Budgeting for cancer treatment can give you a malignant headache. Take one cancer scenario: EGFR-mutation-positive adenocarcinoma of the lung. This is one subset of lung cancer not uncommonly encountered.
In the US, 10,000 such cases are diagnosed each year; in the world, about 100,000.
In Malaysia, a guess estimate would be 800. The treatment of choice for this subset of lung cancer is either gefitinib or erlotinib.
The cost of treatment is RM10,000 a month ($US3,300). This covers the cost of the drug and other incidentals.
How long must the patient take this cancer drug? The answer is, “as long as the drug works”.
Which only begs the next question: “How long will the drug work?”
And this is the tricky part. In some patients, the drug is no longer effective after two months.
In about 5% of patients, the drug keeps the cancer in check for four years or more.
The rest lie in between.
I will tell you with a straight face and an unwavering voice that you will have to budget between RM20,000 and RM480,000 for this treatment, for this particular cancer.
And yet despite this range, I will be perfectly correct and scientifically sound.
Take another scenario: metastatic cancer of the colon, K-RAS wild type.
Again, the number of patients with this cancer is not small, almost as many as the lung cancer subset we discussed.
Seminar after mind-numbing seminar, we are taught that the best results for patients with this subset of colon cancer are obtained if you use up all six effective drugs: 5-fluorouracil, leucovorin, irinotecan, oxaliplatin, cetuximab, and bevacizumab.
We are also taught that liver metastases (spread to the liver) should be resected whenever possible.
If we do our best for patients with this cancer, some will live for six months, and some other fortunate ones live four years or more.
And the cost of treatment? Between RM240,000 and RM1.5mil.
If my figures are wrong, they are wrong on the conservative side.
In HER2 positive metastatic breast cancer, two molecularly targeted drugs are used: trastuzumab and lapatinib.
They are usually used together with conventional chemotherapy.
Again, the answer to the question, “How long must the patient be on the drug?” is “Until the disease becomes worse.”
And this can be anything from six months to five years or more.
Stopping treatment prematurely will make the disease that much worse.
The cost of treatment is very high. Trastuzumab also costs about RM10,000 per month.
The sad thing is that many patients go off treatment because they can no longer afford it…
Source: Money, Money, Money