Integrating Heart Disease and Cancer Care Could Reduce Overall Health Care Costs, According to Researchers

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Study in JNCCN finds coronary artery disease costs increase dramatically in patients who are diagnosed with cancer

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National Comprehensive Cancer Network

Feb 20, 2019, 10:28 ET

PLYMOUTH MEETING, Pa., Feb. 20, 2019 /PRNewswire/ -- New research in the February 2019 issue of JNCCN—Journal of the National Comprehensive Cancer Network calls for much greater integration between cardiologists and oncologists for patients with coronary artery disease (CAD) who are diagnosed with cancer. CAD—commonly referred to as clogged arteries—is the most-common type of heart of disease, and the leading cause of death in the United States. The researchers found that CAD-related medical expenses were considerably higher for patients with this chronic condition who were also diagnosed with cancer, particularly colorectal cancer.

"Heart problems that needed to be treated with in-patient hospitalization accounted for the highest added expenditures; representing two-thirds of the total costs," explained lead researcher Ishveen Chopra, PhD, MBA, Department of Pharmaceutical Systems and Policy, West Virginia University. "There is a need for more coordinated and patient-centered care among older adults with multiple chronic conditions. An interdisciplinary and integrated approach to cardiovascular management in the elderly diagnosed with incident cancer would improve cardiovascular outcomes."

The study used the SEER-Medicare registry as well as a 5% non-cancer random sample of Medicare beneficiaries to compare costs for 12,095 CAD patients diagnosed with breast, colorectal, or prostate cancer, against the costs of 34,237 CAD patients with no cancer. All were continuously enrolled in traditional, fee-for-service Medicare plans. Every individual was 68-years-old or older, and remained alive during the entire 48-month study period. Health care expenses were measured every 120 days during the one-year pre- and one-year post-cancer diagnosis, and were adjusted by the Consumer Price Index for medical services and expressed in 2012 dollars.

The results showed that CAD expenses post-cancer diagnosis increased approximately three times over pre-cancer costs, for people with colorectal cancer. The post-cancer diagnosis expenses were twice as high for women with breast cancer, and one-and-a-half times higher for men with prostate cancer. At the same time, CAD costs in the noncancer group remained steady for the entire time period.

The authors speculated that some of the cost increases could stem directly from cancer treatment.

"Treatment regimens used for colorectal cancer may increase cardiotoxicity and therefore increase the CAD management cost to patients," said Dr. Chopra. "In addition, non-adherence to CAD medications during cancer treatment may also contribute to higher CAD complications and total overall costs."

"For many years clinicians have recognized the impact of cancer chemotherapy treatments on the cardiovascular system," said John Fanikos, MBA, RPh, Executive Director, Pharmacy, Brigham Health, and Member of the panel that develops and updates the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) for Cancer-Associated Venous Thromboembolic Disease Panel. "With the explosion in new therapies and treatments for cancer, this relationship has magnified. In the recent publication by Dr. Chopra, et al, the authors show that health care spending for CAD-related services in elderly Medicare beneficiaries is higher for those with cancer than those without. It highlights the importance of maintaining collaborative relationships between cardiovascular and oncology practitioners for patients that require prevention, early detection, or optimal management when these two conditions intersect."

The authors concluded that providers can reduce many costs by preventing inpatient encounters. They suggest that more research is needed to determine how emerging payment reforms and collaborative care models can lower costs while maintaining high-quality care.

To read the entire study, visit JNCCN.org. Complimentary access to "Impact of Incident Cancer on Short-Term Coronary Artery Disease-Related Healthcare Expenditures Among Medicare Beneficiaries" is available until May 10, 2019.

About JNCCN—Journal of the National Comprehensive Cancer Network
More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside Press. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.asp. Follow JNCCN on Twitter @JNCCN.

About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network^® (NCCN^®) is a not-for-profit alliance of 28 leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, efficient, and accessible cancer care so patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. By defining and advancing high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers around the world.

The NCCN Member Institutions are: Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Dana-Farber/Brigham and Women's Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Comprehensive Cancer Center, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Rogel Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.