High Costs of Cancer Drugs

The Medicare Modernizaion Act (MMA) of 2003 changed how the CMS paid for medical oncologists' services. It called for rewarding medical oncologists to communicate with patients and to spend more time, like dealing with patients' chronic health conditions caused by infusional therapy.

Under the Medicare bill, medical oncologists would be reimbursed for providing evaluation and management services, making referrals for diagnostic testing, other procedures as necessary, and offer any other support (which could include "financial couseling) needed to reduce patient morbidity and extend patient survival. In other words, being paid to think rather than just dispense drugs.

Side effects are another very important consideration for both patients and physicians when making treatment decisions particularly with newer treatments that could provide longer periods of time without advancement of disease. The costs of managing side effects in patients with cancer can be significant.

Different treatment regimens have very different side effect profiles. Reducing the doses of treatments does not appear to affect the efficacy of drug combinations which may lead to lower cumulative toxicity.

Cancer sufferers are taking doses of expensive and potentially toxic treatments that are possibly well in excess of what they need. It would seem that pharmaceutical companies are attracted to studies looking at the maximum tolerated dose of any treatments. It is suggested by some that we make the search for minimum effective doses of these treatments one of the key goals of cancer research.

An increasing number of drug studies are developed through collaborations between academic medical centers and drug companies. In fact, pharmaceutical-industry investment in research exceeds the entire operating budget of the NIH. It is important to understand the influence that industry involvement may have on the nature and direction of cancer research. Studies backed by pharmaceutical companies were significantly more likely to report positive results.

Over the past couple of years, if you watched TV with any regularity, it would have been difficult to miss the direct to consumer advertising that touted the benefits of some drugs over others, especially for patients undergoing treatment for cancer. Even to the point that buses covered with "shrink wrapped" advertising being strategically placed outside major cancer centers for patients and their families to see.

Drugmakers are going directly to the consumer at a time when their products are indeed at the margins of evidence-based medicine. On one hand, pharmaceuticals advertise extensively and the advertising is manipulative in the extreme. On the other hand, even NCI-designated cancer centers do this sort of direct to consumer, hard sell advertising. And in cancer medicine, the media advertising is no more misleading than the one-on-one communication which often goes on between a chemotherapy candidate and an oncologist.

More must be spent on analyzing drug data, and the need for larger and more detailed studies to figure out why there is an association between pharmaceutical involvement and positive results.

Source: Journal of Clinical Oncology, Vol 25, No 25 (September 1), 2007: pp. 31e-32 Tweet