Prostate cancer treatment could be a marker for health reform

This article was originally on a blog post platform and may be missing photos, graphics or links. See About archive blog posts.

For men with prostate cancer, even those with the early-stage type, the urge to treat is undeniable and understandable. The same apparently holds true for their doctors. But sometimes no treatment, at least for a while, is better -- both for men with cancer and for the healthcare system as a whole.

More men -- and, again, their doctors (who are paid by procedure, not by performance) -- need to ask themselves whether less might ultimately provide more. That’s the suggestion posed by a smart, making-the-big-picture-personal piece in today’s New York Times.

For writer David Leonhardt, the true test of health reform can be summed up with our medical and insurance systems’ approach to prostate cancer, specifically the common, slow-growing kind. It’s the kind that can often be monitored with what is known as watchful waiting without the risk of side effects that comes with radiation and surgery.

He writes:

But if the treatments have roughly similar benefits, they have very different prices. Watchful waiting costs just a few thousand dollars, in follow-up doctor visits and tests. Surgery to remove the prostate gland costs about $23,000. A targeted form of radiation, known as I.M.R.T., runs $50,000. Proton radiation therapy often exceeds $100,000.

And in our current fee-for-service medical system — in which doctors and hospitals are paid for how much care they provide, rather than how well they care for their patients — you can probably guess which treatments are becoming more popular: the ones that cost a lot of money.

If you doubt that similar-benefits contention and want an in-depth look at how the treatments compare, there’s this report: ‘Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer’ from the Agency for Healthcare Research and Quality.

The report, released last year, concludes:

Published evidence indicates that no one therapy can be considered preferred for localized
prostate cancer due to limitations in quality of the body of comparative effectiveness evidence. All treatment options result in adverse effects (primarily urinary, bowel, and sexual) though the severity and frequency may vary between treatments and according to the provider/hospital. Even if differences in therapeutic efficacy exist, differences in AEs [adverse effects], convenience, and costs are likely to be important factors in individual patient decision making. Despite this uncertainty, patient-reported satisfaction with any individual therapy received is high.

Leonhardt is right. This one example highlights the seemingly large and intractable problems of rising healthcare costs (proton radiation therapy isn’t cheap) and getting the most effective healthcare for our national dollars.

And, come decision-making time, if less-expensive treatments are as effective as more high-tech ones, perhaps it’s time to question some of the recommendations for expensive treatment and screenings.

-- Tami Dennis