In this joint opinion piece, experts from Qatar Foundation’s Hamad Bin Khalifa University talk about the economic sustainability of cancer care, while placing a special focus on breast cancer
Cancer is a leading cause of human death worldwide. It is a major human health challenge, and a debilitating disease with an ever-increasing annual burden. While death and disease management is one aspect of cancer, others include poor quality of life for patients and unnecessary strain on the economy. Thus, there are broader financial implications in addition to direct costs for treatment, care, and rehabilitation. Indirect costs may include loss of business, insurance claims for missed work and salaries, claims due to premature deaths, and housekeeping and childcare related costs.
The exact scale of this economic burden all over the world is not known but it varies from one country to another. In year 2015, in the US, the health care cost for cancer was around USD80.2 billion. Similarly, in 2014, the annual healthcare related cost for cancer in Europe was around USD110 billion. However, it is impossible to accurately estimate cancer associated direct or indirect cost.
Cancer represents around 17 percent of the total disease burden in developed countries, and some of the new and effective therapies for cancer are expensive. At the same time, healthcare budgets are limited, and only around 4 to 6 percent of this budget is spent on cancer – a figure that has been stable for the past few years.
To achieve sustainable cancer care, it is important that inefficiencies are reduced in the whole system in a way that maximizes patient outcome. Fortunately, the risk of cancer and its far reaching financial strains can be greatly mitigated by putting in place a well thought-after national healthcare economic policy that may include promoting healthy lifestyle, early screening, precision medicine approaches to reduce unnecessary chemotherapy related costs, palliative care, and finally investing in general public awareness programs.
Breast cancer is one such example where early detection and treatment has revolutionized the survival outcome. In the US and Australia, 5-year survival rate of breast cancer was more than 90 percent, thanks to readily available early detection techniques.
One option for early detection is genetic testing. A varying fraction of each cancer type is familial, meaning that it is due to predisposing genetic variants that show variable penetrance. For example, 5 to 10 percent of breast cancer patients have a mutation in one of the two BRCA genes, which greatly increases their chances of developing breast cancer and genetic screening for their family members is an effective prevention measure.
Early detection can also be achieved via population-wide screening programs for those at a vulnerable age. For breast cancer, mammography is a sensitive screening method, and those countries that achieve high participation in the screening program tend to have better outcomes. Finally, educating the whole population and especially those general practitioners who are the first line contacts of patients on recognizing symptoms of cancer is also an effective way to early diagnosis and to reduce treatment-related costs.
With an increasing demand for high-quality cancer care and associated financial pressures on our healthcare systems, there is an imperative need for proper allocation of resources for efficient cancer care. To achieve sustainable cancer care, there is need for a multi-stakeholder involvement including patients, clinicians, academic and industry expertise, in addition to policymakers to build trust, ensure smooth adoption of new strategy of efficiencies, leading to practical policy recommendations and their proper implementation.
Once treatment is needed, an important aspect of breast cancer management is the efficiency of treatment. Efficiency may not necessarily mean reduced cost, but instead it must focus on targeted treatments with beneficial patients’ outcome. Short-term policies only focusing on cost-cutting measures and not taking patients’ outcome into account may not be beneficial and may even lead to overspending.
Central to improving treatment efficiency is the transparent reporting of the patient-relevant outcome data. This data must be used to identify areas of potential improvement in the clinical practice. Unfortunately, lack of availability of this data makes it extremely difficult to determine the patients’ outcome from return to normal life and or free from complications point of view since most healthcare systems are not designed to collect the non-clinical data associated with patients’ lifestyle and economic hurdles.
From the treatment perspective, breast cancer is currently divided into three molecular subtypes, which is determined for each breast cancer as part of the diagnosis process. It is important to have this early classification of these subtypes to avoid unnecessary chemotherapy regimen that comes with a financial strain on the healthcare system and severe strain on patients’ lifestyle.
There is need to inspect the entire cancer-care system in an attempt to improve efficiency at different places within the care system. Inefficiencies need to be identified, while there might be a need to create new efficiency to improve patient outcome and to make the best use of available resources. There is need to adopt a philosophy of continuous improvement, while placing patient outcome at the center to achieve the greatest improvements in their care in a sustainable way.
This piece is written by Dr. Borbala Mifsud and Dr. Omar Khan, Assistant Professors at the College of Health and Life Sciences at Hamad Bin Khalifa University (HBKU), along with Dr. Nehad Alajez, Senior Scientist at HBKU's Qatar Biomedical Research Institute.