#LCSM

#LCSM Chat Topic 4/24: Cost vs. Value with Expensive Cancer Treatments

Our topic for the upcoming #LCSM tweet chat on Thursday, April 24 at 8 PM Eastern, 5 PM Pacific is the question of “cost vs value” in cancer treatments. The moderator for this chat will be Dr. Jack West.

ASCO (American Society of Clinical Oncology) has recently announced an initiative to define value in cancer treatments and apply some expectations of which drugs should be used, given their remarkable cost. Newer medications are typically costing about $10,000 per month, and the price is rising rapidly.

Newer drugs have varying amounts of evidence to support their use in lung and other cancers. For some targeted drugs, the evidence is compelling: patients who have a specific driver mutation have response rates of 60-75%, profound tumor shrinkage, and a duration of response of a year or longer. But there are also pricey drugs that offer a marginally significant clinical benefit. Is six weeks of additional survival with no chance of a cure worth an extra $50,000 per patient? Is it fair to expect society to pay for those marginal benefits?

The increasing use and plummeting cost of genomic testing will catalyze this cost versus value discussion. A cancer tumor’s genomic profile may identify a mutation for which a targeted drug exists. Such a tantalizing lead is likely to encourage a patient or oncologist to a try new, expensive drug or other treatment when it hasn’t been tested on that patient’s type of cancer. For instance, a drug approved for BRAF in breast cancer may have little or no clinical evidence to indicate it will actually work on a lung cancer tumor. Whether such experimental treatments perform spectacularly or fail, they will certainly cost a lot, and some patients may expect their health insurance to cover it.

The FDA has been charged with making decisions about drug approvals without regard to cost vs value, Yet increasing use of newer, expensive cancer drugs could drive up the cost of healthcare insurance premiums for everyone. Escalation of premiums can be crippling for families. It’s difficult to justify the burden of increased premiums for all when the benefit of an approved cancer drug is underwhelming.

How can we provide the best opportunities for patients while being fiscally responsible with limited societal resources? And how can we ensure that if society is paying for experimental treatments, someone learns something from it that can lead to a greater understanding and improved treatment recommendations later?

With these broad ideas in mind, here are the 3 key questions in our upcoming tweet chat on Thursday:

T1: @ASCO is now evaluating “value” of cancer drugs, as new ones are now ~$10K/mo. Is it fair to potentially deem some not worth cost? #LCSM

T2: How can we address societal concerns around rising costs & unproven or marginal benefits of cancer drugs that aren’t curative? #LCSM

T3: Would it be fair & feasible to have unproven agents provided, covered by insurers, only if pts & their docs submit outcomes data? #LCSM

We hope you’ll join us. Please just add the hashtag #LCSM to your tweets at the appointed hour and follow the stream as best you can. More info on how to participate in #LCSM Chat is here.

Background Reading

At What Price? Discussing Cost of Care with Patients, in ASCO Connection

Lung cancer grant opportunity from The CHEST Foundation

Today #LCSM received the following information about a lung cancer grant opportunity from The CHEST Foundation (the philanthropic arm of the American College of Chest Physicians).  We’re sharing it here to encourage more participation in lung cancer research.

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The CHEST Foundation has been supporting lung cancer research since 2002, and this award, established in 2011, funds much needed research that leads to improved treatment and/or a cure for lung cancer. The grant recipient will receive $100,000 in payments of $50,000 each year for 2 years. Eligibility criteria and the application are available online.

For patients and families, our foundation has free lung cancer patient education information available.

#LCSM Chat Topic 4/10: “Exercise During and After Lung Cancer Treatment”

The next #LCSM Chat will occur Thursday April 10 at 8 PM EDT (5 PM PDT) and will focus on “Exercise During and After Lung Cancer Treatment.” Our moderator will be Janet Freeman-Daily.

Exercise is known to improve quality of life and reduce recovery time, fatigue, sleep issues and depression in cancer patients. A recent study indicates high-intensity exercise during cancer treatment can have many benefits. Some facilities now offer pulmonary rehabilitation after lung cancer treatment to help patients recover lung capacity more quickly. Others offer fitness classes that adapt a fitness program based on the cancer survivor’s individual health situation. Even walking a bit each day can make a difference.

We’ll use these topics to stimulate the conversation:

  • T1: What kinds of exercise and rehab activities are helpful during and/or after lung cancer treatment?
  • T2: How can lung cancer patients learn about exercise and pulmonary rehabilitation options?
  • T3: How can caregivers, family members and healthcare providers encourage a lung cancer patient to exercise without “pushing”?

Guidelines on how to participate in an #LCSM Chat can be found on the “#LCSM Chat” page of the #LCSM website. Hope to see you on Twitter!

Background reading

Cure Magazine: Lung Cancer and Exercise?
“…exercise may also have important benefits for lung cancer patients and survivors, regardless of disease stage or limited physical activity, also called “de-conditioning,” which can cause the heart and muscles to regress and become less efficient.”

University of Colorado Hospital: Pulmonary Rehab Helps Patients Battle Back from Lung Disease
“The goal is to help patients recover as much as of their lung capacity as possible. That not only improves their quality of life; it helps prevent return trips to the hospital. ‘Physical reconditioning is the biggest part of recovery,’ ….”

Exercise for the management of cancer-related fatigue in adults (PubMed)
“…aerobic exercise can be regarded as beneficial for individuals with cancer-related fatigue during and post-cancer therapy, specifically those with solid tumours.”

High-Intensity Exercise Best During Lung Cancer Therapy (Medscape)
“High-intensity exercise during treatment for nonsmall-cell lung cancer can be more effective than the same program after cancer treatment”

Physical activity preferences of early-stage lung cancer survivors (PubMed)
“The majority of participants reported a desire for physical activity advice and a willingness to engage in physical activity.”

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