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10% of patients on clinical trial used coping strategies to cover drug cost
2009 ASCO Annual Meeting
Although the majority of drug costs for patients on clinical trials are covered by insurance, many still have to pay for prescriptions for supportive medications to help manage the side effects of chemotherapy such as nausea or high blood pressure.
The results of a companion study to CALGB 80405, a randomized trial that compared several chemotherapy regimens in advanced colon cancer, indicated that 10% of patients in the trial were very worried about paying the cost of their prescription drugs and another 18% were somewhat worried. All the clinical trial participants received prescriptions to help manage chemotherapy’s adverse effects.
“If clinical trial patients do not take supportive care medication
in order to save they may experience excess toxicity. Our goal was to determine
whether affordability of prescription drugs is a problem for clinical trial
participants and to understand their use of various coping strategies,”
said Deborah Schrag, MD, associate professor of medicine at Harvard
Medical School, who presented the results ahead of the 2009 ASCO Annual
Meeting. 
Click
here to listen to a clip from Dr. Schrag's presentation.
The companion trial enrolled patients with newly metastatic colorectal cancer assigned to either bevacizumab (Avastin, Genentech), cetuximab (Erbitux, Imclone) or both when combined with FOLFOX or FOLFIRI.
Prior to the trial initiation and then again at three months patients a subset of patients (n=409) were surveyed about insurance status and strategies used to cope with out-of-pocket prescription drug expenses.
Although 10% of patients reported being “very worried” and 18% “somewhat worried” about paying for supportive medications, less than 15% of patients were forced to adopt some sort of money saving strategy, such as not filling a prescription, taking a less than recommended dose, or cutting other costs to pay for medications. The 15% of patients that did not have a prescription drug coverage plan were the most likely to report using one of these strategies.
Despite the level of worry, only 12% of patients on trial reported having discussed any concerns about prescription drug affordability with their physicians.
“When chemotherapy regimens that are proven to work in clinical trials are rolled out and tried in the general population there is the potential for greater treatment toxicity if patients cannot afford the prescription drugs that make the side effects of these regimens manageable,” Schrag said.
“In particular our findings demonstrate that patients worry about the affordablity of their prescription drugs but only seldom share these concerns with their doctors. Oncologists may wish to consider discussing affordability of prescription drugs with their patients prior to embarking on a course of chemotherapy,” she said.
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