Last week we began an article on how the so-called "Chemotherapy Concession" has led to the more extensive (and expensive) use of drugs by oncologists. We conclude, with references, in this week's newsletter.

"In sum, far from limiting access," the changes under the law "actually increased the likelihood that lung cancer patients received chemotherapy," said Dr. Mireille Jacobson of the RAND Corporation, who was first author on the study. (Disclosure: I serve as a reviewer of scientific studies for RAND.)

The authors chose to focus on lung cancer because of the various treatment options, some of which are considerably more expensive than others. They found that doctors frequently switched drugs to choose the more expensive options. There was, for instance, an increased use of docetaxel (Taxotere), a drug for which oncologist get reimbursed about $2,500 per patient per month.

"The financial incentive seemed to have an effect where there's not strong evidence or more than one equally good treatment option," said Craig C. Earle, MD, of Toronto, one of the study authors.

Oncologists responded by treating a greater number of patients because they had been making so much money under the old system, Prof. Joseph P. Newhouse of Harvard University, another co-author, told the New York Times. "These markups were a substantial portion of their income" (Abelson 2010).

The bottom line is that some oncologists in private practice make crucial treatment decisions not based on medical necessity but on what is most profitable for themselves.

Oncologists are highly skilled professionals, who deserve our support and respect. However, the "chemotherapy concession" introduces a temptation for oncologists in private practice to prescribe according to their economic interests rather than the medical needs of their patients. This has no scientific or moral justification. Congress still needs to thoroughly investigate and fix this problem.

--Ralph W. Moss, Ph.D.

References:

Abelson, Reed. Doctors recouped cuts in Medicare pay, study finds. New York Times, June 16, 2010.

American Cancer Society, Cancer Facts & Figures 2010. Available at www.cancer.org

Jacobson M, Earle CC, Price M, Newhouse JP. How Medicare's payment cuts for cancer chemotherapy drugs changed patterns of treatment. Health Aff. 2010:hlthaff.2009.0563.

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