Considering the cost of chemotherapy

Go ahead, you can admit it. You sometimes think about the cost of the chemotherapy you administer or recommend to patients. In academics, we think about it less, but it is still out there, especially when a patient is uninsured. I was wondering when this issue would make it to the mainstream media. I have come across two recent related articles addressing chemotherapy costs … particularly in relation to modest survival benefits: http://online.wsj.com/article/SB121548254807634713.html?mod=googlenews_wsj and http://www.newsinferno.com/archives/3416. An interesting New York Times photo essay on this issue is here. As it stands today in the United States, we do not formally ration chemotherapy, but base the decision on treatment (or not) on patient factors or patient preferences for care. In general, I like practicing under this model, but it feels like there is a groundswell of opposition (or reason, I suppose) that is going to force a change sooner rather than later.

Some have argued that patients should be responsible for supplemental insurance that would pay for these exorbitantly expensive medical treatments, like biologic chemotherapy. It's an interesting concept, but I don't think it has legs, since the most expensive technologies are inevitably the newest ones, and any insurance company would have a hard time keeping up. Given the frequency of cancer as well, one wonders how such a supplemental insurance could ever make a profit. Asking people to get a large enough health savings account to cover these costs out of pocket is also not reasonable, since the costs are frequently in the many tens of thousands — if not $100,000 — when all the treatments and tests are done.

In an unrelated, but very important note, it looks like hormonal therapy for localized prostate cancer should no longer be standard of care. For those of you who like to hear it (read it?) straight from the horse's mouth, here is the full text story (free! Thank you JAMA).