Cost of Care: A Multidisciplinary Responsibility

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I read the interview with Dr. Ezekiel Emanuel (The ASCO Post, December 15, 2011) with much interest, as the health-care policy problems that America is currently experiencing have plagued other countries for some time. Despite proactive measures and attempts to amend those situations elsewhere, little improvement has yet been achieved.

One of the reasons these problems remain such a challenge is that although we treat a patient with cancer using a multidisciplinary team approach, the main focus in health policy is currently on the cost of chemotherapeutic agents. We tend to forget that the disease is managed by a large number of disciplines and not just by medical oncologists in a solitary therapeutic approach.

Drugs Only Part of the Problem

There is no doubt that the cost of drugs is one of the greatest hurdles in health care that every country and every patient with cancer must confront. In this global recession, it has become a major issue that in some instances precludes us from delivering optimal therapy to our patients.

Dr. Emanuel correctly stated that “we have to get to a point where we’re delivering care efficiently and we’re delivering the best care at the lowest price.” I couldn’t agree more with that statement. Further, in my opinion, the cost of drugs in oncology is only a fraction of the general costs incurred in treating patients.

From surgeries and long stays in hospitals, to numerous consultations and expensive, repetitive tests (biochemistry, pathology, radiology, etc) culminating in multiple therapies (radiotherapy, chemotherapy, supportive care, etc), the bill grows day by day. The cost of chemotherapy represents only a portion of all the money involved.

Nevertheless, it has become popular in many countries, and in many circles, to implicate medical oncologists for prescribing costly and sometimes ineffective therapies. But radiotherapy is also an expensive treatment, and sometimes more fractions are administered when fewer will give the same benefit, as was touched on briefly by Dr. Emanuel. Indeed, all other disciplines involved in the diagnosis and treatment of cancer patients also have a major impact on those elevated costs.

More Than One Front

3.3.02_quote.jpgAs a medical oncologist in South Africa who has been in private practice for many years, I am astonished to sometimes see patients come to us with exhausted insurance coverage and lack of any other funds, even before any therapy is begun for their newly diagnosed cancer.

We need to start somewhere, and therefore, efforts to reduce the price of therapeutic agents are extremely important, but that is not enough. We need to work on more than one front to bring down costs all along the process, from the beginning of the first diagnostic procedures.

Responsibilities should be distributed among all those involved in the diagnosis and treatment of cancer patients. Medical oncologists should not be considered the exclusive gatekeepers of cancer costs; that accountability should be shared by the entire multidisciplinary team. ■

Disclosure: Dr. Vorobiof reported no potential conflicts of interest.

Dr. Vorobiof is Director of the Sandton Oncology Centre in Johannesburg, South Africa, and a member of The ASCO Post’s International Editorial Board.

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