New research published by Chopra et al in JNCCN—Journal of the National Comprehensive Cancer Network calls for much greater integration between cardiologists and oncologists for patients with coronary artery disease who are diagnosed with cancer. Coronary artery disease is the most common type of heart of disease—and the leading cause of death in the United States. Researchers found that coronary artery disease–related medical expenses were considerably higher for patients with this chronic condition who were also diagnosed with cancer—particularly colorectal cancer.
“Heart problems that needed to be treated with in-patient hospitalization accounted for the highest added expenditures, representing two-thirds of the total costs,” explained lead researcher Ishveen Chopra, PhD, MBA, of the Department of Pharmaceutical Systems and Policy at West Virginia University. “There is a need for more coordinated and patient-centered care among older adults with multiple chronic conditions. An interdisciplinary and integrated approach to cardiovascular management in the elderly diagnosed with incident cancer would improve cardiovascular outcomes.”
The study used the SEER-Medicare registry, as well as a 5% noncancer random sample of Medicare beneficiaries, to compare costs for 12,095 patients with coronary artery disease also diagnosed with breast, colorectal, or prostate cancer against the costs of 34,237 patients with with coronary artery disease not diagnosed with cancer. All were continuously enrolled in traditional, fee-for-service Medicare plans. Every individual was aged 68 or older and remained alive during the entire 48-month study period. Health-care expenses were measured every 120 days for 1 year pre–cancer diagnosis and 1-year post–cancer diagnosis, and were adjusted by the Consumer Price Index for medical services and expressed in 2012 dollars.
The results showed that with coronary artery disease expenses post cancer diagnosis increased approximately three times over precancer costs for patients with colorectal cancer. The post–cancer diagnosis expenses were twice as high for women with breast cancer, and one-and-a-half times higher for men with prostate cancer. Coronary artery disease costs in the noncancer group remained steady for the entire time period.
The authors speculated that some of the cost increases could stem directly from cancer treatment.
“Treatment regimens used for colorectal cancer may increase cardiotoxicity and therefore increase the coronary artery disease management cost to patients,” said Dr. Chopra. “In addition, nonadherence to coronary artery disease medications during cancer treatment may also contribute to higher coronary artery disease complications and total overall costs.”
“For many years, clinicians have recognized the impact of cancer chemotherapy treatments on the cardiovascular system,” said John Fanikos, MBA, RPh, Executive Director, Pharmacy, Brigham Health, and member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Associated Venous Thromboembolic Disease Panel. “With the explosion in new therapies and treatments for cancer, this relationship has magnified. In the recent publication by Dr. Chopra [and colleagues], the authors show that health-care spending for coronary artery disease–related services in elderly Medicare beneficiaries is higher for those with cancer than those without. It highlights the importance of maintaining collaborative relationships between cardiovascular and oncology practitioners for patients that require prevention, early detection, or optimal management when these two conditions intersect.”
The authors concluded that providers can reduce many costs by preventing inpatient encounters. They suggest that more research is needed to determine how emerging payment reforms and collaborative care models can lower costs while maintaining high-quality care.
Disclosure: The study authors' full disclosures can be found at jnccn.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.