August 2014 Vol 7, Special Issue ASCO 2014 Payers' Perspectives in Oncology - Health Economics
Wayne Kuznar

The impact of federal budget cuts on cancer research is threatening progress in cancer therapy and access to increasing demand for cancer services, said ASCO president Clifford Hudis, MD, Chief of the Breast Medicine Service at Memorial Sloan Kettering Cancer Center, New York City, in his presidential address at ASCO 2014.

He called for the achievement of “social justice in cancer care” through loosening the purse strings for research and assuring better access to high-quality care. The meeting was attended by approximately 33,000 oncologists, representing more than 100 countries.

Dr Hudis implored legislators to “understand the price our patients pay for inaction and gridlock on this issue.” In keeping with the “Science and Society” theme of the meeting, he said that the 40% projected increase in cancer cases and survivors suggests the need for expanding clinical resources “if we are to achieve our goal of assuring that every patient has access to high-quality cancer care.”

He added, “If we intend to achieve social justice in cancer care, we simply need more public and private resources.”

The current federal budget allocates 0.1% to spending on cancer research. “We need societal awareness of the fact that an investment of 0.1% of our federal budget cannot begin to address the problem we face,” said Dr Hudis. “Research on a disease that affects one third to one half of all Americans garners less than $1 of every $1000 spent federally.”

The impact of these cuts is felt directly or indirectly every day by oncologists and by patients. “We must raise awareness of the remarkable return all of society receives on its investment in federal research,” he said.

In addition to sustaining innovation through a robust national cancer research program, specific investments are needed in the development and testing of new healthcare delivery and payment models designed to preserve access to high-quality care in local communities, where most cancer care is delivered.

Rewarding Value
“Our goal with these models is to reward value as opposed to volume,” said Dr Hudis. “We need to control payment reform and our focus on the quality of care we deliver, or others will quickly step in and define all of this for us. We must end persistent financial threats to clinical practice, especially in vulnerable communities, that are caused by sequester-related cuts and the flawed sustainable growth rate formula that drives physician payment.”

The goal is to help oncologists and patients more fully understand the elements of each treatment. “By understanding the full range of choices­their expected benefit, toxicities, as well as cost—patients can make choices that best suit their personal circumstances,” he said.

To achieve social justice in cancer care, “value in cancer care” must be defined to optimally use society’s previous resources, Dr Hudis pointed out. When breakthroughs in care are available, as in the United States, the rising cost of care is having predictable negative consequences—patients bear more of this cost, leading to declines in compliance.

“Ask yourselves where it could ever make sense to have a copay for an oral cancer treatment that saves and extends life and avoids more toxic and expensive alternatives,” he said. “A financial disincentive for compliance is irrational, no matter how you look at it.”

One key issue is the lack of a rational relationship between pricing and value. The challenge lies in preserving innovation while improving access and affordability.

The potential for industry and providers to collaborate to identify a productive way forward is great. “One that preserves capital flow and reward for innovators, but that provides even more access to care,” said Dr Hudis. “We must be creative and innovative, and we can if we work together.”

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