WCOE: Cost of Cancer Care, Adopting a Shorter Course of Treatment for Some Breast Cancer Patients, and Lung Cancer Screening

In “The Punishing Cost of Cancer Care,” Dr. Mikkael Sekeres describes the difficult conversations he has with patients regarding the cost of cancer treatments and how reviewing the economic risks of treatment is now a standard part of his informed consent process. In the vignette he provides, one patient considers whether the cost of treatment outweighs the potential benefits. It is not rare for a patient to have to decide between incurring crippling debt or improving the quality of their disease. We commend Sekeres for integrating these conversations into his practices, however, having these conversations is only half of the battle. We must make cancer treatment affordable and accessible to all.

Several outlets such as NPR, Vox, Time, and NBC News reported on newly released findings from the Journal of the American Medical Association that state about two thirds of early stage breast cancer patients may be getting more radiation treatment than needed and radiology oncologists are not utilizing the new course of treatment that could take less time and cost less for many women. The research suggests that, among other factors, one reason for the lack of use is the financial incentives associated with the longer and more invasive course of treatment.

Published this week in The New York Times ‘Well Blog,’ Jane Brody thoughtfully examines in “For Lung Cancer Screening, a Small Dose of Hope,” the pros and cons of low-dose computed tomography (LDCT) lung cancer screening on the heels of the CMS decision to provide free screening to many Medicare insured Americans. Brody cites research that LDCT could prevent three lung cancer deaths for every 1,000 people screened, and given the millions of people at risk, that could translate into many lives saved. However, she notes with Dr. Peter Bach’s consultation, that for the benefits demonstrated in the trial to be realized, screening would have to be limited to people at high risk of developing lung cancer and the most common risk of the screening is a false-postive result as up to half of lung nodules seen on LDCT turn out not to be cancer.