The recent announcement by Medicare that it will slash reimbursement for cancer drugs has caused dismay among physicians who care for older, more vulnerable patients. While these cuts apply to drugs the agency already covers -- mainly those administered intravenously in a physician's office -- many people do not realize that cancer drugs available exclusively in oral form, as pills or tablets, won't be covered by Medicare at all until 2006.
This delay is detrimental to the survival and health of the roughly 1 million seniors whose cancers will be diagnosed in the interim.
Clinical trials presented this spring at the American Society of Clinical Oncology's annual meeting -- the world's premier cancer conference -- revealed that, for the first time, doctors using new treatments or making better use of old ones were able to extend the survival of patients suffering from the big four cancer killers: lung, colon, breast and prostate.
Significant advances were also reported against types of brain, kidney and prostate tumors that have long been virtually untreatable. Some of these breakthroughs involved drugs that are available only in oral form.
* Colon cancer: The standard treatment for colon cancer is a brutal combination of chemotherapy drugs that must be given intravenously. But a new study found that a chemotherapy taken in tablet form (capecitabine, which the Food and Drug Administration approved in 1998) had significantly fewer side effects -- and was able to reduce the risk of relapse and death by 13 percent over the intravenous regimen.
* Brain cancer: Malignant brain tumors are some of the hardest cancers to treat. Most patients die within a year. A new study found that three times more patients survived two years or longer when taking chemotherapy orally (temozolomide, approved by the FDA in 1999) along with radiation than those receiving radiation alone. Frank Haluska of Massachusetts General Hospital said the study will have "major implications" for treating brain cancer.
* Prevention: Since it's so hard to treat cancer, oncologists are increasingly interested in preventing it in high-risk populations. In one of the more striking prevention trials, the osteoporosis drug Evista (raloxifene hydrochloride, approved by the FDA in 1997) reduced the incidence of breast cancer by 66 percent over eight years in 3,500 postmenopausal women who were taking the drug for its approved use.
None of these drugs is covered by Medicare for cancer treatment.
Analysis of FDA data reveals that 30 percent of cancer drugs approved since 1995 are available only in oral form. Some of these had been fast-tracked by the agency for "accelerated approval," using a review process designed to speed important new drugs to patients with life-threatening illnesses.
In a recent study I prepared under the auspices of the National Bureau of Economic Research, we found that from 1975 to 1995, an increase in the survival rate and life expectancy among American cancer patients directly correlated with an increase in the number of drugs available to treat cancer. The estimated cost of the drugs used to attain each additional year of life was less than $3,000. Internationally, cross-country differences in cancer survival rates are directly related to the availability of new cancer drugs.
Because Medicare policy restricts the set of treatment options available to elderly cancer patients, they are likely to die earlier and suffer more. Moreover, requiring patients to receive medication intravenously undoubtedly increases Medicare expenditures for chemotherapy administration and may increase other Medicare costs, such as for inpatient hospitalization. Not to be overlooked, the use of oral cancer drugs reduces the burden on cancer patients' caregivers and family members, who must ensure regular transportation for their loved ones, who are often ill and frail, to clinics and hospitals for treatment.
Government is known to work slowly. But with science providing opportunities now to help our aging population -- our parents, our friends, ourselves -- patients should not be denied the benefits of these valuable therapies. A year and a half is a long time for sick people to wait.
The writer is a health economist and business professor at Columbia University. His recent National Bureau of Economic Research study, "The Expanding Pharmaceutical Arsenal in the War on Cancer," can be found online at www.nber.org/papers/w10328.