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Fred Hutch and cancer treatment: ‘We don’t want patients who are cured to be financially devastated’

June 26, 2013

By Colleen Steelquist, Fred Hutch Science Editor

I’ve interviewed enough cancer patients to know that it’s not just a diagnosis that rocks their worlds—it’s also the staggering medical bills that come with cancer treatment. And being insured isn’t always enough to stem the worry and financial impact.

So I sat with interest through a recent talk by Dr. Scott Ramsey, director of the new Hutchinson Institute for Cancer Outcomes Research (HICOR) at Fred Hutch. As an internist and health economist, Ramsey is addressing through research the economic problems cancer patients face. HICOR is the only program of its kind in the nation.

“We want to help patients change from asking for everything to asking for the right, evidence-based things,” Ramsey said.

It’s a fact that today’s growing health care costs are unsustainable. The percentage of the United States’ gross domestic product spent on health care is more than twice that of any other country in the world. And it’s only going to get more costly: Cancer incidence is predicted to increase by 75 percent by 2030 in the U.S. due to our aging population and population growth.

Dr. Scott Ramsey, director of the new Hutchinson Institute for Cancer Outcomes Research (HICOR)

Dr. Scott Ramsey, director of the new Hutchinson Institute for Cancer Outcomes Research (HICOR)

Even though there are fewer smoking-related cancer cases, cancer rates are still increasing due to our diets, sedentary lifestyles and obesity rates.

Expenditures for every type of cancer are rising. We are treating cancers more intensively and expensively than ever before. Thankfully, this is leading to long-term survivorship for many, but as cancer shifts to a chronic disease, the need to keep costs down continues.

A recipe for helping patients

Ramsey pointed out that with this crisis comes opportunity to apply scientific research to the problem. There’s unprecedented interest in comparative effectiveness research: studies designed to inform health care decisions by providing evidence on the usefulness, benefits and harms of different treatment options.

The evidence is generated from research studies—some of which Fred Hutch will lead—that compare drugs, medical devices, tests, surgeries, or ways to deliver health care.

HICOR will look at cancer care access and utilization, patterns of care, early economic evaluations of new technologies, and more. Ramsey and his team are trying to leverage their research expertise to impact cancer care practices, linking research and policies.

We know we have a finite amount of money to spend on health care, especially costly cancer care. Ramsey is on a mission to save costs and improve outcomes for cancer patients, creating a model for the nation through partnerships, data integration, research and the translation and dissemination of their findings.

HICOR plans to work with patients, employers, insurers, and drug and device manufacturers. A collaboration with Premera Blue Cross was just announced.

Helping patients understand their treatment options

Already, Ramsey’s work has been featured as part of the American Board of Internal Medicine Foundation’s Choosing Wisely campaign. In conjunction with the American Society of Clinical Oncology, the campaign issued a “top five” list of common, costly procedures in oncology that are not supported by evidence and that should be questioned.

The campaign highlighted Ramsey’s research into the use of colony stimulating factors—drugs that stimulate white blood cell counts—in patients undergoing chemotherapy.

While there are situations when these $3,000+/dose drugs are essential, growing evidence shows these therapies are misused, overused and cost health systems millions of dollars. Ramsey found the drugs were given to 42 percent of breast cancer patients and 78 percent of lung cancer patients despite no evidence of benefit.

It’s not easy for patients to learn about which procedures or treatments they should question. To that end, Ramsey has talked to Silicon Valley entrepreneurs about creating apps to help patients access this information more easily.1365196725548

HICOR has plans to study low-dose CT screening in patients at high risk of lung cancer. Such screening in appropriate populations could lead to a 20 percent reduction in lung cancer deaths. However, in small initial studies, one in four patients had positive scans, and 90 percent of those were false-positive, so more work remains. HICOR plans to follow use of low-dose CT screening locally, track outcomes and work to improve its cost effectiveness.

It’s critical research at a critical time. Ramsey’s own studies have found that even insured cancer patients often get into financial trouble by seeking treatment. Cancer patients, he discovered, have a three times higher risk of bankruptcy.

“We don’t want patients who are cured to be financially devastated,” he said.

HICOR’s work is part of Fred Hutch’s commitment to helping cancer patients everywhere receive the highest quality care while helping to rein in costs. Together, it will help health care providers and their patients make more informed decisions about treatment.

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