Study: Higher spending on cancer care in U.S. doesn’t improve outcomes

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Lebanese Cancer patients carry placards during a protest at the highway leading to the Presidential palace east of Beirut on May 20. A new study said that, despite the spending more than other countries on cancer care, the United States saw little difference in outcomes. Photo by Wael Hamzel/EPA-EFE

A new global study found that national cancer care spending shows no relationship to population-level cancer mortality rates, leaving the United States with only slightly better outcomes despite outspending other countries.

In the study, which was published Friday in JAMA Health Forum, researchers from Yale University and Vassar College examined 22 of the highest-income countries, including the United States, which spends twice as much as the average high-income country.

Despite the higher spending rate in the United States, six countries — Australia, Finland, Iceland, Japan, Korea, and Switzerland — had both lower cancer mortality and lower spending than the United States.

“The U.S. is spending over $200 billion per year on cancer care — roughly $600 per person, in comparison to the average of $300 per person across other high-income countries,” senior author Cary Gross, professor of medicine and director of the National Clinician Scholars Program at Yale, said in a statement.

“This raises the key question: Are we getting our money’s worth?”

Lead author Ryan Chow, of Yale University, said the study challenges the common perception that the United States offers the most advanced cancer care in the world.

“Our system is touted for developing new treatments and getting them to patients more quickly than other countries,” Chow said. “We were curious whether the substantial U.S. investment on cancer care is indeed associated with better cancer outcomes.”

The study said smoking is the strongest risk factor for cancer mortality, and smoking rates have historically been lower in the United States than other countries. Even when researchers controlled for international variations in smoking rates, U.S. cancer mortality rates became no different than the average high-income country.

Nine countries — Australia, Finland, Iceland, Japan, Korea, Luxembourg, Norway, Spain, and Switzerland — have lower smoking-adjusted cancer mortality than the United States.

“Adjusting for smoking shows the United States in an even less favorable light because the low smoking rates in the U.S. had been protective against cancer mortality,” Chow said.

Researchers said more work is needed to identify specific policy interventions that could meaningfully reform the United States cancer care system, however, they point to lax regulation of cancer drug approvals and drug pricing as two key factors contributing to the high cost of U.S. cancer care.


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