Instruction: 1, Read this con article to review and discuss with your classmates 2, Discuss how credible the source is using the CRAAP evaluation model. Detail as many of the 5 components as possible: Currency: How up-to-date is the resource? Why is the date of publication important? Relevance: How significant is the information in the resource to the topic? Is there a direct coalition to the subject matter? Is the source a primary or secondary source? What makes the source appropriate for an academic paper? Authority: What makes the source credible? What is the publishing body? What are the authors' credentials? Provided info on both. Accuracy: Was the source peer-reviewed (how do you know?)? Were sources cited in the work? What makes the source reliable? Purpose: Why was this source created? What is its original intent (inform? persuade? entertain?). Did you notice any particular agenda or bias in the source? Writing Requirements: 1, Post Length: minimum of 3 college-level paragraphs 2, APA format for in-text citations and list of references Five Myths About Cancer Care In America Goldman, Dana P; Philipson, Tomas . Health Affairs ; Chevy Chase Vol. 33, Iss. 10, (Oct 2014): 1801-4. ProQuest document link ABSTRACT In this commentary we debunk a number of the most common misconceptions about cancer treatment, such as claims that the war on cancer has been a failure and that treatment costs are unsustainable. In addition, there is good evidence that patients value these treatments more highly than traditional cost-effectiveness analysis would indicate. We argue that coverage policies placing undue burden on patients are socially wasteful and will likely discourage further innovation. FULL TEXT Headnote VIEWPOINT ABSTRACT In this commentary we debunk a number of the most common misconceptions about cancer treatment, such as claims that the war on cancer has been a failure and that treatment costs are unsustainable. In addition, there is good evidence that patients value these treatments more highly than traditional costeffectiveness analysis would indicate. We argue that coverage policies placing undue burden on patients are socially wasteful and will likely discourage further innovation. Much has been made recently about the cost of cancer treatment, often played out in editorials in cancer journals or on the opinion pages of major newspapers.1,2 Some of the concern reflects be- liefs that arose years ago when the illness was not as well understood. In this commentary we pre- sent some of the more common myths in America and the much more nuanced reality of today. Myth 1: The War On Cancer Has Been A Failure Perhaps no myth is so pervasive and yet so mis- guided than the one that declares that the war on cancer has been a failure.3 Today cancer patients live longer, healthier, and happier lives than those in prior decades. Survival rates for all can- cers increased by almost four years during the period 1988-2000,4 creating twenty-three mil- lion additional life-years and generating $1.9 tril- lion in additional value to society, once the health gains are tallied.5 Survival rates have con- tinued to improve in recent years. A rough com- parison of these health benefits with spending on research and development-both private and public-suggests a substantial social return on investment. Furthermore, progress is being made in deal- ing with the extreme toxicity of chemotherapy and radiation regimens. Newer therapies often allow better quality of life. For example, long- term breast cancer survivors see an overall im- provement in the two yearsfollowing diagnosis,6 and delays in chemotherapy have been shown to negatively affect patients' quality of life in some instances.7 So, while cancer still remains a per- nicious disease, there is hope that it can be man- aged as a chronic illness, with modest side effects. PDF GENERATED BY SEARCH.PROQUEST.COM Page 1 of 7 Myth 2: Detection, Not Treatment, Accounts For Most Of The Survival Gains The public's attention often is drawn to the ben- efits of early detection. If a tumor is found earli- er, it can be treated before metastasis and dra- matically improve survival. Celebrities such as Katie Couric and events such as National Breast Cancer Awareness Month encourage screening, and new technologies have made detection more accurate and less invasive.8 The result has been that screening for some of the most common cancers has increased steadily.9 Thus, it comes as a surprise to many that treat- ment, not detection, has driven the majority of survival gains over the last few decades. During 1988-2000 almost 80 percent of the aforemen- tioned survival gains were attributable to im- provements in treatment, with the remaining 20 percent attributable to better detection. By some estimates, early detection accounted for only 3 percent of the increase in all cancer survival.4 Furthermore, better detection has no value if effective treatment is not available. A diagnosis of multiple myeloma in the 1960s meant a medi- an survival rate of less than one year,10 compared to more than six years today.11 Patients diag- nosed with metastatic colorectal cancer could expect an eight-month median overall survival rate two decades ago, compared to thirty months today.12 These make detection far more valuable. Thus, perhaps ironically, the best way to encour- age more screening may be to identify better, earlier-stage treatments. Myth 3: Treatment Costs Are Unsustainable As noted earlier, the rising cost of overall cancer treatment-especially the contribution of high- price therapies-has drawn a lot of attention recently.1 However, this debate avoids a funda- mental issue that is broader than cancer care- namely, that the focus should be on the price of health, not the price of health care services. An analogy with highly active antiretroviral therapy (HAART) to treat HIV is instructive. HAART, which was introduced in the 1990s, dra- matically increased longevity for HIV-positive patients,13 although at a significant financial cost to these patients.14 Prior to the introduction of HAART, an HIV-positive patient could not buy a longer life at any price. The advent of HAART thus lowered the price of a longer life, although the price of treatment rose. Ultimately, more than 93 percent of the benefits of developing the new treatment accrued to patients in the form of longer lives, rather than to manufac- turers.15 Similar declines were seen in the price of health for cancer patients, as measured by the price of each qualityadjusted life-year (QALY). Just over a decade ago, patients suffering from chronic myeloid leukemia faced grim prospects for survival. With the introduction of tyrosine- kinase inhibitors (TKIs) in 2002, life expectancy increased by 5.5 QALYs, at a cost of $57,000 per QALYsaved.16 Giventhatthevalue ofalife-year in the United States falls in the range of $200,000- $300,000,17 TKIs seem like a good deal. Thus, society secured good value, even at brand-name prices. Next year, one of the first TKIs will lose its patent, and the price could fall dramatically as a generic enters the market. Of course, not all cancer treatments have had such dramatic improvements on life expectancy, and some drugs may not be worth the cost. How- ever, when the cost of innovative drugs is viewed over their branded and generic lifetime, it seems that a good deal is being obtained for the cancer dollars expended, with substantial increases in survival at reasonable cost. So why the uproar about cancer in particular? Many health care services have higher costs than oncology drugsthe cost of a stay in the inten- sive care unit (ICU) is about $20,00018-or pro- vide little value for the money, such as PDF GENERATED BY SEARCH.PROQUEST.COM Page 2 of 7 magnetic resonance images (MRIs) for sprained ankles.19 Yet one does not see such handwringing about ICU costs or MRIs because payers and providers have deemed those costs to be acceptable and appropriately allocated. In fact, the outrage arises because it is the patient, not the insurer, who has to pay. Among specialty drugs, cancer drugs have the highest out-of-pocket spending burden imposed on pa- tients.20 Patients may be asked to pay 50 percent of the cost of newer cancer drugs out of pocket,21 compared with a much smaller fraction of the cost of an ICU stay. This financial burden can be "devastating," according to leading oncologists.2 Clearly reimbursement for treatments that have little or no health benefit should be chal- lenged. However, blanket policies that shift the cost burden onto a subset of patients with rare or difficult-to-treat cancers-or that lower all prices together-would discourage future innovation and deprive patients of novel therapies. Myth 4: Cancer Treatment At The End Of Life Is Of Low Value This myth arises from a fundamental misconcep- tion about the value of care delivered to the ter- minally ill.22 More specifically, policy makers as- sume that the value of a life-year remains constant, regardless of a patient's circumstanc- es. Evidence-and consumer behavior-would suggest otherwise. An anecdote is helpful. In 2008 the New York Times published a story on Avastin, a drug that inhibits the growth of new blood vessels, empha- sizing the dilemma posedby its modest improve- ment in survival rates and high cost. A few days later, reader Jana Jett Loeb wrote a Letter to the Editor, poignantly explaining the value of Avas- tin to treat her father's glioblastoma off-label: "The hope this drug provides our family is just as important to prolonging my father's life as the drug itself."23 As Loeb makes clear, there is additional value in treatments that give people hope, despite modest survival benefit. One study estimated that patients with metastatic disease value treat- ment at levels twenty-three times higher than the cost of the therapy.24 It is also known that median survival does not capture the right-tail chance of success often associated with the hope of full remission. As a result, coverage decisions based solely on median survival will neglect the great social value for a minority who live long after the trial ends. This does not mean that insurers should cover all hopeful therapies in the absence of clinical evidence. However, it does mean that the way in which trialresults areevaluated should be recon- sidered.Arecent studydemonstratedthat 77per- cent of cancer patients with melanoma preferred hopeful therapies, even with uncertainty as to where they would fall on the survival curve, and were willing to pay over $54,000 for a hypothetical treatment with the same median survival but a better chance at long-term survival.25 Second, behavior demonstrates that life is more precious when less of it remains. Ordinary people recognize this point, but current quality- of-life metrics do not.While patients often refuse to take their ordinary medications when copay- ments increase just a few dollars, cancer drugs are different. Patients are willing to pay substan- tial amounts out-of-pocket, indicating tremen- dous consumer value.20,24 Third, societyas a whole places higher value on treatments for those who are sicker. Surveys show that people are reluctant to forgo care for the elderly, even if resources devoted to that care could more effectively improve population health if used elsewhere.26 The same survey sug- gests that people would rather society choose interventions that make the lives of a few much better off than interventions that make the lives of many only slightly better off. In the United Kingdom, growing complaints about denials of effective but costly treatments for PDF GENERATED BY SEARCH.PROQUEST.COM Page 3 of 7 life-threaten- ing diseases have prompted a compassionate care exception to the cost-effectiveness thresh- old for patients with poor prognoses. Finally, recent evidence suggests that healthy people are willing to pay higher premiums for access to treatments analysts often deem of no value. By some estimates, adults in the United States are willing to pay on average an extra $2.60 in insurance premiums for every dollar of cancer drug coverage.27 Bottom line, the QALY-based approach to decide necessity is in- consistent with patients' and society's value of cancer care. Myth 5: Supportive Care Is Overused Many of the most effective cancer treatments have significant side effects, including pain, nau- sea, fatigue, anemia, and susceptibility to infec- tion. Supportive care therapies, such as colony stimulating factors and antiemetics, address one or more of these side effects. Nevertheless, many view them as a cost with little benefit.22 In reality, supportive care enables the admin- istration of more aggressive chemotherapy regi- mens by avoiding or managing the debilitating effects of the toxicity. Aggressive regimens, fa- cilitated by supportive care, slow disease pro- gression and improve overall survival. Indeed, some of the best clinical trials include supportive care as part of the protocols.28 How- ever, the incidence of neutropenia and the use of supportive care therapies are underreported in clinical trial publications, underrepresenting the value to society of supportive care.29,30 As treatments evolve over time, supportive care reg- imens will remain an integral part of innovation and patient care. Conclusion Cancer has always been the "Emperor of All Maladies."31 But any illness with such a majestic designationisboundtobesurrounded bymyths, many of which arose years ago when the illness was much less understood. The reality of cancer today is of a disease far more nuanced, reflecting systematic progress in treating the disease. New paradigms have led to the development of groundbreaking biologic therapies, with a lower risk of adverse events and side effects-but also with a commensurate cost. It is now known that cancer is actually hun- dreds of diseases, many of which are rare. Scien- tific discovery will likely not allow for the devel- opment of "common cancer" treatments that will be effective in all cases. Rather, identified cancer subtypes that can be targeted by drugs are ulti- mately costly to develop, particularly when the treated population is small. Coverage policies that place undue burden on patients may dis- courage further innovation of treatments target- ing rare genetic mutations and tumor subtypes. The call to artificially lower drug prices may ad- dress immediate affordability problems but-if done incorrectly-will come at too high a cost for future cancer patients' health. ? Support for this research was provided by Amgen. Technical and administrative support was provided by Jacquelyn Chou and Joanna P. MacEwan. Sidebar 77% Preferred hopeful therapy A recent study found that 77 percent of cancer patients with melanoma preferred hopeful therapies and were willing to pay $54,000. PDF GENERATED BY SEARCH.PROQUEST.COM Page 4 of 7 Footnote NOTES 1 Experts in Chronic Myeloid Leuke- mia. The price of drugs for chronic myeloid leukemia (CML) is a reflec- tion of the unsustainable prices of cancer drugs: from the perspective of a large group of CML experts. Blood. 2013;121(22):4439-42. 2 Bach PB, Saltz LB, Wittes RE. In cancer care, cost matters. New York Times. 2012 Oct 15;Sect. A:25. 3 Faguet GB. The war on cancer: an anatomy of failure, a blueprint for the future. New York (NY): Spring- er; 2005. 4 Sun E, Jena AB, Lakdawalla D, Reyes C, Philipson TJ, Goldman DP. The contributions of improved therapy and early detection to cancer survival gains, 1988-2000. Forum for Health Economics and Policy. 2010;13(2): Article 1. 5 Lakdawalla DN, Sun EC, Jena AB, Reyes CM, Goldman DP, Philipson TJ. An economic evaluation of the war on cancer. J Health Econ. 2010;29(3):333-46. 6 Hsu T, Ennis M, Hood N, Graham M, Goodwin PJ. Quality of life in long- term breast cancer survivors. J Clin Oncol. 2013;31(28):3540-8. 7 Calhoun EA, Chang C-H, Welshman EE, Cella D. The impact of chemo- therapy delays on quality of life in patients with cancer. J Support On- col. 2004;2(2):64-65. 8 Whitlock EP, Lin JS, Liles E, Beil TL, Fu R. Screening for colorectal can- cer: a targeted, updated systematic review for the U.S. Preventive Ser- vices Task Force. Ann Intern Med. 2008;149(9):638-58. 9 Clarke TC, Soler-Vila H, Fleming LE, Christ SL, Lee DJ, Arheart KL. Trends in adherence to recommended can- cer screening: the US population and working cancer survivors. Front Oncol. 2012;2:190. 10 Kumar SK, Rajkumar SV, Dispenzieri A, Lacy MQ, Hayman SR, Buadi FK, et al. Improved sur- vival in multiple myeloma and the impact of novel therapies. Blood. 2008;111(5):2516-20. 11 Kumar SK, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Pandey S, et al. Continued improvement in survival in multiple myeloma: changes in early mortality and outcomes in older patients. Leukemia. 2014; 28(5):1122-8. 12 Kopetz S, Chang GJ, Overman MJ, Eng C, Sargent DJ, Larson DW, et al. Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. J Clin On- col. 2009;27(22):3677-83. 13 Sansone GR, Frengley JD. Impact of HAART on causes of death of per- sons with late-stage AIDS. J Urban Health. 2000;77(2):166-75. 14 Goldman DP, Bhattacharya J, Leibowitz AA, Joyce GF, Shapiro MF, Bozzette SA. The impact of state policy on the costs of HIV infection. Med Care Res Rev. 2001;58(1):31- 53; discussion 54-9. 15 Philipson TJ, Jena AB. Surplus ap- propriation from R&D and health care technology assessment proce- dures. Cambridge (MA): National Bureau of Economic Research; 2006 Feb. (NBER Working Paper No. 12016). 16 Reed SD, Anstrom KJ, Li Y, Schulman KA. Updated estimates of survival and cost effectiveness for imatinib versus interferon-alpha plus low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukaemia. Pharmaco- economics. 2008;26(5):435 -46. 17 Aldy JE, Viscusi WK. Adjusting the value of a statistical life for age and cohort effects. Rev Econ Stat. 2008;90(3):573-81. 18 Dasta JF, McLaughlin TP, Mody SH, Piech CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med. 2005;33(6):1266-71. 19 American Academy of Orthopaedic Surgeons. Sprained ankle [Internet]. Rosemont (IL): AAOS; 2012 Sep [cited 2014 Aug 26]. Available from: http://orthoinfo.aaos.org/topic .cfm?topic=a00150 20 Goldman DP, Joyce GF, Lawless G, Crown WH, Willey V. Benefit design and specialty drug use. Health Aff (Millwood). 2006;25(5):1319-31. 21 Smith TJ, Hillner BE. Bending the cost curve in cancer care. N Engl J Med. 2011;364(21):2060-5. 22 Schnipper LE, Smith TJ, Raghavan D, Blayney DW, Ganz PA, Mulvey TM, et al. American Society of Clin- ical Oncology identifies five key op- portunities to improve care and re- duce costs: the top five list for oncology. J Clin PDF GENERATED BY SEARCH.PROQUEST.COM Page 5 of 7 Oncol. 2012;30(14): 1715-24. 23 Letter to the editor. The high price for a drug, and hope. New York Times. 2008 Jul 12. 24 Seabury SA, Goldman DP, Maclean JR, Penrod JR, Lakdawalla DN. Pa- tients value metastatic cancer ther- apy more highly than is typically shown through traditional esti- mates. Health Aff (Millwood). 2012;31(4):691-9. 25 Lakdawalla DN, Romley JA, Sanchez Y, Maclean JR, Penrod JR, Philipson T. How cancer patients value hope and the implications for cost-effec- tiveness assessments of high-cost cancer therapies. Health Aff (Mill- wood). 2012;31(4):676-82. 26 Nord E, Richardson J, Street A, Kuhse H, Singer P. Maximizing health benefits vs egalitarianism: an Australian survey of health issues. Soc Sci Med. 1995;41(10):1429-37. 27 Romley JA, Sanchez Y, Penrod JR, Goldman DP. Survey results show that adults are willing to pay higher insurance premiums for generous coverage of specialty drugs. Health Aff (Millwood). 2012;31(4):683-90. 28 National Cancer Institute. Prospec- tive phase 2 trial of cabazitaxel in patients with temozolomide refrac- tory glioblastoma multiforme [In- ternet]. Bethesda (MD): National Cancer Institute; 2013 [cited 2014 Aug 26]. Available from: http:// www.cancer.gov/clinicaltrials/ search/view?cdrid=750138& version=HealthProfessional& protocolsearchid=9363709 29 Dale DC, McCarter GC, Crawford J, Lyman GH. Myelotoxicity and dose intensity of chemotherapy: reporting practices from randomized clinical trials. J Natl Compr Canc Netw. 2003;1(3):440-54. 30 Duff JM, Leather H, Walden EO, LaPlant KD, George TJ Jr. Adequacy of published oncology randomized controlled trials to provide thera- peutic details needed for clinical application. J Natl Cancer Inst. 2010;102(10):702-5. 31 Mukherjee S. The emperor of all maladies: a biography of cancer. New York (NY): Simon and Schuster; 2011. AuthorAffiliation Dana P. Goldman (dana .goldman@usc.edu) is the Leonard D. Schaeffer Chair and director of the Schaeffer Center for Health Policy and Econcomics, University of Southern California, in Los Angeles. Tomas Philipson is the Daniel Levin Professor of Public Policy,Economics,andLawat the University of Chicago, in Illinois. DETAILS Subject: Cancer therapies; Health care; Studies Location: United States--US Classification: 9130: Experiment/theoretical treatment; 8320: Health care industry; 9190: United States Publication title: Health Affairs; Chevy Chase Volume: 33 Issue: 10 Pages: 1801-4 Number of pages: 4 PDF GENERATED BY SEARCH.PROQUEST.COM Page 6 of 7 Publication year: 2014 Publication date: Oct 2014 Section: CANCER CARE Publisher: The People to People Health Foundation, Inc., Project HOPE Place of publication: Chevy Chase Country of publication: United States, Chevy Chase Publication subject: Insurance, Public Health And Safety ISSN: 02782715 Source type: Scholarly Journals Language of publication: English Document type: Feature, Journal Article Document feature: References DOI: http://dx.doi.org/10.1377/hlthaff.2014.0826 Accession number: 25288425 ProQuest document ID: 1613558910 Document URL: https://chamberlainuniversity.idm.oclc.org/login?url=https://search.proquest.com/d ocview/1613558910?accountid=147674 Copyright: Copyright The People to People Health Foundation, Inc., Project HOPE Oct 2014 Last updated: 2017-11-21 Database: ProQuest Central LINKS Database copyright  2018 ProQuest LLC. 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