The Complex Calculations of Cancer Care

Further, critics argue, the latest technology is often barely better than less expensive alternatives.
A report from the Agency for Healthcare Research and Quality published in the Journal of the National Cancer Institute in March found no evidence that proton therapy provides better outcomes or that the treatment has fewer side effects than traditional photon radiation.

Andrew Pecora, MD, chairman and executive administrative director of the John Theurer Cancer Center at Hackensack (NJ) University Medical Center, says it should not be taboo to question a treatment that is no better or only marginally better than others but costs much more. The trick, he says, is defining what is marginally better. As an example, he cites the prostate cancer drug Provenge, recently approved by the FDA, which will cost roughly $90,000 to $100,000 and extend median survival by four months. “So, people say, ‘Is it worth spending $100,000 to make you live four months longer?’ I guess it depends on who you’re asking,’” Pecora says.

The impact of patient demand
Thanks to ever more powerful diagnostic equipment, physicians and radiologists can now detect the tiniest lesion, lump, or tumor in the human body. But, critics argue, the mere presence of a tiny spot doesn’t mean it should be biopsied. And even if it is tested and does turn out to be cancerous, that doesn’t mean it needs to be treated right away.

Try telling that to patients.

Rajiv Datta, MD, won’t biopsy a thyroid lesion smaller than 10 millimeters. The medical director of Oceanside, NY-based South Nassau Communities Hospital’s cancer center explains to these patients the benefit of watchful waiting for small lesions and that the course of treatment won’t change regardless of whether the biopsy shows it to be benign or malignant. He asks them to come back in three months. Sometimes the patient instead seeks treatment elsewhere.