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Evidence-Based Oncology August 2014
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ASCO's Initiative to Define Value In Cancer Care

Richard L. Schilsky, MD, Chief Medical Officer, ASCO
Commentary
The American Society of Clinical Oncology (ASCO) is very concerned about the escalating cost of cancer care, and since 2007 has been actively pursuing solutions that address
this issue. The unsustainable increase (projected to reach $175 billion per annum by 2020, an increase of 40% from 2010) is the result of:

• an increasing demand for cancer care services (45% new cancer cases estimated by 2030), largely due to aging of the population and due to lifestyle factors
• continued growth of new interventions and treatments without pricing, relative to value.

The overall burden that rising cancer costs place on the national economy translates into enormous strain at the individual level, and may ultimately impede access to lifesaving care. Patients and their families often face crippling expenses during what is already one of the most difficult times in their lives. Furthermore, medical costs are the leading cause of personal bankruptcy, and
people with cancer are 3 times more likely to file for bankruptcy than those without cancer.

It’s important to remember that cost is only 1 component of what really is a question about the “value” of cancer care. Value is defined by more than cost—it includes the clinical outcomes patients can expect from any specific treatment regimen, as well as consideration of costs and side effects. The overall value of care reflects the benefits in quality and quantity of life gained against the physical, emotional, and financial costs of medical intervention.

ASCO has launched a strategic new value initiative to:

• obtain optimal outcomes at lowest cost
• develop a framework or methodology to assess the relative value of treatment options based on:
      • clinical benefit
      • toxicity
      • cost

ASCO believes that medical decision making must be the result of informed discussions between patients and their physicians in the context of the local care delivery system—with the patient’s
preferences and goals at the center. ASCO’s Board of Directors is developing the value framework to help physicians and patients determine the most appropriate evidence-based high-quality treatment option, considering the patient’s clinical status, preferences, and personal and family needs. To achieve the broadest consensus, ASCO plans to solicit input from:

• ASCO members and other oncology providers
• the pharmaceutical industry
• the insurance industry
• patients and patient advocacy groups. EBO
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