Thursday, October 21, 2010

I don't like this idea

I understand the desire to rein in health care costs. I understand that cancer is a very expensive illness to treat. I understand that having standard treatment protocols is a usual practice. I don't understand why insurance companies are trying to get involved with deciding doctors need to follow standard protocols for cancer treatments as a way to control costs.

One of the things you learn with cancer is that every cancer is different. You can take two patients with the same cancer diagnosis and their treatments may differ. Tumor aggressiveness, lymph node status, tumor size, age of patient, other health issues, etc.

In cancer staging, there is some wiggle room. For example with my diagnosis of Stage IIA breast cancer it is defined as one of these three conditions:

'The tumor is 2 cm or less across (or is not found) and either:

* It has spread to 1 to 3 axillary lymph nodes, with the cancer in the lymph nodes larger than 2 mm across , OR
* Tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy, OR
* It has spread to 1 to 3 lymph nodes under the arm and to internal mammary lymph nodes (found on sentinel lymph node biopsy).

OR

The tumor is larger than 2 cm across and less than 5 cm (T2) but hasn't spread to the lymph nodes and the cancer hasn't spread to distant sites (M0).'


So with this range of possibilities, it opens up a lot of different treatment options based on tumor size and lymph node invasion alone. The insurance companies are working with groups of doctors to create treatment protocols that might be less costly. Any doctor would agree there are multiple ways to treat a cancer and that the choice of which chemo drugs, the most costly part of cancer treatment, is dependent on many factors. I think the doctor involved in the treatment should be the one making the decisions not a panel of doctors who haven't ever met the patient.

2 comments:

linda said...

The insurance companies know that more cancer is coming with baby boomers aging. This is a problem for their bottom line. They see controlling costs as a solution. Unfortunately, this is a typical response of short-sighted vision. They know we will be the most costly generation so far. Not just with cancer, but Alzheimer's disease, diabetes, heart disease, you name it and large numbers of people will get it. My guess is they're looking at controlling costs for all diseases before they get swamped with claims.

nancyspoint said...

I agree, insurance companies should not be involved in making medical decisions. That should be left up to each doctor and their patient.