By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    medicare part d benefits
    Everything that You Need to Know About Medicare Part D
    August 15, 2022
    Best Ways to Boost Your Immune System this Winter
    Best Ways to Boost Your Immune System this Winter
    November 15, 2022
    back pain issues
    Ways to Treat Constant Back Pain
    August 21, 2023
    Latest News
    How Probate Planning Shapes the Future of Your Estate and Family Care
    July 17, 2025
    Beyond Nutrition: Everyday Foods That Support Whole-Body Health
    June 15, 2025
    The Wide-Ranging Benefits of Magnesium Supplements
    June 11, 2025
    The Best Home Remedies for Migraines
    June 5, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    More On Wellness Programs To Improve Health and Reduce Costs
    January 25, 2012
    Privatizing Social Security and Medicare: Who Can Defuse Political Dynamite?
    June 12, 2011
    Study: Risk of Death in Elderly Patients with Dementia Doubled with Some Antipsychotic Medications
    February 26, 2012
    Latest News
    How IT and Marketing Teams Can Collaborate to Protect Patient Trust
    July 17, 2025
    How Health Choices and Legal Actions Intersect After an Injury
    July 17, 2025
    How communities and healthcare providers can address slip and fall injuries with legal awareness
    July 17, 2025
    Let Your Lawyer Handle the Work Before You Pay Medical Costs
    July 6, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: What is the Value of Hope in Cancer Care?
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Policy & Law > Public Health > What is the Value of Hope in Cancer Care?
Public Health

What is the Value of Hope in Cancer Care?

psalber
psalber
Share
8 Min Read
SHARE

 

We have all heard about cancer treatments that cost $100,000 or more, but only yield an average survival of a couple of months.  Is it worth it, you may have wondered, especially when there are so many other healthcare treatments that produce longer survivals and, perhaps, better quality of life?

 

We have all heard about cancer treatments that cost $100,000 or more, but only yield an average survival of a couple of months.  Is it worth it, you may have wondered, especially when there are so many other healthcare treatments that produce longer survivals and, perhaps, better quality of life?

More Read

Maslow
Improving Clinical Outcomes by Addressing Social and Basic Needs
Alzheimer’s Report Addresses Action Steps for National Alzheimer’s Plan
Will the Next President Bring Multi-Payer Healthcare to the U.S.?
The “Deep State” in American Health Care
The Passing of Steve Jobs – Pancreatic Cancer

The answer, of course, depends on who you are.  If you are the young, healthy Chief Medical Officer of a Health Plan, responsible for making decisions about how precious resources are spent, you may not value a very expensive cancer treatment with a short median survival time as highly as a less expensive treatment for another disease that has more impressive survival statistics.  However, if you are a young mother with metastatic breast cancer, it is likely that the value calculation is quite different.

If you now factor in the difference between the average survival and the spread of survival related to any given treatment, the calculation changes yet again.  As a patient with an advanced cancer, you may not want to spend $100,000 on a treatment if you knew for sure that your survival was only going to be three months, but what if there was a 15% chance that the same treatment could give you an additional twenty months of life?

In an effort to shed light on this issue, Darius Lakdawalla (Director of Research at the Leonard D. Schaeffer Center for Health Policy and Economics, USC) and colleagues designed an interesting study that was published in the April 2012 issue of Health Affairs.  The empirical question was “Do patients near the end of life like or dislike therapies with greater spread in survival outcomes?”  In other words, “would patients value the ‘hope’ of a large survival gain, independent of a therapy’s average gain.”

Darius Lakdawalla, Dir. Research, USC

To answer the question, the researchers presented different scenarios to cancer patients and asked them to choose which treatment they preferred and how much they would be willing to pay for it.  There were two scenarios, one that described options for treatment of metastatic breast cancer and the other treatment for advanced melanoma.  The treatments presented to the patients were “real-world” therapies based on the published clinical trials.

The metastatic breast cancer treatment “hopeful” scenario was based on a recent clinical trial in which combination therapy, ixabepilone (Ixempra) plus capecitabine (Xeloda), produced a median survival of 12.9 months, but a one in ten chance of living past forty-eight months.  It was compared to a hypothetical treatment that they were told would produce, with 100% certainty, an eighteen month survival – a “sure bet.”

The advanced melanoma scenario compared a hopeful treatment, ipilimumab (Yervoy), that resulted in one out of five patients being alive after forty-four months with the sure bet treatment that they were told would give them exactly  twenty-four more months of survival.

The scenarios were embedded in a survey instruments that also presented different values for payment of the treatments in a “payment card” format.  The surveys were administered by research staff face-to-face with 150 cancer patients who were currently undergoing treatment or “watchful waiting.”  Forty-seven breast cancer patients, twenty of whom were considered “late stage,” were given the breast cancer treatment options survey and twenty patients with advanced melanoma were asked to respond to the melanoma survey instrument.  A third groups of patients with other types of solid cancers were randomized into the two survey arms to balance the groups.

And the results showed…

Overall, seventy-seven percent of the patients preferred the hopeful scenario over the sure bet even though the two treatments provided the same average survival.  The breast cancer group was about 12% more likely than the metastatic melanoma patients to choose the gamble, however the authors note that this could have been related to over representation of “other” cancers in the melanoma group.

Patients were also willing to pay quite a bit for hopeful treatments, the average being $54,362 (95% confidence interval:  $33,501-$75,673).  One quarter of breast cancer patients were willing to pay at least $90,000 and melanoma patients at least $45,000 to gamble on the possibility of a longer survival.  When willingness to pay was examined by income quartiles, however, there was a ten-fold difference in willingness to pay for the hopeful scenario between the lowest and the highest income quartile.  Income, however, was not related to the probability of preferring the hopeful gamble.

The authors acknowledge the limitations of the study, particularly the fact that the patients were not making real life decisions, rather only “paper” decisions.   They do, however, correctly suggest that attempts to value health technology assessments need to include more than just the median gain in survival or quality adjusted survival if we are going to end up with value-based benefit designs that are truly patient-centered.

But, here in lies the rub.  Even if we had a fool-proof methodology to build the value of hope into our insurance designs, how will we balance the desires of the individual cancer patient with the desires of everyone else who pays into the insurance pool?  Can we really afford to offer every cancer patient who wants it the option of a very expensive hopeful treatment, especially given the fact that  folks who can’t afford to pay much out of pocket prefer that type of treatment as strongly as those who could pay.

Given that we have already learned to live with a tiered medical system where the wealthy access more and often better care than the poor, perhaps this isn’t a question we have the national will to address.  If that is the case, the value of hope may be restricted to those willing and able to pay for it.

TAGGED:cancercancer treatment
Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
How IT and Marketing Teams Can Collaborate to Protect Patient Trust
Global Healthcare Policy & Law
July 17, 2025
paramedics in surgical gloves and masks
How Health Choices and Legal Actions Intersect After an Injury
Health care
July 16, 2025
a woman giving a key
How Probate Planning Shapes the Future of Your Estate and Family Care
Health
July 16, 2025
a woman with kinesio tapes on her back arm
How communities and healthcare providers can address slip and fall injuries with legal awareness
Health care
July 16, 2025

You Might also Like

healthcare reform FFS
Health ReformPolicy & LawPublic Health

Bill Frist Wants to Ban FFS

March 28, 2013
digital tools
eHealthFinancePublic HealthTechnology

PCORI Challenge Awards $125K to 8 Digital Tools That Connect Patients & Researchers

June 5, 2013

Consumers Putting Off Medical Care & Risking Health

December 1, 2011
FitnessHealth carePublic Health

Learn About Anxious Eating And How To Stop It In 5 Steps

April 28, 2020
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?