Doctors' Call to Stop Chemotherapy Overuse, Cut Cancer Costs
Some experts say switch to palliative care eases burden and reduces costs.
May 26, 2010— -- Annual costs of cancer care are expected to rise to more than $173 billion dollars by 2020, a nearly $70 billion increase since 2006, according to the National Cancer Institute.
But limiting chemotherapy for patients with metastatic or recurrent cancers would not only dramatically cut exorbitant medical costs but would also improve a patient's quality of life, two oncologists suggest in a paper published Wednesday in the New England Journal of Medicine.
While cycles of chemotherapy vary depending on the type of cancer, authors Dr. Thomas Smith and Dr. Bruce Hillner suggest that oncologists limit treatment for patients who are not responding to three cycles of chemotherapy.
"We shouldn't give chemotherapy or radiation unless there's a reasonable reason," said Smith. "This money could be applied to better clinical trials, better medicines, things that would buy value."
This recommendation is one of 10 Smith and Hillner outlined as a response to a challenge posed by a colleague to suggest changes in the practice of medical oncology that could save the nation billions of dollars.
Current guidelines by the American Society of Clinical Oncologists already recommend stopping treatments that do not seem to benefit the patient. But many oncologists fail to put these guidelines into practice, said Smith, a medical oncologist and palliative care specialist at Virginia Commonwealth University's Massey Cancer Center.
Although chemotherapy may no longer be beneficial for end stage cancer patients, many oncologists choose to continue treatment, said Smith.
Previous studies suggest that as many as 20 percent of patients are getting chemotherapies in their last two weeks of life. Instead, Smith suggests spending the time beforehand to discuss end-of-life care with patients.
"When you've had that conversation you've given people help with that transition," said Smith, who acknowledged that the conversation with patients and families can be challenging. "We can explain to people what they have, set medically reasonable goals, have honest communication and choose less expensive drugs."
While many experts agree with the position, they said the focus should be less about preserving costs than about improving a patient's quality of life.
"Chemotherapy may seem to marginally increase survival rates, it substantially increases the risk of other potentially serious health problems," said Greg Anderson, founder of the Cancer Recovery Foundation International.
Some side effects of chemotherapy and radiation include hair loss, fatigue and memory loss.
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