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More Dollars Don't Boost Lung Cancer Survival

5-year outcomes unchanged since 1970s, despite higher spending on care, study shows

TUESDAY, Oct 23 (HealthDay News) -- Although it can cost more than $1 million to give a lung cancer patient an added year of life, overall survival from the disease hasn't increased significantly, a new study finds.

On average, life-expectancy for Americans with lung cancer increased by less than one month between 1983 and 1997. At the same time, medical costs increased by more than $20,000 per patient, researchers reported in the Oct. 22 online edition of Cancer.

"We haven't made much progress in lung cancer survival, and what progress we have made has come at a significant cost," said Dr. Len Lichtenfeld, deputy chief medical officer at the American Cancer Society. He was not involved in the research.

"The concern is that as we move toward closer examination of survival of people with lung cancer and as our resources in this country become more strained, we are going to see more estimates about how much it costs to save a year of life," Lichtenfeld said.

Today, people diagnosed with lung cancer expect to get the full range of treatment, Lichtenfeld said. But as money becomes less available for health care, studies like this could impact on how health care providers make treatment decisions, he said.

"Right now, money isn't influencing our decisions," Lichtenfeld said. "But, when we look forward 20 years from now, we are going to make decisions about who we treat and how we treat them based on economic considerations," he said. "We are at risk in this country of moving in that direction."

Another expert is hopeful that type of system will never come to pass, however.

"This is America -- we don't ration health care," said Dr. Norman Edelman, chief medical officer at the American Lung Association, New York City.

In addition, Edelman is against pitting one disease against another. "Twenty-five percent of our health care dollars are spent on the last six months of life," he said. "And that's certainly not just lung cancer. Singling out lung cancer is not a useful approach."

According to Edelman, "The costs to treat lung cancer are not higher than the costs of anything else."

Lung cancer remains the leading cause of cancer death in the United States. This year 160,390 Americans will die from the disease.

In the study, a team led by Rebecca Woodward of the U.S. National Bureau of Economic Research drew on data from the National Cancer Institute's Surveillance, Epidemiology, and End Results database. They also looked at reimbursement data from Medicare Parts A and B.

The researchers tracked changes in both costs and outcomes for lung cancer patients from the early 1980s to the mid-1990s.

They found that an additional year of life for a patient with lung cancer cost an average of $403,142. The cost of each additional year of survival for people with local disease was $143,614. For people with metastatic lung cancer, each year of additional survival cost $1,190,322, Woodward's team found.

Each in the United States, more than $5 billion is spent on detecting, diagnosing and treating lung cancer. However, the one-year survival rate from the disease has increased only 5 percent from the late 1970s to 2002, the researchers noted -- between 1975 to 1979 the one-year survival rate for lung cancer patients was 37 percent and, in 2002, it was 42 percent, they said.

Over the same period, the five-year survival rate for those with lung cancer has remained about the same -- currently, it's only about 16 percent.

"The additional money spent on lung cancer treatment in the mid-1990s compared to in the early 1980s did not result in a favorable economic rate of return by conventional benchmarks," the researchers concluded.

To help reduce surging costs, more research is needed to develop better and more effective diagnostic tests and treatments, Edelman said.

"Clearly, we need a really good methodology for detection," he said. "We do need to figure much better ways to treat it," he added.

The most cost-effective way of bringing lung cancer costs under control is to prevent the disease in the first place, Edelman added, and that means "getting the government to spend more money to prevent smoking."

More information

For more on lung cancer, visit the American Lung Association.

SOURCES: Len Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society, Atlanta; Norman Edelman, M.D., chief medical officer, American Lung Association, New York City; Oct. 22, 2007, online edition, Cancer

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