Survey finds broad support for some oncology care rationing

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Rationing has become a dirty word in healthcare politics, but a survey of oncologists, patients and members of the general public found a majority supported controlling healthcare costs by denying payment for expensive care if it didn’t improve survival or quality of life, according to results presented at the annual meeting of the American Society of Clinical Oncology in Chicago.

“The majority of those sampled view Medicare costs as a substantial problem and pharmaceutical and insurance companies as significant contributors,” wrote Keerthi Gogineni, MD, MSHP, of the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, and colleagues in the study abstract.

The researchers randomly surveyed over 1,400 people in 2012 to assess attitudes on ways to control costs. Included in the study were 326 adult cancer patients, 245 oncologists and a random sample of 891 members of the general U.S. public.

Roughly three quarters of patients and the general public felt Medicare spending was a moderate or big problem, along with 97 percent of oncologists. A majority of all groups felt Medicare could spend less without causing harm, according to the results.

When it came to placing blame, more than 90 percent of all groups said rising costs were attributable, at least in part, to drug companies charging too much, while more than 80 percent of all groups added that insurance company profits were also a cause of rising costs.

Unnecessary tests and treatments were seen as a problem by 69 percent, 70 percent and 81 percent of patients, oncologists and the general public, respectively. Most supported refusing payment for expensive care if a less expensive, but equally effective, alternative was available, or if the treatment did not improve quality of life. “Few respondents were willing to refuse payment of [tests and treatments] that extend life by four months,” noted Gogineni and colleagues.

The general public in particular felt that physicians and hospitals added considerably to the cost problem, while oncologists were more accepting of an independent oversight panel.

“These results suggest that patients and the lay public prioritize quality of life, while oncologists appear focused on controlling disease and increasing length of life,” Gogineni said in a press release. “Patients have a much broader set of concerns, from the cost of their doctor’s visits to the side effects of treatment and the emotional toll of their illness.”