August 2014, Vol 3, No 5
Federal Spending on Cancer Research and Access to Care Called Woefully Inadequate by ASCO President
Sequester Threatens Progress Made in Cancer
The impact of federal budget cuts on cancer research is threatening progress against cancer and access to increasing demand for cancer services, said ASCO President Clifford Hudis, MD, in his presidential address. He called for achievement of “social justice in cancer care” by loosening purse strings for research and by assuring better access to high-quality care.
Hudis implored legislators to “understand the price our patients pay for inaction and gridlock on this issue.”
The 50th annual ASCO meeting, the theme of which was “Science and Society,” was attended by approximately 33,000 people representing more than 100 countries and featured 5100 submitted abstracts.
In keeping with that theme, Hudis said that the 40% projected increase in cancer cases and survivors suggests the need for expanding clinical resources “if we are to achieve our goal of assuring that every patient has access to high-quality cancer care. If we intend to achieve social justice in cancer care, we simply need more public and private resources.”
The current federal budget allocates 0.1% to spending on cancer research. “We need societal awareness of the fact that an investment of 0.1% of our federal budget cannot begin to address the problem we face,” said Hudis, chief of the breast medicine service at Memorial Sloan Kettering Cancer Center, New York City. “Research on a disease that affects one-third to one-half of all Americans garners less than 1 dollar of every thousand spent federally.”
The practical impact of these cuts is felt directly or indirectly every day by oncologists and patients. “We must raise awareness of the remarkable return all of society receives on its investment in federal research so that it can be increased,” he said.
Striving for Social Justice
He also sounded off on social justice in cancer care, saying that disparities in access to high-quality care must be addressed.
“To delineate the challenges we face in providing quality care and to develop solutions to uneven access now and in the foreseeable future, in April of 2014, ASCO issued its first annual assessment of the State of Cancer Care in America,” he said. The report describes ways ASCO is trying to adapt to a growing demand for services, the rapidly evolving healthcare environment, and the economic pressures associated with maintaining access to care.
In addition to sustaining innovation through a robust national cancer research program, specific investments are needed in the development and testing of new healthcare delivery and payment models designed to preserve access to high-quality care in local communities, where most cancer care is delivered.
“Our goal with these models is to reward value, as opposed to volume,” said Hudis. “We need to control payment reform and our focus on the quality of care we deliver, or others will quickly step in and define all of this for us. We must end persistent financial threats to clinical practice, especially in vulnerable communities, that are caused by sequester-related cuts and the flawed sustainable growth rate formula that drives physician payment.”
To achieve social justice in cancer care, “value in cancer care” must be defined to optimally use society’s precious resources, he said. When breakthroughs in care are available, as in the United States, the rising cost of care is having predictable negative consequences – patients bearing more of this cost, leading to declines in compliance, he said.
“Ask yourselves where it could ever make sense to have a copay for an oral cancer treatment that saves and extends life and avoids more toxic and expensive alternatives,” he said. “A financial disincentive for compliance is irrational no matter how you look at it.”
Although components to the cost of cancer care are numerous, one unsolved problem is the lack of a rational relationship between pricing and value. The challenge lies in preserving innovation while improving access and affordability.
The potential for industry and providers to collaborate to identify a productive way forward is great. “One that preserves capital flow and reward for innovators, but that provides even more access to care,” said Hudis. “We must be creative and innovative, and we can if we work together.”
To this end, ASCO is organizing a Summit on Value in Cancer Care that involves all stakeholders. The aim is to provide a “value framework” to help clinicians and patients more fully understand the likely benefits of specific treatment plans for their cancers. “By understanding the full range of choices – their expected benefit, toxicities, as well as cost – patients can make choices that best suit their personal circumstances,” he said.
For the second-line treatment of chronic lymphocytic leukemia (CLL), ibrutinib improved not only progression-free survival (PFS) but also overall survival (OS), the phase 3 RESONATE study showed. In conjunction with the ASCO presentation, the study was published online in the New England Journal of Medicine. “Ibrutinib beat a standard comparator [ Read More ]
In breast cancer patients with bone metastasis, less frequent infusion of zoledronic acid was as effective as the standard monthly dose, the randomized OPTIMIZE-2 study showed. “We found that less frequent treatment may reduce the risk of serious side effects, with the additional benefits of reduced inconvenience to the patient [ Read More ]