Paperwork, High Costs Could Mean Worse Survival for Lung Cancer Patients
Drugs called tyrosine kinase inhibitors can help certain patients with advanced lung cancer live longer and better. But high out-of-pocket costs might stand in the way, a preliminary study suggests.
Researchers found that of 106 patients who started tyrosine kinase inhibitors (TKIs) for advanced lung cancer, one-quarter with the highest out-of-pocket costs died sooner: They were more than twice as likely to have died three months after beginning treatment, than patients with the lowest personal costs.
The findings do not prove that drug costs, per se, hastened people's deaths, according to the study's lead researcher.
"These results still need to be confirmed in additional studies," said Dr. Bernardo Goulart, a medical oncologist and outcomes researcher at Fred Hutchinson Cancer Research Center, in Seattle.
If that happens, he said, there would be "scientific grounds" to advocate for changes in coverage policies for the drugs.
Goulart is scheduled to present the findings Friday at a meeting of the American Society of Clinical Oncology, in San Diego. Studies presented at meetings are generally considered preliminary until they are published in a peer-reviewed journal.
TKIs are oral drugs that, broadly, work by blocking specific proteins that help fuel cancer growth. The TKIs for lung cancer include drugs such as afatinib (Gilotrif), crizotinib (Xalkori), erlotinib (Tarceva) and gefitinib (Iressa).
These drugs are an option for lung cancer patients who have mutations in either of two genes, called EGFR and ALK+. It's estimated that about 20% of lung cancer patients carry those mutations, Goulart said.
TKIs are not a cure, but they can extend by a year or more the amount of time patients live without any progression in their cancer, and help them feel better.
"So," said Dr. Neeraj Agarwal, of the University of Utah's Huntsman Cancer Institute in Salt Lake City, "it's not only improved survival, but also improved quality of life."
The problem is TKIs also cost thousands of dollars a month. And patients' personal contributions vary widely, based on their insurance coverage, Agarwal noted.
The new findings, he said, are "pretty remarkable" in demonstrating the possible consequences of those expenses.
"Patients with the highest out-of-pocket costs were less likely to fill their prescriptions and had a shorter duration of treatment," said Agarwal, who was not involved in the study. "The most striking finding was the difference in mortality."
The one-quarter of patients with the highest out-of-pocket costs had a median survival of nine months; that means half of them lived longer than nine months, while half died sooner. In contrast, the median survival among the rest of the study patients was 22 months.
Patients with the biggest personal expenses typically paid out almost $2,900 a month for their TKI prescription, the researchers said.
Such out-of-pocket costs could affect patients' survival in various ways, according to Goulart: They might stop taking their TKI, or they might have a hard time affording their basic needs, for example.
However, out-of-pocket costs for TKIs could also be a "proxy" for other things, Goulart pointed out -- including a heavy economic burden from health care in general.
Agarwal agreed that additional, nationwide studies are still needed to understand how TKI costs to patients may be affecting their outlook.
A separate study presented at the meeting looked at another issue in cancer care: The need to get prior authorization from patients' insurance plans. Researchers with the Seattle Cancer Care Alliance found that in cases where patients needed prior authorization to get an imaging test -- like a CT scan or MRI -- approvals were ultimately given about 95% of the time.
That might sound like good news. But Agarwal said it actually highlights a major problem: Prior authorizations needlessly delay care, stress patients and their families, and burden doctors with paperwork and phone calls.
"Think about all the time doctors could devote to patients instead of paperwork," Agarwal said. "And think about what can be going on in the minds of patients and their families while they wait for an approval."
The TKI study was funded by the U.S. National Institutes of Health. One of the researchers, as well as Agarwal, has received research funds or served as a consultant to drug companies that make TKIs.
The American Cancer Society has more on drug therapy for lung cancer.
SOURCES: Bernardo Goulart, M.D., M.S., medical oncologist, outcomes researcher, Fred Hutchinson Cancer Research Center, Seattle; Neeraj Agarwal, M.D., professor of medicine, University of Utah School of Medicine, Huntsman Cancer Institute, Salt Lake City; Sept. 6-7, 2019 presentations, American Society of Clinical Oncology Quality Care Symposium, San Diego
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