A study published online in Medical Care shows that during a recent 10-year period, the rate of metastatic colorectal cancer patients older than 75 years of age receiving three or more treatments increased from 2% to 53% in the U.S. During this period, the cost for one year of treatment increased 32% to an estimated $2.2 billion annually. However, median survival for these patients increased by only one month.
“In addition, these newer therapies carry more toxicities than many of the older therapies. These patients may get sicker, and it costs them a lot of money with almost no survival benefit,” said lead author Cathy J. Bradley, PhD, a professor at the Colorado School of Public Health.
The data included results from more than 20,000 Medicare patients with metastatic colon or rectal cancer between the years 2000 and 2009. The study examined the percentage of these patients treated with chemotherapy or a targeted agent (bevacizumab). These drugs have shown a survival benefit in younger patients and in those with earlier-stage disease. For example, the current study showed a gain in overall survival of approximately eight months in patients 65 to 74 years of age. However, this same benefit was not evident in patients older than 75 whose cancer had metastasized.
“Doctors and patients come to a point where none of the standard therapies has worked, and so they’re willing to take a risk because there are no other treatment options available. They decide to give newly approved therapies a try despite there being no solid evidence for their use in these older low-life-expectancy patients,” Bradley said.
In addition to demonstrating an overall cost increase of 32% in colon cancer and 20% in rectal cancer, the authors found that much of this additional cost is borne by the patients. Specifically, patients paid approximately $16,000 in out-of-pocket costs for care in 2009 compared with $11,000 in 2000. Patients not treated with chemotherapy paid, on average, less than $5,000 in the 12 months after a diagnosis. For example, treatment with oxaliplatin cost $11,593 during the study, whereas treatment with the commonly used combination of 5-fluorouracil and leucovorin cost only $1,028. In addition to the direct costs of these chemotherapies, they require supportive medications to assist patients in coping with adverse effects and also incur additional hospital inpatient and outpatient charges, the authors noted.
“No one wants to give up. It’s hard for anyone to say they’ve had enough,” Bradley said. “However, in these situations palliative care may be a good option.”
The authors concluded: “Taken together, multiagent regimens may not be of high value in terms of costs and survival for older mCRC [metastatic colorectal cancer] patients.”