Frank Discussions About Oral Cancer Therapies

June 8, 2015
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asco_200

ASCO 2015

Oral cancer therapies seem poised to revolutionize cancer care for many cancer types. More convenient, more effective, and often less toxic.

asco_200

ASCO 2015

Oral cancer therapies seem poised to revolutionize cancer care for many cancer types. More convenient, more effective, and often less toxic.

But…they are quite expensive—in many cases, more than $100,000 a year per patient. And some experts have been discussing combining two drugs. Think of it, that’s more than $200,000 per year.

We must talk more about cost and not just echo the mantra of researchers who are “excited” about trial results. They are the first to admit they are not health economists.

Surely, it is unbelievably good when people who were near death see their tumors melt away. And credit goes to the researchers, companies and patients who moved trials forward. But as new oral therapies are approved, we have to use these precious medicines wisely and precisely. They are super valuable, laser-guided approaches that not everyone needs or not necessarily throughout their journey fighting a cancer. We have to figure that out.

pills-200Another frank discussion we need to have is more about side effects. Traditionally, in cancer care the goal has often been to kill as many cancer cells right now at all costs. So when you visit a cancer clinic or hospital, you often see platoons of very sick people, not just sick from the cancer but sick from the treatments. I have lived it myself.

Fortunately, this is changing with several new supportive care medicines and great oncology social workers and health psychologists, too. BUT even with the new oral therapies there are side effects. It could be fatigue, out-of-whack blood counts, risk for second cancers, heart and lung problems, skin problems, and, often, gastro-intestinal problems.  We have to be more up front about this.

In my own case, a new and very expensive medicine is doing a terrific job controlling the symptoms of myelofibrosis. But my platelets are low (and stable). So I bruise more easily. I can live with that. However, the other day I visited with a friend with chronic myelogenous leukemia, CML, and she spoke frankly about imatinib (Gleevec). She has been on it more than 10 years and wants to get off. Why? Increasing expense and unpredictable, for her, diarrhea and skin problems. She will ask her doctor if she can be part of a cessation trial.

“Cessation” is something we will speak about much more going forward. As great new medicines come out and are used, expensively in combination, can they knock back the cancer so well—and invigorate our immune system—so we can look forward to stopping taking medicine just like we do with an antibiotic? Can we look forward to that to limit side effects and to limit untenable cost?

The ASCO, American Society of Clinical Oncology, meeting breaks up this week in Chicago. News about “exciting” clinical research flows from it like a wave. But it’s important to step back and to look at the big picture. Yes, saving lives, and lengthening lives is job #1. But HOW we do it to preserve quality of life and to make it affordable must be part of the discussion. Otherwise, new breakthrough new medicines will be like the Rolls Royce Silver Cloud I always wanted but could never have.

I welcome your comments. Wishing you and your family the best of health!