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A New Cancer Drug Increases Patients' Financial Burdens

A treatment for colon cancer has undergone criticism lately for its prohibitive costs. The drug is up for FDA approval to treat two new cancers, which means more access to state-of-the-art medicine, and also more financial problems for cancer patients.

On a recent afternoon, Sandra Stockhorst and her husband entered a waiting room at the OSU Medical Center. A nurse greeted them like friends, and they joked together easily. Sandra's sunny personality lit up the large waiting area. Husband and wife now sit in a private room waiting for Sandra's chemotherapy appointment time. A smile remains on her face as she talks about her experience so far living with colorectal cancer.

She says one stumbling block came right away. And she laughs to herself as she tells the story. "It was particularly scary because I'd just taken a new job, and when they found out I had to do chemo, they made the decision they didn't want me in that position. So there I was unemployed. So we've had to learn a lot of trust."

Other stumbling blocks have yet to come, like knowing the amount of money she'll need to pay for her continuing treatment. "Even though I've been in treatment, I haven't received explanation of benefits from my insurance company to know what the cost side of it might be yet." When asked if she worries about it anyway, she replies without missing a beat, "Yea, it's a constant worry. But then, I tend to worry about that side of it anyway."

Like Sandra, cancer patients across the country worry about the cost side of it. One drug called Avastin has both relieved and increased some patients' worries. Currently approved for colorectal cancer, it has recently ignited debate while seeking FDA approval to treat lung and breast cancers too. The debate is not about the drug's effectiveness; it's over its cost. The cost for patients who add Avastin to their already expensive chemotherapy regimen is almost 50-thousand dollars a year. The cost of Avastin is not an anomaly among cancer treatments, however. Dr. Steve Miller is Chief Medical Officer of CuraScript. The firm works with insurance companies and government programs to provide medications to patients. Miller says cancer drug prices have risen markedly and at faster rates than drugs that treat other illnesses. "The last several years, while we haven't seen a dramatic increase in the number of patients with cancer, we've seen close to a 30 to 35 percent increase in the cost of cancer drugs, year over year."

An expanded approval for Avastin from the FDA would qualify 200,000 new lung and breast cancer patients to receive it. For those patients, the already steep cost of Avastin would double to nearly 100-thousand dollars per year because the drug dosage for lung and breast cancers is twice the dosage for colorectal cancer. Sandra's oncologist, Dr. Tanios Bekaii-Saab of OSU's James Cancer Hospital, says expensive drugs like Avastin do add time and quality to his patients' lives. Even so, as a physician, his hands are tied when it comes to treatment costs.

He explains, "All we can do is look at the data that is available to us and that suggests that those patients survive much longer. The problem is, of course, the price of those drugs. And that puts physicians in a very difficult position because our mission is to help patients survive longer and live full lives."

But Dr. Saab says it's tough for cancer patients to enjoy full lives. Every day they face money problems, not being able to work, the stress of surviving an illness, and more. In order to relieve some burden on the patient, Dr. Saab says there must be a reduction in the cost of co-payments. The government must find ways to negotiate pricing with drug companies. And companies must study a drug's cost as they study its use so that they can determine both financial and medical effectiveness.

Without these reforms, he fears consequences across the entire healthcare network because, "If one arm of the system get breaks, it's the only system that will get break. So we truly have to work with the government and with the pharmaceutical industry to try to improve the pricing process."

Sandra is new to Avastin and doesn't know what it's going to cost her yet. She tries to guess what she might do if she receives a bill her family cannot afford, chuckling again at first. "It uh, it'd be hard, it'd be a decision I don't think I could make on my own, because I would probably say no I'm not worth that but uh Boy, if it was going to wipe you out financially, it's just one more thing you'd have to think through."

She is somber as finishes her thought, and her husband chimes in to let her know how many more factors, other than money, would weigh into a decision like this. He says, "No matter what the costs are, if that's what's gonna make you better--"

"But there's no guarantee," Sandra interrupts. "True, there's no baselines to go off of." Sandra nods, "There's no guarantee. No promises." She trails off.

The biotechnology company, called Genentech, which developed Avastin expects about a 60 percent increase in profits from 2005 to 2006, largely due to Avastin sales and the drug's possible expanded treatment of lung and breast cancers. The FDA will make the new approval decision late this year.