Cancer survival, U.S. vs. Europe: Flawed study makes for flawed headlines

It s a story that s making big headlines: American Cancer Patients Live Longer Than Those in Europe. The implication of the paper, published Monday in Health Affairs, is that all that money we spend on cancer care in the U.S. is, in fact, worthwhile. However, as soon as the research appeared in publication, critics questioned what they perceived to be an overly simplistic conclusion.

In order to examine whether there are significant benefits to the amount of spending on U.S. cancer treatments, researchers led by University of Chicago public policy specialist Tomas Philipson sifted through databases to compare cancer treatment costs and cancer survival data in the U.S. with those costs and outcomes in 10 countries from the European Union, as well as two from the U.K. The data were from the year 1983 through 1999.

The researchers found that U.S. spending on cancer care increased 49 percent over that period, while spending grew by only 16 percent in the European countries. By 1999, the U.S. was spending $70,000 per cancer case (in 2010 dollars), while its European counterparts spent about $44,000. By looking at survival data for patients with a variety of cancer types, they found that, among patients diagnosed from 1995 to 1999, the average duration of survival was 11.1 years in the U.S. and 9.3 years in the European countries.

However, the researchers did observe that a key question for policy makers is whether the U.S. survival gains are actually produced by higher U.S. spending on cancer care or by some other factor unrelated to the health care delivery system.

But Dr. Otis Brawley, the chief medical officer and executive vice president of the American Cancer Society doesn t think the study s results support the authors conclusions. Pointing out what he believes is the study's huge fatal flaw, Brawley explainsthat the over-diagnosis and subsequent unnecessary treatment of cancer in the U.S. is what creates the appearance of increased survival due to treatment.

As other experts have noted, there is a tendency in the U.S. to over-diagnose cancers, and thus spend an unnecessary amount on treatment. Brawley observed that a proper study would have looked at mortality rates, not survival rates. These two outcomes are quite different, since survival time depends on when the cancer was diagnosed, and is thus not as reliable an outcome as the actual death rate.

Even more disconcerting, Brawley noted, is the issue of the costs of cancer treatment both financial and in terms of human harm. We spend money in an irrational way, Brawley said. We harm people by over-treating them, and over-treatment costs money. He acknowledged that, while it s hard for a doctor to tell a patient there is nothing that can be done, and advise against treatment, he also asserted that doctors need to get better at this kind of honesty.

"We all need to take a step back and take a look at reality and ask whether the patient stands a good chance of benefiting from a particular treatment. If there aren't benefits, then we ought to, perhaps, stop," Brawley said. Instead of talking about rationing care, we need to talk about the rational use of care." To which we say, Amen.