Saturday, January 13, 2007
January's Journal of the National Cancer Institute has an article (and associated editorial) which tries to answer "How Much Does Cancer Suck?" in the most literal of ways. It looks at the (dollar) cost to patients--in time-spent receiving care for their cancers--across several phases of cancer treatment including the of-dubious-significance-from-a-research-standpoint last year of life. Nevertheless it's an attempt to measure, albeit in a clumsy way, the toll of cancer & its treatment on patients. The study looks at claims data (from U.S. based cancer databases) for various medical events (doc visits, chemotherapy treatments, hospitalizations, blood draws, etc. etc.**), estimates patient time-spent on these, then attaches a dollar amount to that time. Needless to say there's a lot of 'estimation' going on, and their results must be interpreted as the grossest of ballpark figures, so to speak. **Curiously, the researches excluded hospice care.
You can read the abstract for dollar estimates. Time-estimates were the most interesting to me. During their last year of life, patients with many cancers spent over a month in the hospital (ovary, lung, gastric) and ~500 hours or more getting medical care in some way (lung, ovary, renal, gastric). This last figure is a low-estimate as they "discounted" time spent in the hospital for methodologic reasons (long story). It of course doesn't include time at home recovering from treatments (or not) feeling sick/debilitated/angry/alone, time spent arguing with insurance companies about how much Zofran they can get, and the all the other ways cancer & its treatments alter a patient's life. And then, of course, there's the cost/time-spent by 'informal' caregivers.
Research like this is frequently used to argue that this is time/money ill-spent. "Look at how much we spend/waste on people in the last year of life!" etc. That's a debate I've weighed in on before in the blog (can't find the posts--we're approaching 300 of them!) and not one I feel like opining on on this Saturday morning, other than to say that this sort of research gives us a sense of the tremendous human burden (time, money) of cancer and its treatment, but that doesn't necessarily mean it's ill-spent. Sick people are sick; sick people die; sick people need medical care; dying people need lots of care; that care is costly (time, money, for caregivers, etc.): caring for people in their last year of life should be costly. The question is how to get those people the right sort of care. How to measure that is tougher than adding up dollars, and there are people smarter than me trying to do it, and for that I am grateful.