ASCO's New Strategy to Define 'Value' in Cancer Care

Roxanne Nelson

April 03, 2014

The American Society of Clinical Oncology (ASCO) has launched a strategic initiative to define value in cancer care.

The organization is currently developing a working definition of value that is specific to oncology, and their Value in Cancer Care Task Force is working on an algorithm that will help oncologists determine the value of different cancer treatments. Within this framework, value will be defined by clinical benefit, toxicity, and cost.

The recent ASCO State of Cancer Care in America: 2014 report makes it clear that the United States cannot sustain the continually rising cost of cancer care, said Lowell Schnipper, MD, chair of Value in Cancer Care Task Force.

It is projected that the annual cost will increase to $173 billion by 2020, which is an increase of 40% from 2010, he told to Medscape Medical News. At the same time, the demand for cancer care services is growing significantly, in large part because of the aging population, and it is estimated that the number of new cancer cases in United States will increase by 45% by 2030.

"Understandably, the cost of cancer care is receiving increased scrutiny from policymakers, the media, and the public at large," said Dr. Schnipper. In addition, "the oncology community has been an active participant in this national dialogue."

However, cost is only one component of the value of care. "This more broadly speaks to what clinical outcomes patients can expect for any specific treatment, at what cost, and with what side effects," said Dr. Schnipper.

The ASCO task force has identified 3 goals for its strategic value initiative.

First is that oncologists will have the skills and tools needed to evaluate the relative value of interventions, and will use these when discussing treatment options with their patients.

Second is to have information readily accessible to help patients select high-value treatment that meets their individual needs.

Third is to have an algorithm that can be used by those responsible for covering the costs of cancer care to define and assess the value of treatment options.

ASCO Value Initiative

Dr. Schnipper explained that ASCO is undertaking this initiative to help keep patients at the center of the value discussion. "Making fully informed decisions requires a better understanding by oncology providers and their patients about the relative values of different available treatment regimens," he noted. "We also hope this effort will help inform the policy decisions of payers, as well as the pricing of cancer drugs when they come to market."

"We firmly believe that the doctors who care for patients with cancer — those integrally involved in treatment decisions — can make an important contribution to the national conversation on cancer care costs and value," he added. "This value framework can also provide an important tool for physicians in their capacity as a critical conduit to ensuring that patients receive high-quality cancer care."

Challenges to Goals

However, there are 2 major challenges to achieving these goals, and they require immediate attention by the oncology community, according to ASCO.

The first is that oncologists will have to "adapt to growing demands to demonstrate quality, efficiency, and transparency in the care they provide to their patients."

A more formidable challenge is addressing the skyrocketing costs of new cancer therapies and tests. This is becoming increasingly urgent as novel therapies are tested and administered in combinations. Other drivers of escalating costs include expensive imaging, diagnostics, new technologies, advanced delivery mechanisms, and hospitalization, but for the majority of cancer patients, drugs represent a significant percentage of their direct expenses.

"Most troubling are the reports that high drug prices are limiting patient access to treatment and challenging patients' (and their families') financial stability and security," according to an ASCO in Action Brief.

"With many newly approved oncology drugs costing as much as $100,000 or more for a single course of treatment, these therapies are out of reach for many," it states.

However, the brief emphasizes that drug costs are only one of a "multiplicity of causes (technological innovations in surgery and radiation therapy, hospitalizations, futile cancer care provided at the end of life) for rapid rises in the costs of cancer care and the financial burdens they collectively represent."

The Value Framework

The task force is putting together an initial framework that can assist in "evaluating value" in cancer care and defining its key components. Thus far, 3 key elements have emerged.

The first is clinical benefit. The commonly accepted meaning is that the treatment demonstrates an improvement in survival, compared with no therapy (when appropriate) or a known effective therapy, although this can sometimes differ (e.g., improvement in time to disease progression).

The second is toxicity. It is important to consider the degree of treatment-associated adverse events, particularly those that affect quality of life or the ability to complete usual activities of daily living, because many can be managed with supportive or additional treatments.

The third is cost, which encompasses expenses incurred by patients, society, and insurers. Financial toxicity — when patients do not adhere to their treatment regimens because of limited financial resources — can result in poorer outcomes.

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