Article cites potential to save money on end-of-life care, medical imaging and new drug prices
In a review article published Feb. 14 in The Lancet Oncology, Johns Hopkins experts identify three major sources of high cancer costs and argue that cancer doctors can likely reduce them without harm to patients. The cost-cutting proposals call for changes in routine clinical practice involved in end-of-life care, medical imaging and drug pricing.
"We need to find the best ways to manage costs effectively while maintaining the same, if not better, quality of life among our patients," says Thomas Smith, M.D., The Harry J. Duffey Family Professor of Palliative Medicine and professor of oncology at Johns Hopkins.
Smith and co-author Ronan Kelly, M.D., say that rising numbers of new cancer cases among an aging population are inflating total cancer costs, projected to increase by nearly 40 percent in 2020, and that changing practice patterns should be a priority among oncologists to achieve affordable costs.
"Oncology professional societies, such as the American Society of Clinical Oncology, are beginning to guide oncologists on cost-saving opportunities, but change in routine clinical practice is happening slowly," says Kelly, an assistant professor of oncology at the Johns Hopkins Kimmel Cancer Center.
In the article, Smith and Kelly say the biggest opportunities for safe and ethical cost-cutting solutions rest in caring for patients with metastatic cancer, not on new surgical or radiation treatments, clinical trials, curative care or pediatric care.
For example, the authors suggest that improving end-of-life care with better decision-making and planning could reap large cost savings by reducing hospitalizations in the last month of life. They note that 25 percent of total Medicare costs are spent in the last year of life; 40 percent of which is spent in the last month of life.
"Most people prefer to spend their last days of life at home with family and friends rather than in a hospital, but we still see high rates of hospital utilization in the last month of life," says Smith. Medicare data show that 60 percent of poor-prognosis cancer patients are admitted to a hospital in the last month of life, and 30 percent die there.
The Hopkins team says studies show that hospice care improves symptoms, helps caregivers and costs less, with equal or better survival for patients, yet only half of cancer patients use hospice in their last month of life.
