Affording Supportive Care Medications Hard for 10% of Patients in Cancer Trials; Better Communication with Physicians Needed

Cytotoxic chemotherapy agents are associated with a variety of adverse effects that often must be treated with additional prescription medications. Failure to lessen or resolve the burden of these effects increases the risk of treatment interruption or discontinuation.

Although participants in clinical trials are not charged for the chemotherapy drugs to treat their cancers, they pay for the drugs used to counter treatment-related effects, such as chemotherapy-induced nausea, pain, and opioid-induced constipation. Researchers from Dana-Farber Cancer Institute in Boston, MA, wondered whether some patients cope with the expense of these supportive treatments by adopting cost-saving measures that are ultimately deleterious to their cancer care. This might include delays in filling/refilling prescriptions or failing to adhere to the prescribed dose.

Lead author Deborah Schrag, MD, MPH, and colleagues surveyed 806 of the 1422 participants in the CALGB 80405 study, a phase III trial evaluating the effectiveness of bevacizumab (Avastin) versus cetuximab (Erbitux) monotherapy versus both agents combined in patients with newly diagnosed metastatic colorectal cancer. At the beginning of the study, patients were asked how many different prescription drugs they used, how they afforded them, and whether they discussed drug costs with their physicians. Investigators re-administered the same survey 3 months later to 409 of the original respondents,.

At baseline, 23% (91) of the 409 patients included in the final data analysis reported taking five or more prescription drugs; this increased to 39% (163) at 3-month follow-up. Although 15% of the patients lacked drug coverage, only 10% expressed serious concern about affording their medications. Slightly less than 15% said they resorted to one or more cost-saving strategies. The most common included obtaining samples from their physician (14%), comparison shopping (12%), spending less on basic necessities (9%), borrowing money (7%), and not filling a prescription (7%). Only 3% took a lower dose than prescribed; while this is not a high number, it is still a concern because these patients are more likely to stop treatment because of adverse effects. With some cancer treatments, such as cetuximab, common adverse effects like skin rash are indicative of the drug’s effectiveness, and patients with this response need to stick with their treatment.

Only 12% of respondents said they had discussed the expense of prescription drugs with their physicians. Dr. Schrag said, “If cost is a particular concern, it is important that patients and families communicate this to their doctors early on.” She said physicians might be aware of options to help patients better afford their medications. Dr. Schrag expressed concern that the current economic situation in the United States could make it harder for patients with cancer to afford supportive care medications, especially those who are not enrolled in a clinical trial. “This is one factor,” Dr. Schrag said,” that may contribute to outcome differences in clinical trial versus nonresearch settings.”

ASCO Abstract 9503.