Is the increased spending on cancer care in the US "worth it"?

This was the question asked by health economy scientists at the University of Chicago, the University of Southern California, Precision Health Economics, and Bristol-Myers Squibb in a recent publication in Health Affairs (April 2012, 31:667-675). Spending on cancer care in the US is almost double the amount that is spent in Europe ($70,000 vs $44,000 per cancer patient). Many have debated if this increased spending is evidence of waste and unnecessary excess of the US health care system or if it equates to improved survival for patients. In this paper, Tomas Philipson and colleagues evaluated the financial cost and gain from increased spending on cancer care. Interestingly, they found that the increased spending in the US averted cancer-related deaths as seen in decreased mortality and led to improved survival rates. According to their calculations, the authors estimate that an increase of $20,000 in cancer spending per patient results in a 1 year increase in survival. This may be due to improvements in technology, more targeted therapy that is incorporated into therapeutic care faster, and/or increased screening procedures. While they cannot dismiss other factors that are not related to care delivery, such as improved diet and increased exercise, the evidence presented suggests that a correlation between spending on cancer care and survival does exist. It cannot be argued that excesses and inefficiencies in the US health care system do still exist, however this analysis suggests that improvements in detection, prevention and treatment - while costly - produce favorable outcomes.

http://content.healthaffairs.org/content/31/4/667.abstract

n3 science communications, llc

A new cancer vaccine

It has been a relatively long standing theory that an effective cancer vaccine can and will be created. Such a vaccine would infect and replicate only in cancer cells and would leave normal cells unscathed. A new publication in the journal Nature (477:99-102 at nature.com) demonstrates that researchers have conducted the first clinical trial demonstrating efficacy of just such a cancer vaccine.

Using vaccinia virus, the virus used to develop the small pox vaccine, Dr. Breitbach and colleagues engineered a virus that can seek out and infect cells that express the protein EGFR, a protein that is commonly elevated in cancers. In fact, the vaccinia virus can only live and replicate in cells with EGFR overexpression. Their data show that this engineered virus can be injected intravenously and can selectively infected cancer cells (but not normal cells). When the virus finds and infects these cancer cells, it can effectively kill them. Importantly, by using this vaccinia virus technique, researchers were able to produce high enough levels of vaccine to eliminate a significant amount of the tumor. This is a big step forward towards the development a new therapy in patients.

n3 science communications