A patient recently asked me if I had heard about the new “wonder drugs” used to treat skin cancer. Indeed, I had. In a widely reported story in early June, two novel cancer drugs were found to benefit patients with advanced melanoma, a devastating form of skin cancer. These cases typically have a dismal outcome, with patients surviving only six months to 10 months after diagnosis.
Curious, I then asked my patient about another cancer story reported the same day. It focused on a National Cancer Institute study, which questioned the benefits of ovarian cancer screening. The institute found that a yearly blood test and ultrasound did not improve the survival or the rates of early detection in women with ovarian cancer.
She hadn’t heard about it. I wasn’t surprised. Of the two cancer stories, the one trumpeting the melanoma drugs received much more attention, with six times as many headlines according to Google News. One headline went so far as to tout: “New drug treatment for skin cancer ‘as big a breakthrough as chemotherapy.’”
But whether the hype was warranted remains in question. With costs of cancer care expected to rise from $104 billion annually in 2006 to over $173 billion in 2020, it is not unreasonable to ask what patients are getting in return.
The first of the two melanoma drugs, named ipilimumab, lengthened survival from about nine months in patients undergoing standard treatment to 11 months in patients who also received the medication. A single course costs $120,000. Treatment with the second, vemurafenib, is predicted to cost tens of thousands of dollars annually. Yet only 1 in 4 patients responded to the drug, and the potential benefit was again measured in months.
In the face of unsustainable health care costs, our society needs to ask the hard question of whether we can afford such drugs with marginal benefits.
The disproportionate media attention given to new drugs doesn’t help. Such coverage can sway patients toward expensive treatment — especially cancer sufferers who see new drugs as new hope — while making it challenging for doctors who want to practice cost-effective medicine.
News influences patients
A 2009 study in the journal Cancer found that patients who heard about newer treatments for colon cancer, from the media or through the Internet, were more than three times as likely to receive them. And in a May 2011 New England Journal of Medicine column, health economists Victor Fuchs and Arnold Milstein noted that “misleading headlines, designed to attract larger audiences, can make life difficult for physicians… (who) are beset by patients’ requests or demands for costly new therapies.”
No doubt, my patient who had heard about only the skin cancer drugs was one of many. After I told her the results from the less-publicized study on ovarian cancer screening, she was surprised that early tests weren’t always beneficial. I explained that more frequent tests are not the answer, and could be harmful. There were more than 3,000 “false positives” in the 34,000 women who were screened in the study. In some of these cases, women underwent surgery to remove their ovaries, when no cancer was present. This led to serious side effects in some, including infection and heart-related complications.
I understand that any advance in cancer treatment is noteworthy. But it cannot overshadow less glamorous studies. A disproportionate focus on cutting-edge medicine will only perpetuate the demand for expensive treatments of uncertain benefit, and continue to fuel soaring health costs.