Certain components of the cancer care continuum have the potential to favorably impact the rapidly encroaching crisis in cancer care costs at the societal level.
Maurie Markman, MD
The state of oncology in the United States today is on the verge of chaos. At a time of stunning advances in our understanding of the fundamental mechanisms responsible for the establishment and progression of malignant disease and of the process of inherent or acquired drug resistance, along with the development of increasingly effective molecularly targeted and immune-based therapeutics, a simply unsustainable nancial model threatens to dismantle our poorly coordinated and distressingly fragile cancer care delivery system.
Consider, for example, a recent report suggesting that the total cost associated with the optimal management of chronic lymphocytic leukemia (CLL) in the United States will increase to $5.13 billion by 2025, a 6-fold increase from $0.74 billion in 2011. This forecast estimates the “cost of success” in CLL, with novel agents entering the oncologist’s armamentarium that have the potential to improve both the quality and quantity of life for patients with this relatively common malignancy. But how can individual patients, families, and society continue to afford the staggering costs of novel effective treatments?
The intent of this commentary is not to attempt to answer this critically important yet profoundly complex question, but to focus on a component of the cancer care continuum that has the potential to favorably impact the rapidly encroaching crisis in cancer care costs at the societal level.
Targeting Tobacco Use
Regardless of whether we are talking about a developed or a developing country, it is essential to acknowledge approaches to cancer care that have been documented or strongly suggested to be effective in the prevention of malignant diseases and that do not require expensive technology or drugs. Although the 3 strategies highlighted in this commentary may sound to some like a broken record, a truly sustained focus on low-cost measures that can favorably reduce cancer incidence becomes ever more relevant in light of the relentless escalation in the costs associated with care of a confirmed malignancy.Of course, the No. 1 item on any list of interventions must be a renewed emphasis on effective strategies for tobacco control. Currently, it is estimated that approximately 17% of all adults in the United States smoke cigarettes, and that 1 in 4 high school students use tobacco products. Furthermore, recent data suggest that at least 167,000 deaths in the United States in 2014—or a truly staggering 28.6% of all cancer deaths—were related to cigarette smoking. And, one must add to this figure an unknown number of smoking-related cancers resulting from second-hand smoke exposure.
If the minimum legal age for access to tobacco products were increased from the current threshold of 18 years to 21 years, public health experts estimate that there would be a 25% reduction in the initiation of smoking by adolescents. The impact of this change would translate into an overall 12% reduction in cigarette smoking rates and 45,000 fewer deaths from lung cancer among individuals born between 2000 and 2019. One can only speculate on the added number of deaths and costs associated with the treatment of other smoking-related cancers that would be avoided by implementing this simple regulatory approach.
Strategies to Fight Obesity
Although it must be acknowledged that all efforts to reduce cigarette smoking would be strongly opposed by the powerful tobacco lobby, legislators need to be constantly reminded of both the individual impact of tobacco-associated cancers (and other serious medical conditions) and the enormous financial burden this addiction imposes on families and society.The second area to highlight is the increasingly recognized, rapidly progressing, and extremely worrisome epidemic of obesity (defined as a body mass index >30) in the United States, estimated to include 38% of all adults, and its impact on the development of cancer. The risk of certain malignancies, such as liver, esophageal, gastric, colon, pancreas, endometrial, gall bladder, and postmenopausal breast cancers plus multiple myeloma is considerably greater for obese patients compared with normal weight individuals, and mortality may also be increased.
More Protective Sunscreen
At this point, we can only speculate on the overall impact that a sustained societal effort would have on the trajectory of this distressing trend, but the influence may be substantial. Possible strategies include taxing certain foods and beverages associated with obesity, a focus on developing an overweight individual’s solid understanding of the health-related value of exercise, and public education regarding the negative consequences of certain potentially harmful activities of daily living. Notably, a recent report strongly correlated adolescents’ excessive use (≥5 hours/day) of “screen devices” such as smartphones, tablets, computers, and videogames with a greater intake of sugar-sweetened beverages and obesity.The final strategy to highlight is an effort to favorably impact the distressing increase in the incidence of melanoma, the most deadly form of skin cancer, in the United States. Besides avoiding excessive sun exposure and abandoning artificial indoor tanning devices, the use of high-protection sunscreens may reduce the subsequent risk of this malignancy for women aged 40 to 75 years by as much as 18%, one report recently revealed.
In conclusion, it is critical to acknowledge that society cannot count on the discovery of a “magic bullet” to prevent or cure all cancers, and that novel antineoplastic strategies will not suddenly become inexpensive. As a result, it is essential that, in our constant search to find beneficial strategies for the treatment of patients with malignant disease, we also actively focus efforts on relatively low-cost approaches that realistically and meaningfully can help moderate the ever-escalating costs of the success of cancer research.
Maurie Markman, MD, editor-in-chief, is president of Medicine & Science at Cancer Treatment Centers of America, and clinical professor of medicine, Drexel University College of Medicine. email@example.com.