‘Treat them into the grave’: cancer physicians’ attitudes towards the use of high‐cost cancer medicines at the end of life

Abstract

The prescribing of high-cost cancer medicines at the end of life has become a focus of criticism, due primarily to concerns about the safety, efficacy and costeffectiveness of these medicines in this clinical context. In response to these concerns, a number of interventions have been proposedfrequently focused on improving physician-patient communication at the end of life. Underpinning these strategies is the assumption that the prescribing of high-cost cancer medicines at the end of life is primarily the result of poor communication on the part of cancer physicians. In this paper, we explore the factors perceived by cancer physicians to be driving the use of high-cost cancer medicines at the end of life. Drawing on semi-structured interviews with 16 Australian oncologists and haematologists, we demonstrate that these physicians believe that the use of high-cost medicines at the end of life is driven by multiple factorsincluding individual, interpersonal, socio-cultural and public policy influences. We conclude that these factors, and their interactions, need to be taken into account in the development of public policy and clinical interventions to address the use of high-cost medicines at the end of life.

Cancer Survivors’ Long-Term Health Service Costs in Queensland, Australia: Results of a Population-Level Data Linkage Study (Cos-Q)

“…Leukemias (with one of the highest per person costs) make up almost a quarter of cancers diagnosed in people under 20 years, while breast, prostate, colorectal cancer and melanoma (with some of the lowest per person costs), make up a relatively higher proportion of cancers in older people. In Australia, there is some evidence of the use of expensive cancer drugs at the end of life, despite limited benefit [ 47 ]. This is partially due to socio-cultural and systemic factors, such as public reimbursement, but also societal attitude towards death and continuing with futile treatments at end of life [ 47 ].…”

“…In Australia, there is some evidence of the use of expensive cancer drugs at the end of life, despite limited benefit [ 47 ]. This is partially due to socio-cultural and systemic factors, such as public reimbursement, but also societal attitude towards death and continuing with futile treatments at end of life [ 47 ]. More research is needed to explore our findings for young cancer patients.…”

Running out of time: The case of patient advocacy for ovarian cancer patients' access to PARP inhibitors

“…Nevertheless, in sociological studies, unclear effectiveness and inappropriate pricing of targeted cancer drugs have been highlighted, raising concerns about unrealistic expectations and false hope (Davis, 2015;Wiersma et al, 2019). This literature suggests that patient advocates often engage uncritically with scientific data on new cancer drugs.…”

Accessing targeted therapies for cancer: self and collective advocacy alongside and beyond mainstream cancer charities

“…Nevertheless, concerns abound in the medical and social science literatures about the hype, limited evidence of effectiveness, and inappropriate pricing of targeted therapies for cancer (Davis 2015 ; Maughan 2017 ; Wiersma et al . 2019 ). Davis’s ( 2015 ) study of what she calls “chemotherapeutic expansion”, based on interviews with cancer patient advocates, regulators, specialists, and other stakeholders in the US and EU, suggests that experimental therapies with limited evidence of efficacy proliferate because of permissive regulatory standards, which prioritize the development of these therapies as a means to grow national bioeconomies, exploiting the hopes of desperate patients with advanced disease.…”