Smok­ing dur­ing can­cer treat­ment will add to bill

The Buffalo News - - FRONT PAGE - By Sarah Gantz PHILADEL­PHIA IN­QUIRER

Smok­ing is known to pose sig­nif­i­cant health risks for can­cer pa­tients, but also car­ries a hefty price tag, ac­cord­ing to new re­search from the Med­i­cal Univer­sity of South Carolina.

Can­cer pa­tients who smoked dur­ing treat­ment were more likely than non­smok­ers to have their ini­tial treat­ment fail and ended up spend­ing more on sub­se­quent treat­ments, ac­cord­ing to the study, pub­lished Fri­day in the Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion.

The find­ings high­light the sig­nif­i­cant im­pact pa­tient be­hav­ior has on the to­tal cost of treat­ment that is al­ready in­cred­i­bly ex­pen­sive. Pa­tients can eas­ily spend over $100,000 a year – and if they smoke dur­ing treat­ment will end up spend­ing more.

“In ad­di­tion to treat­ing can­cer, we need to con­sider smok­ing, a health be­hav­ior, as not only an im­por­tant health is­sue but a cost is­sue,” said Gra­ham W. War­ren, the study’s lead au­thor, who works as an on­col­o­gist and pro­fes­sor at the univer­sity.

War­ren and his team an­a­lyzed data from the 2014 sur­geon gen­eral’s re­port on the health con­se­quences of smok­ing to look at how treat­ment-fail­ure rates and treat­ment costs from ad­di­tional in­ter­ven­tions com­pared be­tween smok­ers and non­smok­ers.

They found that pa­tients who smoked had higher fail­ure rates for their first-line can­cer treat­ment than non­smok­ers. That was true re­gard­less of the sever­ity of the can­cer, though smok­ing posed the great­est risk for treat­ment fail­ure among pa­tients with can­cers with high cure rates.

For ex­am­ple, a can­cer with a 30 per­cent treat­ment fail­ure rate for non­smok­ers had a 40.7 per­cent fail­ure rate for pa­tients who smoked.

Re­searchers es­ti­mated that for a co­hort of 1,000 pa­tients with a 20 per­cent smok­ing rate – mean­ing about 200 were smok­ers – ad­di­tional treat­ment af­ter their first ap­proach failed would cost a to­tal of $2.1 mil­lion, or about $10,678 per smok­ing pa­tient.

Though the con­nec­tion be­tween smok­ing, poor health out­comes and high cost is clear, ces­sa­tion re­sources are of­ten limited for can­cer pa­tients, wrote Cara Petrucci and An­drew Hy­land of Roswell Park Com­pre­hen­sive Can­cer Cen­ter in Buf­falo, in an in­vited re­sponse to the study, also pub­lished in JAMA.

In­sur­ance cover­age for smok­ing ces­sa­tion in­ter­ven­tions is of­ten limited, and on­col­o­gists spe­cial­ized in treat­ing can­cer may not be equipped to also tackle an in­grained habit such as smok­ing.

How to bet­ter in­te­grate smok­ing ces­sa­tion – and who will pay for it – are is­sues that war­rant more at­ten­tion.

“The fu­ture of health care is fo­cused on value-based medicine and pro­vid­ing the best care at the low­est cost. It will become in­creas­ingly im­por­tant for clin­i­cians and or­ga­ni­za­tions to be able to ac­cu­rately iden­tify and an­a­lyze both the clin­i­cal and the fi­nan­cial con­se­quences of health care and pub­lic health in­ter­ven­tions,” they wrote.

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