ASCO 2009: Physicians Need to Address Cost of Cancer Care With Patients

Roxanne Nelson

May 18, 2009

May 18, 2009 — Cancer patients who participate in clinical trials infrequently report problems coping with cost of their prescription drugs. More importantly, researchers say, they generally do not discuss the issue with their physicians.

In this study, about 10% of colon cancer patients participating in a clinical trial were concerned about being able to afford supportive medications, which include agents for managing the adverse effects of chemotherapy. In addition, the study raises the concern that patients treated outside the context of a trial might have a harder time affording supportive-care medicines.

Even thought the ability to afford medication was not a major concern for clinical-trial participants, few stated that their doctors discussed the cost of prescription medications, reported lead author Deborah Schrag, MD, during a presscast. The study results will be presented at the upcoming 2009 Annual Meeting of the American Society of Clinical Oncologists (ASCO).

"The implications are that when chemotherapy regimens proven to work in clinical trials are tried in the general population, there is the potential for greater treatment toxicity if patients are less able to cope with prescription-drug costs than the subset of patients who participate in clinical trials," said Dr. Schrag, a professor of medicine at Harvard University in Boston, Massachusetts.

Coping Strategies Adopted by Some, But Not Most Participants

Dr. Schrag and colleagues found that most patients surveyed reported that they did not experience anxiety about paying for their prescription drugs, and that they generally did not adopt strategies to help pay for these drugs, such as neglecting to fill prescriptions or skipping doses.

But in the current economic climate, with more people becoming uninsured or underinsured and with the cost of prescription drugs rising, this problem could become more pronounced, according to Dr. Schrag. "Oncologists may wish to consider discussing access to prescription-drug coverage with their patients prior to embarking on a course of chemotherapy," she said.

The trial was conducted as a companion study to CALGB 80405, a phase 3 trial that compared first-line systemic chemotherapy with bevacizumab (Avastin) and/or cetuximab (Erbitux) in patients with metastatic colorectal cancer. The strategies used by clinical-trial participants to cope with the high cost of prescription drugs are poorly characterized, and the researchers hoped to gain a better understanding of this issue.

"Cancer treatment requires supportive medications, such as those to prevent nausea and vomiting," said Dr. Schrag. "These drugs can be expensive and not all patients have drug coverage."

She added that their study was begun at about the same time as Medicare Part D was implemented, which allowed for coverage of outpatient prescription drugs. The cost for bevacizumab and cetuximab, 2 traditionally high-cost therapies, were covered by the study sponsors (National Cancer Institute), but patients were responsible for the cost of the other drugs.

Of the 1422 trial participants, 409 were included in the final analysis of the companion study on prescription drug cost. Interviews about treatment strategies used were conducted at baseline and then 3 months after the start of the trial. Of this group of 409, 60 (15%) lacked prescription-drug coverage.

The researchers found that there was a "high need" for prescription drugs within this population. At baseline, 23% of patients used more than 5 medications, and this number increased to 39% at 3 months. "Virtually, the entire population took 2 or more prescription drugs regularly," Dr. Schrag told journalists.

"But curiously, and in contrast to what we expected, we found that few reported use of coping strategies during the 3 months from the start of the study trial," she pointed out.

Only 7% failed to fill a prescription, 3% took less than the recommended dose to save money, 14% obtained samples from their doctor, and 9% spent less on other basics to pay for prescriptions. However, only 48 of 409 (12%) discussed prescription-drug costs with their physicians.

Prescription-Drug-Cost Coping Strategies

Coping Strategy Baseline,
n (%)
3 Month Update,
n (%)
Comparison shopping 84 (21) 50 (12)
Didn't fill a prescription to save money 57 (14) 28 (7)
Spent less on basics to pay for drugs 38 (9) 37 (9)
Borrowed money for prescription 56 (14) 27 (7)
Took less than prescribed dose to save money 18 (4) 12 (3)
Obtained drug samples from physician 176 (43) 57 (14)
Sought assistance from pharmaceutical company 14 (3) 5 (1)
Used more than 1 strategy 182 (45) 76 (19)


"As oncologists, our goal is to provide the highest quality of care to our patients, which can include everything from ensuring that they receive the best treatment to helping them cope with side effects," said Douglas Blayney, MD, president-elect of ASCO and clinical professor of medicine at the University of Michigan in Ann Arbor. "This highlights an important and growing issue in oncology field — what role we as doctors should play in helping our patients address the costs of cancer care."

One or more of the authors have consulted or held an advisory role at Amgen, Bristol-Myers Squibb, ImClone, or sanofi-aventis. Dr. Blayney serves as a consultant to Eli Lily and Cephalon and on Bristol-Myers Squibb's Data Safety Monitoring Board, and receives research funding from the National Comprehensive Cancer Network.


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