Curbing Costs of Cancer Care
The escalating cost of cancer medicines—and how treatment can be made more cost-effective—was the main focus of discussion at a three-day Georgetown symposium.
The symposium, “Fighting a Smarter War Against Cancer: Linking Policy to the Patient” was sponsored by The Ruesch Center for the Cure of Gastrointestinal Cancers at Georgetown Lombardi Comprehensive Cancer Center, in collaboration with Georgetown University Law Center and Georgetown’s McDonough School of Business.
Organized by John Marshall, M.D., head of hematology and oncology at Georgetown Lombardi and Ruesch Center director, the rich program convened national experts imparting perspectives from the federal government, regulatory agencies, private insurance industry, biotechnology companies, patient advocacy groups, and practicing physicians.
Comparing Effectiveness of Treatments
U.S. Rep. Steny Hoyer (D-MD), a 1966 alumnus of the Law Center who served for nearly a quarter century on the National Institutes of Health’s labor subcommittee, opened the symposium December 1 at the McDonough School of Business’ Rafik Hariri Building. Hoyer said the federal government’s current budgetary crisis highlights the critical need to take a harder look at the value and effectiveness of cancer therapies.
He lauded the Affordable Care Act’s creation of the Patient-Centered Outcomes Research Institute (PCORI), a nonprofit corporation created to provide evidence to help patients and health care providers make more informed decisions about medical treatments.
Hoyer also candidly described his own personal brush with cancer; his wife Judy died at age 57 just four months after being diagnosed with stomach cancer and both his mother and mother-in-law died of cancer. John Potter, M.D., Georgetown Lombardi’s founder and first director who was also in the audience, was Hoyer’s mother-in-law’s physician.
Referring to his wife’s battle, Hoyer says, “As with many [gastrointestinal] cancers, stomach cancer is often rapid and fatal. Even in our age of advanced medicine, effectively treating and curing [gastrointestinal] cancers remains difficult and elusive.”
However, Hoyer remains hopeful that this deadly set of diseases might have improved prognoses in the not-too-distant future.
“Certain cancers that just 10 or 20 years ago were a death sentence are now treatable â€¦ With hard work and continued perseverance, we may be fortunate to see the same thing happen with GI cancers in the coming years.”
Hoyer’s remarks were followed by a talk by Louis M. Weiner, M.D., director of Georgetown Lombardi, on the importance of considering science when devising health care policy to determine where the best investments can be made.
“Cancer care costs are rising,” Weiner said. “But the answer does not lie simply in the rationing of inferior care. Rather it is by investing in science, using it to inform treatment choices and forthrightly distinguishing between effectiveness and futility masquerading as progress.”
Also on Thursday, David Kerr, M.D., D.Sc., who has advised two British prime ministers on health care policy and who helped reform the United Kingdom’s National Health Service, delivered the Schafer Memorial Lecture, an endowed annual lectureship established by the family and friends of the late Thomas Schafer, who died of pancreatic cancer.
“Value will be the philosophical driver of 21st century health care,” Kerr says. He noted that one critical change must be to stop hailing “each moderate step as a breakthrough” in drug development. Such over-inflated pronouncements increase demand for marginally effective treatments, unnecessary scans, or increasingly aggressive surgeries that do not produce sufficient positive outcomes in patients.
Treatments such as chemotherapy “cannot be a psychological crutch,” Kerr says, but rather should be employed when the evidence shows they will be effective and do more good than harm.
Kerr’s remarks were followed by a round table discussion including: Mace Rothenberg, M.D., senior vice president of clinical development and medical affairs for Pfizer, Inc.; Gilad Gordon, M.D., M.B.A., president of ORRA Group, a firm that consults for the pharmaceutical and biotechnology industries; and Martin Brown, Ph.D., chief of the Health Services and Economics Branch of the National Cancer Institute.
Shining a Bright Light
The second day brought more experts to the table at the Law Center for a full afternoon of debate over how to define value in cancer care. The session was opened by M. Gregg Bloche, M.D., J.D., Georgetown Law professor and author of The Hippocratic Myth: Why Doctors Are Under Pressure to Ration Care, Practice Politics, and Compromise Their Promise to Heal.
“My hope is that today's conversation will shine a bright light ... on what we might do in the long term to make sure that medical costs are not the cause of our nation's ruin,” Bloche said.
Among the topics discussed were the need for a more transparent national dialogue about palliative care, which focuses on alleviating pain and managing symptoms with the goal of improving patients’ quality of life when other options have been exhausted, and the need to focus on therapeutic innovations that do more than provide a temporary benefit to just a few patients.
“The current problem of escalating health cost will not easily be solved,” says Antonio Tito Fojo, M.D., Ph.D., who heads the experimental therapeutics section at the National Cancer Institute’s Center for Cancer Research. “We are currently sowing the seeds that, in the years to come, will not solve but instead risk exacerbating our problems.
The day culminated in a round table involving a number of Ruesch Center Advocacy Board members, who represent the spectrum of gastrointestinal cancer advocacy organizations.
Saturday’s program focused on the patients and caregivers with a morning of “Navigating Cancer Care: What Every Patient Should Know.” A lineup of faculty and caregivers from Georgetown University Medical Center and Georgetown University Hospital presented on topics ranging from genetic risk of cancer to nutrition to how to handle insurance companies.
A Conversation Catalyst
Marshall hopes the three-day event will help catalyze a more frank, and less politically charged, national conversation around the value of cancer medicine by promoting such a high-level exchange of ideas.
“Evidence-based medicine does not equate with highly effective medicine. We need a new standard for new therapies—one that incorporates the magnitude of benefit and value. I believe we can fight a smarter war on cancer,” Marshall says.
By Lauren Wolkoff, Georgetown Lombardi Communications