Cancer: Progress but a long way to go

I admire President Biden for trying for a cancer cure moonshot but unfortunately, cancer is not just one disease; it’s many with a range of different causes, physiologies, and treatments. What treatment works in one patient may not work in another but we have to keep trying to beat cancer anyway we can.

As I was getting ready to go on my bike ride, I met a neighbor walking his dog. He told me he had just lost his wife, 59 years old, to cancer a couple of months ago. I could hear the pain in his voice, and he was still recovering from the shock of losing his wife of 27 years.

In the battle against cancer, there is some good news. The mortality rate from lung cancer has dropped in recent decades—by 56% in men from 1990 to 2019 and by 32% in women from 2002 to 2019. In recent years, early detection and treatment improvements have helped boost the 3-year survival rate for lung cancer from 21% in 2004 to 31% in 2015 through 2017. The 5-year survival rate has increased by 6% for distant-stage lung cancer, 33% for a regional-stage disease, and 60% for localized disease. But it’s’ still the leading cause of cancer deaths. (American Cancer Society’s ACS)

The COVID-19 pandemic has claimed millions of lives and taken an emotional, physical, and financial toll on countless others worldwide. A new national study details the devastating effect the COVID-19 crisis has had on cancer care. Specifically, fearing exposure to COVID-19, many people delayed or even skipped regular screenings. As a result, many cancers are being diagnosed at later stages when they require more complex treatment and often result in higher mortality rates.

In addition, the early weeks of the COVID-19 pandemic caused 44% of breast cancer survivors to have a delay in care, according to an online survey. The research was published online on Aug. 9, 2020, by the Breast Cancer Research and Treatment journal. Read “Patient-reported treatment delays in breast cancer care during the COVID-19 pandemic.”

There is also the issue of medical debt of surviving cancer patients. According to the American Cancer Society Cancer Action Network:

  • Majorities of cancer patients and survivors say they were unprepared for what the costs of their care would be, and most report making major changes to their lifestyle or finances as a result.
  • Cost concerns weigh heavily: 73% are concerned about their ability to pay current or future costs of their care and 70% are worried about incurring medical debt due to their cancer care and treatment.
  • In line with recent national reports, 51% of cancer patients and survivors report incurring medical debt as a result of the costs of their cancer care. The debt is often carried for years with significant impacts, including 53% of debt-holders facing collections and 46% seeing their credit score negatively impacted.
  • Experiences with medical debt can hinder seeking care and limit treatment option: 45% of those who have had medical debt have delayed or avoided medical care for serious issues as a result, and 62% have delayed or avoided medical care for minor issues, while half have sought the least expensive treatment options due to their debt.
  • The cost burden associated with cancer care is not felt equally. African Americans in our survey are more likely to report having medical debt associated with their cancer care, and more likely to have been contacted by collections regarding their debt. Residents of states that have not yet or only recently expanded Medicaid are also more likely to report having medical debt, as well as higher rates of feeling unprepared for the costs of their cancer care.

The cost of cancer medicines is unsustainable. Medicare spent nearly $600 million over three years to pay for cancer care involving four drugs later found to provide no clinical benefit for some forms of the disease. The Food and Drug Administration approved them, an analysis JAMA Internal Medicine found.

This leads to an ethical question: Should we deny hope to cancer patients because a drug may not work, or should the FDA only approve cancer drugs that show significant clinical benefits (i.e., sustaining life)?

Pharma companies are making billions from cancer treatments. For patients and their families, the costs associated with direct cancer care are staggering. In 2018 cancer patients in the U.S. paid $5.6 billion out of pocket for cancer treatments, including surgical procedures, radiation treatments, and chemotherapy drugs. (Source:American Cancer Society)

In addition to a cancer “moonshot,” we need treatments that patients and our healthcare system can afford. I wonder if pharma emphasizes families who have lost loved ones to cancer or see cancer patients as a continued revenue stream?