated group. In terms of cosmetic outcomes, 71.3% of women in the control group had a good or excellent cosmetic outcome compared to 69.8% in the hypofractionated group.
Time to Restructure Financial Incentives Accordingly?
New Study In New England Journal of Medicine Supports Shorter Course of Radiation Therapy in Breast Cancer Patients
As part of our research on the Oncology State of the Union we reported on work United HealthGroup was doing to gather data on utilization of chemotherapy drugs by tumor type and stage. Their goal to assess whether physicians were delivering care in accordance with NCCN guidelines, and how this related to patient outcomes. As part of this work they also plan to send participating medical oncologists report cards detailing their performance. They've been collecting this data for past three years from 1,321 oncologists and early results are in, and they're interesting. For instance, their data indicate that for colorectal cancer patients, 31% of medical oncologists did not comply with guidelines which indicated patients should receive chemotherapy following surgery. Instead, the majority of those patients received Avastin as first line therapy when it is currently approved for metastatic or recurrent disease. There were similar findings in non-small cell lung cancer, as 24% of the patients received Avastin, even though they didn't fit the prescribing criteria.
The analysis also provided insight into patient compliance with oral drugs. Specifically, they found that 28% of breast cancer patients were not filling their prescriptions for aromatase inhibitors. There were numerous other metrics they looked at, each focused on ensuring patients are receiving the appropriate care.
UnitedHealth Begins Sending Report Cards to Medical Oncologists