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Two National Institutes of Health (NIH) practitioners have questioned the wisdom and utility of treating terminally ill cancer patients with expensive treatments that only extend their lives by weeks.
In a commentary published in the Journal of the National Cancer Institute, the pair wrote that the use of extremely expensive treatments that barely extend patients' lives "is a serious ethical dilemma in the US that needs to be addressed by the oncology community."
Specifically, the authors ask, "Is an additional 1.7 months (the additional overall survival for colorectal cancer patients treated with cetuximab) a benefit regardless of costs and side effects?" Cetuximab, which is made by the American pharmaceutical company Merck, is also prescribed for advanced cases of lung cancer.
Millions to keep patients alive
According to study authors Tito Fojo, an oncologist at the National Cancer Institute, and Christine Grady, an NIH bioethicist, an 18-week course of cetuximab for a lung cancer patient would cost
about 80,000 dollars (more than R630 000), and extend the patient's life by an average of 1.2 months.
Using the drug to extend a patient's life by a year could cost 800,000 dollars (R6,3 million), the authors wrote.
It would cost 440 billion dollars (R3,400 billion) annually, a figure 100 times more than the National Cancer Institute's budget, to extend by one year the lives of the 550,000 Americans who die of cancer each year.
Consider cheaper interventions
The authors recommend that studies geared towards treatments that will extend patients' lives by two months or less only consider interventions that will cost 20,000 dollars or less.
"We cannot ignore the cumulative costs of the tests and treatments we recommend and prescribe," the commentary said.
"As the agents of change, professional societies, including their academic and practicing oncologist members, must lead the way. The time to start is now," the authors wrote.
The research comes amid considerable debate over US "baby boomers" - born in the aftermath of World War II and the largest US generation - tens of millions of whom are now reaching retirement and whose end-of-life health care costs will have a substantial impact on the US economy. – (Sapa, June 2009)
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