Guidelines will help doctors talk with patients about affordability

Though a patient gains a few extra months, the family could be left bankrupt.

WASHINGTON (AP) — You’ve just been diagnosed with cancer, and the doctor is discussing treatment options. Should the cost be a deciding factor?

Chemotherapy costs are rising so dramatically that later this year, oncologists will get their first guidelines on how to have a straight talk with patients about the affordability of treatment choices, a topic too often sidestepped.

“These are awkward discussions,” says Dr. Allen Lichter of the American Society of Clinical Oncology, which is writing the guidelines. “At least we can bring this out in the open.”

It’s a particular issue for patients whose cancer can’t be cured but who are seeking both the longest possible survival and the best quality of life — and may be acutely aware that gaining precious months could mean bankrupting their families.

The prices can be staggering. Consider: There are two equally effective options to battle metastatic colon cancer, the kind spreading through the body — but one costs $60,000 more than the other, says Dr. Leonard Saltz of Memorial Sloan-Kettering Cancer Center.

What’s the difference? The cheaper one, irinotecan, causes hair loss that makes it impossible for people trying to keep a job to hide their cancer treatment, he explains. The pricier oxaliplatin can cause nerve damage in hands and feet that might make it a worse option for, say, a musician or computer worker.

Saltz offers a tougher example: A drug for pancreatic cancer — an especially deadly cancer with few treatment options — can cost $4,000 a month. Yet though Tarceva has offered some people remarkable help, research suggests that extra survival on average is a few weeks.

“Is it a good investment, a high-risk investment, or buying a lottery ticket?” is how Saltz puts these choices.

Drug prices are a growing issue for every disease, especially for people who are uninsured. But cancer sticker shock is hitting hard now, as more advanced biotech drugs have made treatment rounds costing $100,000, or even more, no longer a rarity. Also, patients are living longer, good news but meaning they need treatment for longer periods. The cost of cancer care is rising 15 percent a year, Lichter notes.

Make no mistake: Some of these newer drugs have greatly helped some patients — Gleevec, for example, has revolutionized care for a type of leukemia — and the prices reflect manufacturers’ years of research and development investment.

Also, drug companies do donate a certain amount of medication to prescription-assistance programs that provide them for free to patients who otherwise couldn’t pay. Since 2005, nearly 5 million people — cancer patients and people with other diseases — have been matched to such programs through the drug industry’s “Partnership for Prescription Assistance.”