It’s been well established that U.S. healthcare is expensive, and that patients living in the United States tend to have earlier access to new cancer therapies. But whether that spending has translated into fewer cancer deaths has been unclear, says senior author Cary Gross, MD, professor of medicine and founder and director of Cancer Outcomes, Public Policy and Effectiveness Research Center at Yale School of Medicine in New Haven, Connecticut. “The most recent studies comparing cancers costs with outcomes at the national level are over a decade old,” says Dr. Gross. That’s important, in part, because there have been many significant advancements in cancer treatment in the last 10 years, including a new type of immunotherapy that can make changes to a patient’s T cells (a type of immune cell) to better fight cancer, according to American Cancer Society (ACS). Those breakthrough treatments can come at significant cost — in some cases, upward of one million dollars per patient, according to the Lown Institute, a nonpartisan think tank dedicated to improving America’s healthcare system.
Cancer Is Second Leading Cause of Death in the U.S.
Although the risk of dying from cancer has been dropping since its peak in 1991, it’s still the second most common cause of death in the United States, after heart disease, according to the ACS. In 2022, it’s estimated that 1.9 million people will be diagnosed with cancer, and 609,360 will die from it. Lung cancer is the leading cause of cancer death in the United States, followed by colon and rectum cancer, pancreatic cancer, breast cancer, prostate and liver and intrahepatic bile duct cancer, according to the Centers for Disease Control and Prevention (CDC).
U.S. Had the Highest Cancer Care Spending Rate Compared With Other Countries
To find out whether or not the considerable U.S. investment on cancer care leads to better outcomes, researchers performed a nation-level analysis of 22 high-income countries and compared how much each country spent on cancer care relative to the age-standardized cancer death rates in 2020, with and without adjusting for smoking. Key findings included:
The United States spent over 200 billion dollars on cancer care — the highest spending rate of any of the 22 countries.The United States had the seventh best mortality rate out of the 22 countries — Australia, Finland, Iceland, Japan, Korea, and Switzerland spent less on cancer care but had better cancer outcomes than the United States.Researchers found no correlation between how much a country spent on cancer care and what the cancer death rate was; in other words, countries that spend more on cancer care do not necessarily have better cancer outcomes.
After Accounting for Fewer Smokers, U.S. Cancer Mortality Rates Are No Better Than Average
Smoking is the strongest risk factor for dying from cancer, and smoking rates in the United States have historically been lower compared with other countries. In 2018, about 20 out of 100 adults in the European Union (EU) reported they were daily cigarette smokers compared with 12.5 out of 100 U.S. adults, according to the CDC. After controlling for international differences in smoking rates, the U.S. cancer mortality rate was no better than the average high-income country: Nine countries had lower smoking-adjusted cancer mortality than the United States. “The findings show that although the United States is spending the most — twice the average spending on cancer compared with other high-income countries — we only achieved middle-of-the road results, in terms of cancer mortality. We are paying a lot for our cancer treatments but not achieving the outcomes that our patients deserve,” says Gross.
Findings Suggest the U.S. Healthcare System Needs to Reevaluate Priorities in Cancer Care
“Simply put, this is all about value — and values. Like they say, price is what you pay, but value is what you get. And in this case, the United States is not getting high value for its cancer care. And this relates to values — how should we prioritize our cancer spending?” says Gross. According to Gross, the United States could better prioritize the money spent on cancer care by investing more in cancer prevention programs, controlling cancer drug prices, and doubling-down on cancer research. What exactly does “doubling-down on cancer research" mean? For starters, it would include reforming the clinical trial and drug regulation process to one that places patients’ interests first, says lead author Ryan Chow, an MD and PhD student at the Yale School of Medicine. “It’s not just about doing more research and getting more drugs approved; we need to make sure those research efforts are going towards clinical trials that are evaluating whether patients will indeed live longer and better on these new drugs. Otherwise, we are just spending more and more money on new cancer drugs that won’t meaningfully help our patients,” he says. “The clinical trials process for cancer drugs is one of many aspects that needs to change. It’s likely that a multipronged approach to cancer care reform is needed to address the issues highlighted by this study,” adds Chow.
