Personalized cancer medicine (PCM) is one of the hottest focuses of cancer treatment. In the not-too-distant past, all cancer patients with the same tumor type and at the same stage received the same treatment. Personalized treatment, however, allows variations in treatment based on genetic differences.
PCM offers hope for patients—analyzing a tumor in a patient allows the treatment team to choose the most effective drugs for that patient and ideally prolong his or her survival. But personalized medicine has its drawbacks. Critics say it’s too expensive for the marginal benefit it offers, and some believe the funding would be better directed to early-detection programs.
Both points are valid.
Healthcare spend accounts for almost 20% of our GDP, costs are rising faster than revenues, and consumers are complaining about high healthcare costs. Hospitals, health systems, and commercial and government payers are seeking ways to minimize the burden of healthcare costs for their beneficiaries while maintaining quality of care.
However, hope is crucial when dealing with a life-threatening illness. It is difficult to put a monetary value on the hope that a new and promising treatment could be the answer to a critical problem that affects many lives directly and indirectly.
Nonetheless, because limited resources are available to address the detection and treatment of cancer, we have to think of how to best meet the needs of those currently dealing with later stages of the disease and those whose disease could be controlled if it is identified and addressed earlier.
I work with hospitals and health systems every day who are trying to decide what level of services they should provide at various sites of care. Many are considering developing oncology programs and making those services more widely available in the communities they serve.
Many community hospitals are developing or expanding infusion and radiation therapy services at their campuses, which increases patient access to these therapies, particularly in communities that are far from major cancer centers. These patients often must make multiple trips to the cancer center during their course of treatment, and having convenient and accessible infusion and radiation therapy services in the community could make a difficult process easier by reducing travel time.
Many programs are also evaluating adding a higher level of clinical trial services to the repertoire of services offered in their cancer programs. However, given the cost of developing the infrastructure for leveraging PCM effectively, providers, particularly health systems, need to evaluate what role their programs will play in pushing forward the potential of genome-directed cancer care. Not every program has the financial ability to put the required infrastructure in place and should consider partnering to achieve economies of scale, focusing their resources to advance cancer treatment for the broadest swath of people in the communities that they serve.
Providers should also try to make advances in treatment accessible for patients with metastatic disease by participating in trials where appropriate but being careful to avoid duplication of efforts, especially in a healthcare environment with limited resources. At-risk payment models are gaining prominence as healthcare stakeholders try to address the problem of rising costs without compromising quality.
Consequently, providers should be thoughtful about investments at various sites of care. Before making large investments in PCM infrastructure or research, consider your organization’s mission, financial capacity, and what role each site of care should have in achieving your cancer care goals.
 Cancer Net. (2018, November). What Is Personalized Cancer Medicine? https://www.cancer.net/navigating-cancer-care/how-cancer-treated/personalized-and-targeted-therapies/what-personalized-cancer-medicine
 Ian F. Tannock, M. P. (2016, September 29). Limits to Personalized Cancer Medicine. The New England Journal of Medicine, 375(13), 1289-1294. https://pdfs.semanticscholar.org/439b/e2fa90a39f8405bd9562c7d244d4a27564de.pdf
 CMS.gov. (2018, December 11). CMS.gov Centers for Medicare & Medicaid Services: National Health Expenditure Data. http://www.cmc.gov: https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical.html