Changes Oncologists Could Make That Would Lower Costs

Today’s Managing Health Care Costs Indicator is $173 billion

Two courageous oncologists wrote in the May 26 New England Journal of Medicine (Free full text) that there were five changes in behavior and five changes in attitude that could lower overall health care costs.  They cite a projection that the cost of oncology care in the US will be $173 billion in 2020, and state that continued increases are unsustainable.   

The behavior changes (reworded by me):

  1. Don’t do routine tests of cancer survivors looking for recurrence, except where there is evidence that this improves quality of life or survival
  2. Give a single chemotherapy agent for most solid tumors –don’t use multiple agents except where there is good evidence to do so
  3. Don’t give chemotherapy to patients who are so frail that they can’t walk
  4. Don’t routinely use medicines to raise white blood cell counts. (This is for solid tumors – chemotherapy for leukemias and lymphomas does sometimes require these medications)
  5. If patients fail three chemo regimens, limit further chemo to clinical trials.

The changes in attitudes (also reworded)

  1. Recognize that costs are due to choices that oncologists make
  2. Have realistic expectations
  3. Pay more for cognitive services rather than chemo
  4. Start palliative care earlier
  5. Support comparative effectiveness research, and accept that there will be some limits on the care we can offer.

We’ve had over a generation of the “war on cancer,” and we’ve promised society that we can ‘cure’ cancer.   The authors suggest that we should acknowledge that palliation is often the best goal, and we should avoid costs for treatment that has not been shown to be valuable. 

This is rational – but could easily be misconstrued to be an endorsement of “death panels.”  I think this is an important addition to the dialog on how to lower health care costs. We will clearly need to bring patient advocates along for this approach, and sometimes it’s hard to tell patient advocates from parties interested in maintaining high health care costs (and company revenues)