The American Society of Clinical Oncology has released a list of tests and treatments that it believes oncologists should not offer to some patients, under some circumstances. This is exactly the kind of comparative information private sector entities should be generating to help patients and physicians make better decisions about cancer treatments, about how to address end of life care - and, frankly, how poor current treatments are for many patients with metastatic solid tumors like lung cancer. From Reuters:
Although the task force emphasized that its recommendations -- winnowed from about 10 suggestions by oncologists -- were driven by medical considerations, the report makes clear that expense was a major factor. A number of cancer drugs cost nearly $100,000 but extend life a few months or not at all. Widely-used imaging tests cost up to $5,000 yet do not benefit patients.
The list has been closely guarded, with public announcements scheduled for Wednesday. Patients, advocacy groups, and policy experts contacted by Reuters were mixed in their reaction to the recommendations.
"The American people have a much higher opinion of doctors than of government bureaucrats," said Kate Nix, a policy analyst at the free-market Heritage Foundation. Whether the ASCO recommendations to withhold some tests and treatments will be seen as rationing "depends on how they are used. Will they inhibit the ability of doctors and patients to make the best decision in each case?"
Having a single government panel make across the board decisions that set reimbursement decisions (like IPAB) is much more problematic than having a multitude of private sector entities, including practicing oncologists and patients' groups, issue their own recommendations.
The recommendation that may stir up the most controversy is the recommendation that patients who have not responded to previous first, second, or even third line chemotherapy regimens not receive additional treatment beyond palliative care. The study notes that "such [additional chemotherapy] is widespread" but "unlikely to extend [patients' lives] or improve its quality. The exception would be when the patient has been identified with a specific cancer gene mutation that responds to a targeted therapy, like Xalkori.
Rather than rail against the recommendations, cancer patients and their loved ones should ask why our treatments for solid metastatic cancers are often so poor, and what we can do to change that prognosis through better research or clinical trial designs.
We should save our outrage for fighting cancer, not the physicians who are admitting - bravely - that the outlook for treating metastatic cancer for many patients is bleak given the tools at their disposal today.
For an excellent discussion of the disincentives for producing better information on health care outcomes, and how to encourage more private sector organizations to generate comparative effectiveness research, see this Kauffman Foundation report by Wharton School professors Scott Harrington and Alan Miller. You can also find my podcast with Scott Harrington discussing the paper here.