Personalized Treatments Could Increase Value of Cancer Care

There are a lot of ideas about ways to increase the value of cancer care, but personalized treatments may be the most significant and immediate.

Individualized medication doses, particularly for oral chemotherapy, is one area already being explored, but oncology thought leaders say there may be room for increased values in other treatment modalities, as well. Radiology, for example, has the potential to yield substantial savings by personalizing treatments, according to Daniel A. Goldstein, MD, of a medical oncologist at Rabin Medical Center in Israel and lecturer at Tel Aviv University.

"In the era of personalized treatment, one thing research could lead to is the ability to also give personalized treatment frequency," Goldstein says. "We may be able to check the level of drugs in a patient's blood stream and tell then when to get their next treatment."

Goldstein co-authored a study in early 2019 detailing the potential of hypofractionated radiation. The study focused on localized prostate cancer, for which intensified radiotherapy has been the standard radiation therapy. However, the report notes that several studies have now demonstrated similar results and patient outcomes with moderate hyfractionation. Researchers in this particular study analyzed the cost of external beam radiotherapy (EBRT) for localized prostate cancer, comparing the cost of intense versus moderate hypofractionation. The team found that the cost of standard fractionation was 45 or 39 fractions at a cost of $26,782 and $23,625 per patient, respectively, while the cost of moderate fractionation was 28 or 20 fractions at a cost of $17,793 and $13,402 per patient. The researcher team estimated that this change-which would not compromise survival or tolerability of treatments-could lower the cost of radiation treatments for localized prostate cancer alone by 25% to 50% annually, translating to somewhere between $150 million and $360 million in yearly savings.

Goldstein says he and his colleagues are currently trying to enlist payers who would like to participate in additional trials of programs that used personalized radiation therapy in other types of cancer, as well. 

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"It could possibly be used for prostate cancer, breast cancer, and more," Goldstein says. "It's proven that if 40 treatments were standard-but only 20 of a high-dose fractionated therapy-it's more convenient for patients and payers can save a significant amount."

Goldstein says this is just the tip of the iceberg, though, when it comes to finding ways to increase the value of cancer care. In a report published in The Oncologist, also co-authored by Goldstein, researchers discussed the increasing scrutiny of cancer care costs, as well as the many ideas generated to contain costs while improving outcomes. Payer perspectives were addressed in the report, including a suggestion that new regulation is needed to allow public and private payers the right to refuse coverage for expensive therapies that provide only minimal improvement in patient outcomes. A suggestion was also made to cap profits for drug administrations at 18%-a margin authors note is currently the average sales price plus 28% for community physicians to an additional 152% for cancer clinics owned by hospitals at one payer organization. The paper compared several payment models from around the world, as well as the need for clinicians to improve communication with patients about cost. Both financial and physical costs should be a bigger consideration in clinicians' discussions with patients, the paper suggests, adding that earlier referrals to palliative care have been shown to improve both and costs and quality of care. A part of these discussions also should include end-of-life care and timely hospice admissions for patient who have not responded to therapy verses hospitalizations and intensive-care-unit stays or additional invasive treatments that don't benefit patients and only drive costs higher.

While many of these suggestions will take significant changes in the current environment of cancer care, the report also highlights some of the progress that has already been made. This includes advances in precision, early cancer detection, the development of cancer care pathways and new value-based reimbursement models, and efforts to bring down drug prices at the regulatory level. Continued research and trials on personalized drug and radiation regimens in just another piece of the equation, Goldstein says.

Rachael Zimlich, RN, is a writer in Columbia Station, Ohio.