Cost of cancer care climbed between 1991 and 2002, as radiation and chemotherapy increased

The cost of cancer care incurred during the period two months prior to cancer diagnosis and 12 months following diagnosis increased substantially between 1991 and 2002 for elderly patients in the United States, according to a study published online June 10 in the Journal of the National Cancer Institute. The increases in costs for breast, lung, and colorectal cancer were due in large part to increases in the percentage of patients receiving radiation therapy and chemotherapy and the rising costs for those therapies. There have been general reports of increases in the cost of cancer care, but little research has examined the magnitude of those changes or the type of treatments that are driving them.

To find out, Joan L. Warren, Ph.D., of the National Cancer Institute in Bethesda, Md., and colleagues analyzed data from the Surveillance, Epidemiology, and End-Results (SEER)-Medicare linked database. They identified 306,709 individuals aged 65 or older who were diagnosed with breast, lung, colorectal, or prostate cancer between 1991 and 2002. The researchers compared the cost of initial cancer treatment, separating cancer-related surgery, chemotherapy, radiation therapy, and other hospitalization.

During the study period, the average cost per lung cancer patient rose by $7,139 to $39,891, after adjusting for inflation. Similarly, the cost per colorectal cancer patient climbed by $5,345 to an average of $41,134, and per-patient breast cancer care rose by $4,189 to an average of $20,964. The cost of per-patient prostate cancer care declined by $196 during the same period to an average of $18,261 in 2002. The decline in the cost of prostate cancer care was due to a reduction in the number of men undergoing surgery as treatment for their prostate cancer. The total cost of initial care for patients with these four cancers was $6.7 billion in 2002.

Warren and colleagues note that the fraction of lung, colorectal, and breast cancer patients who received chemotherapy increased over the study time. That rise, combined with the higher cost of newer drugs, accounted for a substantial fraction of the increases in cost of care. And this increase, they suggest, is an underestimate because the most expensive agents did not gain U.S. Food and Drug Administration approval until after the study period. The authors note, however, that the cost of hospitalizations still accounted for the largest fraction of care in all four cancers.

These new data need to be considered by policy makers, according to the authors. "These data do not reflect the current (2008) or future costs to the Medicare program related to cancer care. Expensive chemotherapies will place a strain on the financial resources of the Medicare program. [Center for Medicare and Medicaid Services] needs to anticipate the burden of paying for new chemotherapies and may need to promote programs to identify those patients who may benefit the most from these expensive treatments," the authors write.

Source: Journal of the National Cancer Institute