Saying it would cost $440 billion annually to extend by one year the lives of 550,000 Americans who die of cancer annually, U.S. government researchers argue the oncology community needs to address the “serious ethical dilemma” of using expensive cancer therapies that typically produce only a relatively short extension of survival. Writing in the Journal of the National Cancer Institute, the researchers say that every life is of infinite value, but that the spiraling cost of cancer care makes this dilemma inescapable.

 

“The current situation cannot continue,” says Tito Fojo of the Medical Oncology Branch, Center of Cancer Research at the National Cancer Institute and Christine Grady of the Department of Bioethics, the Clinical Center at the National Institutes of Health. “We cannot ignore the cumulative costs of the tests and treatments we recommend and prescribe. As the agents of change, professional societies, including their academic and practicing oncologist members, must lead the way. The time to start is now.”

 

The writers urge the oncology community to tackle the controversy concerning the life-extending benefits of certain cancer drugs and the extent to which their cost should factor in deliberations. Among their points, the authors ask whether an additional 1.7 months of life—the additional overall survival for colorectal cancer patients treated with cetuximab—is a benefit regardless of costs and side effects.

 

Treating a patient with non-small cell lung cancer with 18 weeks of cetuximab extends life by 1.2 months. But it costs an average of $80,000, which translates into an expenditure of $800,000 to prolong the life of one patient by 1 year, the researchers say. At this rate, the researchers calculate it would cost $440 billion annually, or 100 times NCI's budget, to extend the lives of 550,000 Americans who die of cancer annually by 1 year.

 

The researchers say that studies conducted to detect a survival advantage of two months or less should test only interventions that can be marketed at a cost of less than $20,000 for a course of treatment.