Your doctor is likely a member of The American Society of Clinical Oncology (ASCO), which is a membership organization of more than 35,000 oncology professionals. For more than two decades ASCO has provided doctors with clinical practice guidelines to help make sure your treatment is based on the best scientific evidence. This summer, however, ASCO moved beyond traditional guidelines with the release of their draft “Value Framework.” Some believe the Value Framework represents the future of cancer care and a way to improve clinical outcomes while controlling costs; others view it as a dangerous scheme to limit your treatment based on an impersonal formula. The New York Post, with their flair for the dramatic, called it “The Cancer Death Panel App.” So just what is the Value Framework and what does it mean for your cancer care?
Essentially the Value Framework is a way to compare the relative benefit of various treatments by creating a weighted score utilizing clinical outcome, toxicity (side-effects), and cost to the patient, insurers and society. With this concept, your doctor would have access to a value “score” for a given treatment regimen. Theoretically then, the treatment regimen with the best score would be the best cancer treatment for you.
As the Value Framework is a draft concept and ASCO has requested feedback, here is what we feel future versions should address:
- The Patient’s Perspective: ASCO claims the patient is at the heart of the Value Framework but we don’t see the patient perspective at all. Each of us have our own hopes, dreams and life goals, but nowhere in the value equation are you, as a unique human being, considered. Side-effects, for example, are not a fixed number, but needs to be addressed relative to individual issues and goals. ASCO needs to remember this about our lives, not scoring a clinical trial.
- The Full Cost of Cancer Care: ASCO rightly points out that the cost of cancer care is rising at an alarming rate. However, in the Value Framework they elect to only consider the cost of pharmaceutical products, not the total cost. It is not unusual to focus on pharmaceuticals as this is the area where patients experience the highest percentage of co-pay or co-insurance. This, however, loses sight of the fact that today pharmaceuticals represent about 10% of health care costs and have been at that same percentage for more than forty years. Any cost metric needs to consider the whole tab, not just on part of it.
- The Unintended Consequences: ASCO intends for the Value Framework to improve care by providing clinicians with a metric to effectively evaluate benefit, toxicity and cost. But importantly, it is not just cost to the patient, but cost to your insurance company and to society. We have no idea what cost to society means, but cost to insurance companies is clear. Since the dawn of modern medicine, physicians strive only for what is best for the health of their patient and the Hippocratic Oath makes no mention of serving the bottom line of insurance companies. Once there is a framework to score different treatment options, how long will it be until reimbursement is tied to that score. At best this drives a formulaic, one-size fits all cancer care model; at worst it puts price parameters on surviving cancer.
So what do you think? ASCO is encouraging the cancer community to share our views on their Value Framework and have an on-line survey. Please take a moment to provide your thoughts at www.surveymonkey.com/s/Valueframework and, as always, post your reaction to our Speak Up, Speak Out blog.
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