Expense and Hype and Uncertain Value
Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work
FEBRUARY 16, 2017
The title pretty much sums up one of the real problems in health care today. Our focus is cancer and cancer drugs, but the same issues apply for many other worrisome medical conditions--or even for some things that are less serious but worry people.
This issue comes up almost daily in my work as I talk with people who have advanced cancer, have discussed a potential new drug therapy with their doctor, and are very distressed re how to proceed. The upset is, of course, primarily due to the overall situation of having advanced disease, but it is really upsetting to believe that a particular medication might help and then discover that the cost/co-pay/co-insurance/deductible is going to be thousands of dollars a month and that there is no certainty that it really will help.
I don't have any solutions here, but I strongly believe that there need to be better and more frank patient/doctor conversations about these treatments. Doctors need to come clean with the uncertainty of value and the difficult prognosis, and patients need to be honest about costs and what is affordable for them and what their own values and wishes are.
From Kaiser Health News comes this good article:
Dozens Of New Cancer Drugs Do Little To Improve Survival, Frustrating
By Liz Szabo |
Marlene McCarthy’s breast cancer has grown relentlessly over the past seven
years, spreading painfully through her bones and making it impossible to
walk without a cane.
Although the 73-year-old knows there’s no cure for her disease, she wants researchers to do better. It’s been years, she said, since she has found a drug that has actually helped. McCarthy said she’s frustrated that the Food and Drug Administration is approving cancer drugs without proof that they cure patients or help them live longer.
“That simply isn’t good enough,” said McCarthy, of Coventry, R.I. “I understand [why] that could be satisfactory for some people. It isn’t to me.”
Pushed by patient advocates who want earlier access to medications, the FDA has approved a flurry of oncology drugs in recent years, giving some people with cancer a renewed sense of hope and an array of expensive new options. A few of these drugs have been clear home runs, allowing patients with limited life expectancies to live for years.
Many more drugs, however, have offered patients only marginal benefits, with no evidence that they improve survival or quality of life,
said Dr. Vinay Prasad, assistant professor of medicine at the Oregon Health and Sciences University, who has written extensivelyabout the FDA’s approval process for cancer drugs.
Overall cancer survival has barely changed over the past decade. The 72 cancer therapies
approved from 2002 to 2014 gave patients only 2.1 more months of life than older drugs, according
to a study in JAMA Otolaryngology