Cancer doctors may see cost as 'side effect'

WASHINGTON - You've just been diagnosed with cancer, and the doctor is discussing treatment options. Should the cost be a deciding factor?

Chemotherapy costs are rising so dramatically that later this year, oncologists will get their first guidelines on how to have a straight talk with patients about the affordability of treatment choices, a topic too often sidestepped.

It's a particular issue for patients whose cancer can't be cured but who are seeking both the longest possible survival and the best quality of life - and may be acutely aware that gaining precious months could mean bankrupting their families.

The prices can be staggering. Consider: There are two equally effective options to battle metastatic colon cancer, the kind spreading through the body - but one costs $60,000 more than the other, says Dr. Leonard Saltz of Memorial Sloan-Kettering Cancer Center.

What's the difference? The cheaper one, irinotecan, causes hair loss that makes it impossible for people trying to keep a job to hide their cancer treatment, he explains. The pricier oxaliplatin can cause nerve damage in hands and feet that might make it a worse option for, say, a musician or computer worker.

Saltz offers a tougher example: A drug for pancreatic cancer - an especially deadly cancer with few treatment options - can cost $4,000 a month. Yet while Tarceva has offered some people remarkable help, research suggests that extra survival on average is a few weeks.

'Is it a good investment a high-risk investment, or buying a lottery ticket?' is how Saltz puts these choices.

'As long as a therapy provides a benefit, it will tend to be offered to patients. Whether it's a small benefit or a moderate benefit, it may be offered with the same level of enthusiasm,' says Dr. Neal J. Meropol of Philadelphia's Fox Chase Cancer Center, who is leading the panel writing ASCO's new guideline on how to weigh treatment costs.

The idea: treat cost essentially as another side effect to weigh in choosing a therapy. Meropol has watched patients do those calculations on their own, like the colon cancer patient who asked to switch from oral chemo to cheaper but more laborious intravenous chemo, or the woman who refused a pricey anti-nausea drug that would make her chemo more bearable.

Even the well-insured are feeling the bite as patients are having to shoulder a higher portion of the bill.

When Medicare began its Part D prescription coverage, retiree Helen Geiger of Whiting, N.J., paid for a premium plan and put it to good use when she was diagnosed with multiple myeloma, a blood cancer. She said the plan listed the cost of her dose of Thalomid at $5,500 a month but her copay was $60 a month.

In renewing the prescription plan last year, the 71-year-old Geiger didn't notice that Thalomid coverage had been changed. It now was classified a specialty drug, costing a $1,051 monthly copay that she couldn't afford. She went several months without the anti-cancer pills, as her doctors at Philadelphia's Fox Chase Cancer Center and her family appealed to the insurer and then scoured charities in hopes of finding her a free or cheaper drug.

'You don't need this kind of stress when you're sick,' says Geiger, who finally stumbled onto a prescription assistance program that provided her free medicine.