Recommending Unfunded Innovative Cancer Therapies: Ethical vs. Clinical Perspectives among Oncologists on a Public Healthcare System—A Mixed-Methods Study

Abstract

Over the past decade, there has been a growing development of innovative technologies to treat cancer. Many of these technologies are expensive and not funded by health funds. The present study examined physicians’ perceptions of the ethical and clinical aspects of the recommendation and use of unfunded technologies for cancer treatment. This mixed-methods study surveyed 127 oncologists regarding their perceptions toward using unfunded innovative cancer treatment technologies, followed by in-depth interviews with 16 oncologists. Most respondents believed that patients should be offered all treatment alternatives, regardless of their financial situation. However, 59% indicated that they often face dilemmas regarding recommending new unfunded treatments to patients with financial difficulties and without private health insurance. Over a third (38%) stated that they felt uncomfortable discussing the cost of treatment with patients. A predictive model found that physicians facing patients whose medical condition worsened due to an inability to access new treatments, and who expressed the opinion that physicians can assist in locating funding for patients who cannot afford treatments, were more likely to recommend unfunded innovative therapies to patients (F = 5.22, R2 = 0.15, p < 0.001). Subsequent in-depth interviews revealed four key themes: economic considerations in choosing therapy, patient–physician communication, the public healthcare fund, and discussion of treatment costs. Physicians feel a professional commitment to offer patients the best medical care and a moral duty to discuss costs and minimize patients’ financial difficulty. There is a need for careful and balanced use of innovative life-prolonging technologies while putting patients at the center of discourse on this complex and controversial issue. It is essential to develop a psychosocial support program for physicians and patients dealing with ethical and psychosocial dilemmas and to set guidelines for oncologists to conduct a comprehensive and collaborative physician–patient discourse regarding all aspects of treatment.

In Service of the Society? Medical Associations as Agents of Social Change—Implications for Health Policy and Education in Israel

“…The National Health Insurance Law (1994) sets a healthcare package that is uniform, equal, and universal to all Israel's citizens. Pursuant to the law, citizens are insured with mandatory insurance in one of the four health funds that act as non-profit organizations [12]. The health funds' package includes services such as medications, doctors' visits, hospitalization services, mental health services, dental care and paramedical treatments.…”

Patients’ and oncologists’ perceptions towards the discussion on high-cost innovative cancer therapies: findings from a qualitative study

“…The rising burden of cancer, as a leading cause of death in the western world, has accelerated new developments of cancer treatments, such as personalised medicine, immunotherapy and more. [1][2][3] High-cost therapies used to treat cancer are a challenge to national budgets, even in wealthy countries. 4 Therefore, public health systems do not fund most of these treatments, the price of which can be very high and continues to increase.…”

“…The rising burden of cancer, as a leading cause of death in the western world, has accelerated new developments of cancer treatments, such as personalised medicine, immunotherapy and more 1–3. High-cost therapies used to treat cancer are a challenge to national budgets, even in wealthy countries 4.…”