Following the life stages of baby boomers has become somewhat of a national pastime — and now, as the flower-power generation reaches the age of Medicare eligibility, policymakers are wondering how much their health care will cost.
A new study published today by researchers at the National Cancer Institute (NCI) predicts how much more the nation can expect to spend on its collective cancer care a decade from now.
The aging of the population alone means that the cost of cancer care will increase by 27 percent between 2010 and 2020, the study showed. That's a jump from $125 billion now to $158 billion in 2020 (in 2010 dollars), and doesn't take into account any increase in cancer rates or in the cost of treatment.
And when the researchers included estimates of cancer care continuing to become more expensive, the dollar amount projected for 2020 increased even more.
"I think the rising costs represent a challenge for both government and private sectors," said lead researcher Angela Mariotto, who is a branch chief of data modeling at the NCI, part of the National Institutes of Health.
The report was published today (Jan. 12) in the Journal of the National Cancer Institute.
Planning ahead
"We thought that, given the aging of the U.S. population, we should try to provide some numbers for policymakers and health planners so they could prepare for the future," Mariotto said.
The researchers used data from Medicare payments and the Surveillance, Epidemiology and End Results (SEER) survey, and modeled several scenarios in cancer advancement to determine how much cancer care is likely to cost ten years from now.
For example, if cancer costs continue to rise by 2 percent a year across all cancer types, the cost of cancer care would rise to $173 billion by 2020 — a 39 percent increase from 2010 spending.
"But for some cancer sites, and some new chemotherapy agents, then you could see much higher increases," Mariotto said.
For that reason, Mariotto said her team took into account the possibility that cancer costs could increase at a higher rate. Her upper estimate — that cancer costs would rise by 5 percent a year — would raise cancer spending by 66 percent in 2020, up to $207 billion a year.
However, Mariotto said, it "was surprising that the main driver of these cost estimates are the aging of the U.S. population."
While nothing can be done about an aging population, ethicists, public policy experts and cancer researchers said the report is still able to influence key decisions about the future.
"It's a nice study. It is the most comprehensive set of estimates, that I've seen," said Ken Thorpe, professor of health policy at Emory University in Atlanta. "It really identifies what the potential savings in health care spending are."
For example, Thorpe said efforts to reduce smoking rates and fight obesity could reduce cancer costs by preventing cancer in the first place.
"Seventy-five percent of what we spend in health care is linked to chronically ill patients; less than 3 percent [is spent] in prevention," Thorpe said. "We do a great job of taking care of people after they're sick, we do a mediocre job of preventing people from getting sick."
Elizabeth Ward, national vice president of intramural research at the American Cancer Society, agreed that the study was essential to prepare policymakers for the aging baby boomer population.
But given the projected high costs of cancer care during the last year of life, Ward said that some cost reductions may come from research into when hospice care should be offered instead of end-of-life care within a hospital.
"Some of the costs for the last year of life are multiple hospital admissions, and there may be ways that you can improve the care of patients and reduce the costs," Ward said.
Limited resources raise ethical questions
The report also raises some tough ethical challenges, said Nancy Berlinger, a research scholar at the Hastings Center, an independent bioethics research institute in Garrison, N.Y. Berlinger said oncologists have already faced a burden in deciding between available treatment options that have some medical benefit, but drawbacks in terms of hassle, side effects and cost.
But Berlinger agreed end-of-life care may also play into ethical questions as the population ages.
"One of the key ethics questions is, 'what is a fair way to allocate limited resources?', because all medical care is a limited resource," Berlinger said. "Even if one could pay for everything with cash – not all cancer is curable and one's cancer cells do not care how rich you are."
She said in many cases, taking a look at patient suffering can actually lead to better resource management.
Berlinger cited a 2010 study led by Dr. Jennifer Temel at Massachusetts General Hospital, which followed two groups of patients with terminal lung cancer during the last year of their lives. One group started palliative care (in which providers try to relieve symptoms and suffering, rather than cure a disease) while also receiving cancer treatments, while another group received palliative care later in their treatment.
The study found the group who received palliative care earlier lived longer, and actually used less expensive end-of-life treatments.
But Mariotto said the report indicated a need to research targeted drug therapies.
"With these target therapies… you can individualize [who] are the individuals who will be receive the benefits and who will not," Mariotto said.
By sequencing genes, doctors have already begun to find exactly which patients will respond to which drugs – saving costly, unnecessary treatments, she said.
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