Terminal cancer therapy is futile and costly, experts say

A report on managing  cancer costs, made by 37 cancer experts (economists, patient advocates and physicians) from developed countries (U.S., UK, Germany, Australia), was published in the Lancet Oncology on September 26 . The study highlights the need of a judicious medication for terminal cancer patient.

Professor Richard Sullivan, of the King’s Health Partners Integrated Cancer Centre, London, has presented the study at the European Multidisciplinary Cancer Congress in Stockholm.

Input from drug-makers, payers and educators will be key to future discussions, David Collingridge, the journal’s editor, said.

“With an aging global population and an endless conveyor belt of expensive new drugs and technologies and increasing financial pressures, the cost of cancer care in high-income countries is becoming unsustainable,” The Lancet Oncology said.

Developed countries have varying levels of GDP assigned to health, but the percent of  cancer care cost is between four and seven  in the majority of countries.

Around 12 million people worldwide are diagnosed with cancer annually, the costs of the new cases was at least $286 billion in 2009, according to the report. By 2030, about 22 million people will be diagnosed with the disease annually. More than half of the $286 billion in costs was related to treatment, while a quarter was linked to lost productivity.

"We over-diagnose, over-treat, and over-promise. This extends from use of complex technology, surgery, and drugs to events related to the acceptance of treatment side-effects." say experts, making a special reference to terminal cancer.

In UK around 310,000 people are diagnosed with cancer every year and by 2030 this is expected to have risen to 400,000. The National Health Service spends over £5billion annually on cancer treatments, up from £3billion in 2002.

“All health systems face budget limitations, while at the same time the cancer burden and expenditures are increasing steeply. Every cancer patient, now and in the future, must have fair access to quality cancer care and to innovation. This can only be safeguarded by transparent and evidence-based analysis and policy development,” said Professor Michael Baumann , president of the European cancer organization, ECCO.

The cancer experts have criticized a “culture of excess” that gives false hopes to patients with terminal cancer.

“In developed countries, cancer treatment is becoming a culture of excess. We over-diagnose, over-treat, and over-promise. This extends from use of complex technology, surgery, and drugs to events related to the acceptance of treatment side-effects.” the cancer experts said.

They emphasized the importance of choosing a right treatment strategy for terminal cancer patients. The life-extending medication should not be use as it shows no benefits for terminal cancer, and has dangerous side-effects.

The life-extending medication should not be use as it shows no benefits for terminal cancer, and has dangerous side-effects, said the cancer experts.

“Special consideration must be given to costs of cancer care at the end of life. Many forms of cancer are currently incurable and patients will eventually die from their disease.”

“In fact studies suggest that a substantial portion of the total cost of cancer care is for care delivered in the last weeks or days of life, and that much of this care is futile and potentially inconsistent with patients’ wishes.”

“If we could accurately predict when further disease-directed therapy would be futile, we clearly would want to spare the patient the toxicity and false hope associated with such treatment, as well as the expense.”

The scientists said a more rigorous evaluation of the relative benefits of surgery to treat cancer and of the less invasive robotic surgery had to be done.

Reducing the cost of cancer services or reducing the number of people using them, especially terminal cancer patients, are the two ways the authors proposed to solve the problem.

The best cancer treatments would be the preserve of the rich because they would be too expensive for the Health Service, warned last week Professor Karol Sikora, one of the 37 cancer experts.

Molecular bio-markers could be used to pre-screen patients for treatments and imaging methods should be used to select only those patients who could benefit from a treatment. Early-stage studies could also help to remove marginally effective or ineffective drugs faster, researchers said.

“We are at a crossroads for affordable cancer care, where our choices, or refusal to make choices, will affect the lives of millions of people. Making individual patients more sensitive to the costs of care is necessary for an informed public debate around this critical issue,” Professor Richard Sullivan said.

MRI performed prior to surgery predicts the follow-up treatment for advanced rectal cancer, recent study shows. Generally the doctors will not abandon drugs for terminal cancer patients, despite the costs.

Cancer diagnosis and treatment has became more complex, with imaging, surgery, radiation and drug therapy. Specialists need to come together and discuss with patients, insurers and industry players the best ways to lower costs without compromising care, they said.