Expect More From... Cancer Care!

Now is a critical time to be your own healthcare advocate, especially when it comes to cancer care. Excitement is at fever pitch with 100+ new cancer therapies coming to market in the next five years. Emotions run high as patients receive their diagnosis and it can be challenging to know the right questions to ask during these challenging moments. Employer sponsored health plans are in a unique position that if designed and implemented with true vendor partners, can setup a system designed to help patients be their own advocate by providing access to high quality providers acting in the patient’s best interest while balancing costs and other social determinants.

We read countless articles from clinical trials to an array of foreign and domestic guidelines, but nothing hits home more than the stories told directly by the patients themselves. For example, Jill Feldman advocates on behalf of herself and other cancer patients when she says, “No one should have to endure avoidable harmful effects of treatment.” Jill, like many others, has had enough of receiving “maximum tolerable doses” of chemotherapy. 

We shine a light on cancer care this week by highlighting the importance of receiving the right individualized care including the dose and duration of treatment. Novel therapies are being developed using an outdated strategy that many refer to as a battering ram used to assault the body. Today’s approach is different, highly specific to a target and often leverages the body’s own defense or editing systems. As Dr. Lillian Liu at Princess Margaret Cancer Center in Toronto states plainly, “If you can get the same bang for your buck, why go higher?”  It is time to EXPECT MORE from cancer care. We combine a view of the drug pipeline and tools already available to ensure cancer patients and their families are provided access to lifesaving therapies compassionately.

Setting the stage with the numbers you need to know as a plan sponsor or one that advises employer sponsored health plans, IQVIA's 2024-2028 outlook calls attention to oncology as:

• The “largest therapy area by spending (Exhibit 37), increased 21% over the past five years by volume, an average of 3.9% per year, outpacing population growth and indicative of rowing rates and durations of cancer treatment.”

• “New launches in the next five years are expected to include 100 new cancer drugs globally, with most of those available in the U.S. at launch.”

• “Other clusters of innovative drugs cover as many as 50 next-generation biotherapeutics, which include cell and gene therapies and RNA therapeutics, and which partly overlap with oncology treatments.”

• “Oncology is expected to grow 14–17% CAGR through to 2028 as novel treatments continue to be launched for the treatment of cancer.”

With the 2022 annual oncology launch price averaging $283,000, we have to take a step back to face the practical issues confronting us. How are patients going to have access to these therapies? How are patients going to respond in their quality of life and lifespan to these therapies? How are patients and employers going to pay for these therapies? Let’s turn back to Jill and other cancer advocates to help answer some of these questions.

Let’s start with eliminating the “maximum tolerated dose” from practice.  According to the National Cancer Institute, Maximum Tolerated Dose (MTD) is defined as “the highest dose of a drug or treatment that does not cause unacceptable side effects. The maximum tolerated dose is determined in clinical trials by testing increasing doses on different groups of people until the highest dose with acceptable side effects is found." Superior experts like Dr. Julie Gralow, Chief Medical Officer of the American Society of Clinical Oncology, is one of many physicians starting clinical trials across the country looking for ways to lower the dose of cancer therapies while not sacrificing outcomes. Her 500-patient trial is focused on breast cancer that continues to spread. These patients are at particular risk of high doses resulting in significant side effects causing them to take breaks from therapy and allowing their cancer to thrive. Not only does reduced doses minimize toxicity risks for patients, but it helps alleviates the drug shortages which have caused cancer centers to ration certain oncology drugs.

On a macro level, two noteworthy governmental programs are underway. Both have shortcomings, but if used appropriately, offer hope for what is possible when we focus collective efforts on population health management. First, Project Optimus | FDA encourages drug development reform in dose optimization and selection.  Some argue that requiring head-to-head dose comparisons while a drug is in clinical trials could add 6 months to a drug launch date. Voices of reason such as Dr. Timothy Yap, a drug developer at MD Anderson Cancer Center in Houston, reminds us that it is more important to identify the dose right from the start then to risk losing patients who could have benefited from therapy if they stop taking the medication from toxicity. Enrolling more patients and identifying unique characteristics regarding who and how they respond may take more time, but the research could be invaluable. The goal is to identify genetic marker(s), age, gender, or impact of comorbidities.  While some highlight individual drugs that have undermined Project Optimus. Holding the FDA accountable for their initiative is imperative to moving forward.

Secondly, Cancer Moonshot is ringing the alarm bells for addressing 4 major obstacles to cancer care:

1. Wait times from early detection to the first appointment can be too long, creating a downstream impact for missed healthcare opportunities. For patients living in a rural area or who have a rare cancer needing a specific specialist, appointments have far more complexity in scheduling.

2. The US healthcare system is fragmented without a universal patient chart. Pertinent labs, other drug therapies and comorbidities require information sharing and collaboration. Patients cannot be treated in vacuum to the specialist seeing them at that moment.  Health outcomes can only be optimized, and adverse effects minimized, when we treat patients holistically and communicate with the entire team.

3. Patients need social support. Transportation, access to healthy foods, safe environments to enjoy exercise and greenspace are equally important to our health span and lifespan as the drug itself.

4. Cancer therapy is expensive. Even if patients can leverage manufacturer coupons for drugs, they will likely meet their out-of-pocket maximums year over year. As we mentioned previously, one quarter of patients use all their savings while three-quarters experience financial hardship such as collections, liens, foreclosure, forced to relocate or other financial sacrifices.

Employer sponsored plans are feeling the financial pressure and are actively seeking ways to control healthcare costs to maintain a balanced benefit package. Similar to landing a man on the moon, the details for treating a patient with cancer range from precision through medical breakthroughs to the mundane trials of daily life, but all must be accounted for with equal importance. As plan sponsors and their advisors continuously review their fiduciary plan responsibilities, I challenge us all to take the approach from the patient’s perspective. I think we will find that a well-designed plan addressing the known obstacles with partners working collectively on behalf of our members will not only save money but provide a world class experience.