US researchers have identified drug pricing as one area of high costs of cancer care, and say that they can be reduced without harming patients.

End-of-life care and medical imaging are two other areas where costs can safely be reduced, say Johns Hopkins experts Prof Thomas Smith and Dr Ronan Kelly, in a review article published in The Lancet Oncology. 

Rising numbers of new cancer cases among an aging population are inflating total US cancer costs, which are projected to increase by nearly 40% in 2020, and changing practice patterns should be a priority among oncologists to achieve affordable costs, they say.

And the biggest opportunities for safe and ethical cost-cutting solutions rest in caring for patients with metastatic cancer, not on new surgical or radiation treatments, clinical trials, curative care or paediatric care, they add.

For example, improving end-of-life care with better decision-making and planning could reap large cost savings by reducing hospitalisations in the last month of life.  Most people prefer to spend their last days at home, but US Medicare data show that 60% of poor-progress cancer patients are admitted to a hospital in the last month of life, and 30% die there.

Also, studies show that hospice care improves symptoms, helps caregivers and costs less with equal or better survival for patients, but only half of cancer patients use hospices in their last month of life. The researchers call for patients with poor prognoses to have better and earlier discussions with their oncologists about chemotherapy use at the end of life, as well as transitions to hospice care.

Unneeded and expensive imaging poses another opportunity to limit costs of care, they add. PET and other scans, for example, are often used to detect cancer recurrence in patients after initial treatments, but studies show that cure rates are just as good when recurrences are found through other examinations.

Finally, the authors suggest that reducing the prices of new cancer drugs can help contain cancer costs.

“There are drugs that cost tens of thousands of dollars with an unbalanced relationship between cost and benefit. We need to determine appropriate prices for drugs and inform patients about their costs of care,” says Prof Smith.

One approach suggested by the authors is to price drugs according to how well they prolong life.

“We need to include patients, pharmaceutical companies and legislators in our efforts to contain cancer care costs, so that we can afford to provide innovative, quality care to future generations,” adds Prof Smith.