Hospital systems react to cancer care crisis
To this day, cancers often are discovered at late stages with one-size-fits-all treatments, raising the risk of health damage and throughthe-roof health care costs.
Medical research is trying to change this, with many cancers now considered chronic illnesses rather than death sentences. If study results are any indication, researchers are working feverishly to develop better, cheaper methods to diagnose cancer earlier and more precisely, with personalized treatments to improve outcomes, all promising cost savings.
That push comes at a time when health care experts are describing a crisis in cancer care related to consistency, availability and cost.
By 2020, annual cancercare costs nationwide will skyrocket to $207 billion, compared with 2010 total costs of $125 billion, the U.S. Centers for Disease Control and Prevention states. The price of chemotherapy alone is jumping 17 percent annually with oral cancer treatments having doubled in five years, the Dartmouth Atlas Project reports. Variations in care and duplicate testing continue pushing costs 30 to 50 percent higher with a heavy toll on patient’s lives and survival rates.
“One in four cancer patients stops taking medications due to costs,” the Dartmouth report states, noting that a growing number of patients don’t get their prescriptions filled or take less than prescribed. That means adults with cancer are “almost three times more likely to declare bankruptcy,” with that same group facing 79 percent higher mortality rates.
The house is on fire.
Numbing numbers
In 2013, the Institute of Medicine said that “the cancer-care delivery system is in crisis” due to growing demand for care, increasing complexity of treatment, a shrinking workforce and rising costs. “Changes across the board are urgently needed to improve the quality of cancer care.”
That’s no small challenge, given that 14 million Americans have had cancer, with more than 1.6 million new cases diagnosed annually. “By 2022, it is projected that there will be 18 million cancer survivors and, by 2030, cancer incidence is expected to rise to 2.3 million diagnoses per year,” the institute noted.
Barriers to providing excellent care for all patients remain daunting, with the Dartmouth project saying that almost one in two Americans ultimately will get cancer. The Agency for Health Care Research and Quality reports that more than 600,000 people are likely to die this year alone from cancer — about 1,650 a day. “Cancer costs us billions of dollars. It also costs us the people we love,” it stated. “Reducing barriers to cancer care is critical in the fight to eliminate suffering and death due to cancer.”
One key problem is that care remains fragmented with complicated treatments and patients sometimes getting wrong treatments or dosages, the studies say.
Even government is implicated in the crisis with the American Cancer Society Cancer Action Network on Aug. 3 saying that Pennsylvania “is falling short when it comes to supporting policies and passing legislation to prevent and reducing suffering and death from cancer.” It graded the state on nine areas of care, with poor or insufficient ratings in tobacco cessation programs and smoke-free laws, pain policy and restrictions on indoor tanning devices.
“Passing and implementing the policy recommendations in the report would not only save lives in Pennsylvania but also save millions in long-term health care costs and in some cases would even generate additional, much-needed revenue,” the network stated.
System overhaul
The cancer-care crisis has prompted UPMC and the Allegheny Health Network to adopt methods to control costs and improve care, with neither arguing the existence of concerning trends in cancer care.
“Many cancer experts come together to talk about the current state of cancer and optimizing the cost for cancer care — prevention, screening, diagnosis, treatment, follow-up, survivorship and supportive care,” said David S. Parda, system chair of the Allegheny Health Network Cancer Institute. “What most studies have shown is that optimal care coordination helps with overall cancer care.”
For that reason, AHN has adopted a multidisciplinary approach, with different departments coordinating the patient’s progression through the entire process of diagnosis, treatment and follow-up care, to avoid duplication of effort, mistakes and variations in treatment.
In the meantime, Dr. Parda said AHN has 200 clinical trials underway with its partner, Johns Hopkins University in Baltimore, sponsoring 400 of its own, many of them focused on diagnostic and treatment strategies. “Early, more accurate diagnosis can lower costs,” he said. “Early, more accurate diagnosis can lead to better treatment.”
That fact remains that cancer is expensive from the start, with diagnoses traditionally involving Magnetic Resonance Imaging, bone scans, colonoscopies, surgical biopsies and various scans and ultrasound procedures, among others. Highmark reports that two-thirds of cancer-related costs in the Tri-State area involve drugs, radiation therapy and surgical biopsies and procedures.
That’s why researchers are developing “liquid biopsies” as diagnostic tools that help identify the most personalized treatment.
“We’re sorting out various agents of each tumor and the whole lung-cancer story,” Dr. Parda said, as an example. “The focus is targeting agents special for the patient and immunotherapy treatments, where you are looking for changes in the tumor and using targeted therapies, all of which involves personalized medicine.”
Other cost savings derive from outpatient or at-home treatments, with the goal of keeping cancer patients out of the emergency room or intensive care unit, he said.
Liquid biopsy
The New England Journal of Medicine published a study Thursday describing the first successful use of a liquid biopsy, through analysis of blood plasma. Researchers found people with Epstein-Barr virus DNA they used as a biomarker for nasopharyngeal cancer to identify patients at risk for the cancer. Eventually, they were able to make an early cancer diagnosis for 34 people who were yet to have symptoms.
“Nasopharyngeal carcinoma was detected significantly earlier and outcomes were better in participants who were identified by screening” than those who underwent the standard routine of diagnosis, concludes the study done by the Royal College of Pathologists of Australasia, based in Sydney, Australia.
As the study indicates, DNA, along with other molecular agents in the blood and urine, may be used to signal the presence of specific cancers and stage of their development. Studies published weekly in medical journals reveal the potential of identifying genetic markers of subgroups of cancers, through blood or urine tests, to determine whether specific treatments could work.
“Liquid biopsies provide a less invasive approach to the current gold standard of interrogating tumors by tissue biopsies, which are frequently unfeasible, associated with morbidity and cannot be performed as often,” said one study published July 29.
UPMC has been leading the way with such research with computer chips or panels that analyze drops of blood and provide detailed information about the presence of cancer.
Robert L. Ferris, the newly appointed director of the UPMC Hillman Cancer Center, said a needle biopsy that UPMC developed for thyroid cancer — the widely available ThryoSeq test — stands to prevent overtreatment of more than 90 percent of those diagnosed with the cancer. Only 8 percent of patients, as it turns out, require full removal of the thyroid. ThyroSeq provides great relief for most patients and significant cost savings.
Liquid-biopsy tests, however, are “not yet ready for prime time,” he said, prior to the NEJM announcement.
Nucleic acid biomarkers in urine also “hold potential” for clinical use in diagnosing and describing genital and urinary cancers, states a study published in March in the journal European Urology Focus. Advantages include “the potential for more frequent testing, monitoring and home use” in detecting early-stage cancers, it said.
A July 28 study in Epigenetics identified a blood plasma test to detect various cancer biomarkers for colorectal cancer, which shows potential for noninvasive detection of colorectal adenoma and cancer.
In a report published online July 25, a Chinese research team described other tumor biomarkers circulating in blood plasma or serum that could be used to diagnose various cancers.
“Liquid biopsies can help clinicians screen and detect cancer early, stratify patients to the most suitable treatment and real-time monitoring of treatment response and resistance mechanisms in the tumor, evaluate the risk for metastatic relapse and eliminate prognosis.
“In the future, liquid biopsies could be used to guide cancer treatment,” the study concluded. “They could also provide the ideal scheme to personalize treatment in precision medicine.”