Socioeconomic Status, Quality of Care, Outcomes in Lung, Pancreas and Esophageal Cancer

At ASCO 2011 there were very few studies on cost efficacy, it doesn’t seem to be an issue to researchers funded mainly by pharmaceutical manufacturers. There was however an interesting abstract (6004) which looks at the care provided and outcomes of patients in different socioeconomic groups.

The study was of patients with cancers of the lung, esophagus and pancreas which “account for over 35% of all cancer deaths in the US and a sizable share of cancer costs.”

The researchers from the University of Michigan used the SEER-Medicare data base and examined the effect of socio-economic status on treatment and 2 year survival rates. The authors found:

The lowest SES (socio-economic status) patients were more likely to require urgent or emergent admissions and to be treated at very low volume hospitals and non-teaching hospitals. For all three cancer types, low SES patients were more likely to receive no cancer-directed treatment (e.g., 60% of the lowest SES patients received no treatment for pancreas cancer). Receipt of cancer-directed surgery, chemotherapy, and/or radiation therapy was consistently higher for the highest SES patients, with most patients receiving at one type of treatment and many receiving a combination of treatments.

And concluded:

There is pronounced variation in types of cancer treatment received by different SES groups. Despite receiving more aggressive treatments, higher SES patients do not have improved survival rates.* Reducing variation in treatment strategies may improve healthcare efficiency without changing patient outcomes.

*emphasis by medicynic

Medicynical Note: I’m not sure what more there is to say. We have a primeval, possibly money driven urge, to do all modalities of treatment to patients with bad disease, especially to those with money, insurance or other resources. But we have no impact on the ultimate course of the disease.

This mania is costly. We are using drugs and procedures costing our health care non-system many thousands of dollars a month, uselessly. More careful shepherding of resources and more considered use of treatments would save money (lots) and not impact outcomes adversely.

4 responses to “Socioeconomic Status, Quality of Care, Outcomes in Lung, Pancreas and Esophageal Cancer

  1. I follow your blog regularly, sometimes quoting it on one of my two daily cancer related sites. But it is easy to say we spend too much money and studies are funded by drug companies and treatments aren’t cost efficient–all true. I was at ASCO. I understand what you mean. But what can be done about it? As a cancer patient, are you going to make that choice for me? Who decides what is too expensive or when to deny treatment? Like with Medicare, political realities trump all else. Help answer how we change the system and you will really be making a difference!

  2. I feel the key here is educating the patient. After a diagnosis of an aggressive stage 2 breast cancer I did my homework. At that point Herceptin was being heralded as a panacea for early stage Her2+ disease at $50,000 a year of treatment. The relative benefit published along with the studies in the Sept. 05 NEJM was 54%. We mere mortals, however, think in absolutes and the absolute benefit is about 6% according to Dr. Ralph Moss’ paper “Herceptin or Deceptin”. Needless to say I declined the treatment as the heart toxicity issues were also absolutely 6%. As far as i was concerned it was a wash given the congestive heart issues in my family.. Too many patients are given relative benefits, when what they really need to make an “informed” decision are the absolute benefits. Until the medical professionals are willing to educate the patient in relative vs. absolute too many will receive little or no benefit from these expensive drugs. The “absolute” benefit is to the pharmaceutical companies not to us. I doubt that will ever happen as I don’t believe the oncologist who pushed Herceptin realized she was giving me the relative benefit. I think oncologists think in absolutes, just as we do, and may not know that, too often, the benefit of the drug is given in relative terms.

  3. To improve viability to our national health care system, equality in treatment between all SES groups must occur. While people in the lower SES groups are more numerous and require greater interventions (greatly due to less access to health care as a whole), the better off SES groups tend to expect the “best care” and the most extensive treatment plans, often regardless as to whether those expectations improve the patient prognosis.

  4. The intention being to reduce or at least manage total costs!

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