ASCO wants to talk value when talking cancer

Doctors are being encouraged to talk about value
Doctors are being encouraged to talk about value

Innovation is far from a stumbling block in the cancer space, but grappling with getting patients the right medication—meaning the right treatment and at an appropriate price point—is still an issue, according to a report from the American Society of Clinical Oncology.

The need to consider a treatment's high price in relation to the benefit offered is not a new concern—payers are vigilant about keeping care costs from exploding—but ASCO's discussion about finding the balance is somewhat unique in the healthcare space. Its report, the State of Cancer Care in America, was released this week.

The organization is encouraging doctors to initiate patient conversations about cost within the context of “personal goals of care, potential treatment options, expected benefits and the physical and financial impacts of treatment options.” [Doctors have also taken an active role in seeking to lower costs.]

This is important in a field in which ASCO said the average monthly cost of a branded cancer drug has more than doubled to $10,000 over the past ten years with some closing in on about $40,000 a month in 2014 dollars.

The organization's Value in Cancer Care Task Force has been looking to address this issue since it was created in 2007. It began working on how physicians and patients can talk about the value of different treatments last year. The framework is expected to include discussions that include survival time and quality of life.

The group supported this issue in this week's report by noting that cancer patients in other countries have similar or better outcomes than US patients but their care costs less. It also said that some cost interventions like prior authorization requirements do not necessarily achieve this and ASCO found in an earlier survey that there is “little evidence that these requirements improve the quality of patient care.”

ASCO said in January that what it called high-quality care, expensive or otherwise, can be cheaper in the long term, but the report shows that this does not mean drugmakers do not have to worry about the cost of a single cancer medication. Instead, cancer often requires a choreography of treatments, as opposed to being a one-condition, one-medication regimen. For marketers, this would indicate a need to think about treatments within this broader context.

This also means discussions about cancer treatments need to go beyond specialists and their patients and include the nurse practitioners and physician assistants who are becoming increasingly vital to cancer care. Twenty states allow nurse practitioners to prescribe chemotherapy treatments and about 1,900 of the country's 192,000 nurse practitioners are oncology-certified. ASCO said about 1,800 physician assistants work in oncology, and numbers for both professions are expected to grow within oncology.

Marketers also need to think more about age and potential workforce gaps as oncologists head into retirement. ASCO said that almost 20% of oncologists are close to 64 years old and that oncologists younger than 40 years old account for 16% of the cancer workforce. These younger doctors are less likely to run independent practices. This could have an impact on what treatment regimens doctors, nurse practitioners and physician assistants may discuss with patients, if they join a practice or a group like an accountable care organization that shifts decision making to someone other than the healthcare practitioner.