Originally published as JCO Early Release 10.1200/JCO.2009.23.1183 on July 6 2009

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American Society of Clinical Oncology Guidance Statement: The Cost of Cancer Care

From the Department of Medical Oncology, Fox Chase Cancer Center; Leonard Davis Institute of Health Economics and Center for Bioethics, University of Pennsylvania, Philadelphia, PA; Dana-Farber Cancer Institute; Beth Israel Deaconess Medical Center, Boston; Commonwealth Hematology/Oncology, Quincy, MA; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; Oncology Hematology West, PC, Omaha, NE; CancerCare, New York, NY; Center for Behavioral and Decision Sciences in Medicine, University of Michigan; and Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI.

Corresponding author: Lowell Schnipper, MD, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215-5491; e-mail: Ischnipp{at}bidmc.harvard.edu.

Advances in early detection, prevention, and treatment have resulted in consistently falling cancer death rates in the United States. In parallel with these advances have come significant increases in the cost of cancer care. It is well established that the cost of health care (including cancer care) in the United States is growing more rapidly than the overall economy. In part, this is a result of the prices and rapid uptake of new agents and other technologies, including advances in imaging and therapeutic radiology. Conventional understanding suggests that high prices may reflect the costs and risks associated with the development, production, and marketing of new drugs and technologies, many of which are valued highly by physicians, patients, and payers. The increasing cost of cancer care impacts many stakeholders who play a role in a complex health care system. Our patients are the most vulnerable because they often experience uneven insurance coverage, leading to financial strain or even ruin. Other key groups include pharmaceutical manufacturers that pass along research, development, and marketing costs to the consumer; providers of cancer care who dispense increasingly expensive drugs and technologies; and the insurance industry, which ultimately passes costs to consumers. Increasingly, the economic burden of health care in general, and high-quality cancer care in particular, will be less and less affordable for an increasing number of Americans unless steps are taken to curb current trends. The American Society of Clinical Oncology (ASCO) is committed to improving cancer prevention, diagnosis, and treatment and eliminating disparities in cancer care through support of evidence-based and cost-effective practices. To address this goal, ASCO established a Cost of Care Task Force, which has developed this Guidance Statement on the Cost of Cancer Care. This Guidance Statement provides a concise overview of the economic issues facing stakeholders in the cancer community. It also recommends that the following steps be taken to address immediate needs: recognition that patient-physician discussions regarding the cost of care are an important component of high-quality care; the design of educational and support tools for oncology providers to promote effective communication about costs with patients; and the development of resources to help educate patients about the high cost of cancer care to help guide their decision making regarding treatment options. Looking to the future, this Guidance Statement also recommends that ASCO develop policy positions to address the underlying factors contributing to the increased cost of cancer care. Doing so will require a clear understanding of the factors that drive these costs, as well as potential modifications to the current cancer care system to ensure that all Americans have access to high-quality, cost-effective care.

Approved by the Board of Directors on February 23, 2009.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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