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Cancer Trends Progress Report – 2011/2012 Update

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Costs of Cancer Care
Life after Cancer

National cancer care expenditures were an estimated $124.6 billion in 2010.

The financial costs of cancer care are a burden to people diagnosed with cancer, their families, and society as a whole. National cancer care expenditures have been steadily increasing in the United States. Cancer care accounted for an estimated $124.6 billion in medical care expenditures in the United States in 2010. In the near future, cancer costs may increase at a faster rate than overall medical expenditures. As the population ages, the absolute number of people treated for cancer will increase faster than the overall population, and cancer prevalence will increase relative to other disease categories—even if cancer incidence rates remain constant or decrease somewhat. Costs are also likely to increase as new, more advanced, and more expensive treatments are adopted as standards of care.

The national economic burden of cancer care in 2010 is shown below for bladder, brain, female breast, cervical, colorectal, esophageal, head and neck, kidney, lung, ovarian, pancreatic, prostate, stomach, and uterine cancers, as well as lymphoma, leukemia, and melanoma. All other cancers are combined as a single category.

National expenditures were largest for lymphoma and female breast, colorectal, lung, and prostate cancers, reflecting prevalence of disease, treatment patterns, and costs for different types of care.

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Expenditures associated with cancer are commonly reported by phase of care, which divides care into clinically relevant periods: (1) the initial phase, which is the period after diagnosis, (2), the continuing phase or the monitoring phase, which is the period between the initial phase and last year of life phase, and (3) the last year of life. Expenditures for cancer patients with short survival are typically grouped with the last year of life phase because their care is most similar to care received at the end of life. For all cancers, annualized costs associated with cancer are highest in the initial and last year of life phases and lowest in the continuing phase of care, following a “u-shaped” curve.

National expenditures in 2010 are calculated by combining 2010 cancer prevalence by cancer site and phase of care with annualized expenditures associated with cancer care in 2010 dollars.

The following figures display expenditures by phase of care and the proportion of expenditures by phase of care for the 17 cancer sites and all cancer sites combined. Estimates do not include expenditures related to screening, which are likely to be substantial in 2010.

Cancers with the largest expenditures in the initial phase of care in 2010 are female breast, colorectal, lung, and prostate. In the last year of life phase of care, cancers with the largest expenditures are lung, colorectal, lymphoma, and female breast. In the continuing phase of care, female breast, prostate, lymphoma, and colorectal cancers have the largest expenditures.

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In this cross-sectional snapshot of national expenditures for cancer care in 2010, the proportion of expenditures in each phase of care varies by cancer type. For cancer types with short survival following diagnosis, such as pancreas, stomach, and lung, the majority of expenditures in 2010 are for patients in the initial and last year of life phases, with only a small percentage for patients in the continuing phase. Other cancer types with longer survival, such as female breast, melanoma, and prostate, have a higher percentage of expenditures for patients in the continuing phase of care.

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The types of cancer care and associated costs vary by cancer site. The percentage of Medicare payments in the first year following diagnosis in 2002 stemming from cancer-related surgery, chemotherapy, radiation therapy, other hospitalizations, and other services among the four most common cancers is listed in Figure 4. The percentage of all care represented by hospital care, either associated with cancer-directed surgery or other hospitalizations, varied for female breast (43 percent), colorectal (72 percent), lung (50 percent), and prostate cancers (33 percent). The percentage of first-year costs attributable to chemotherapy and radiation therapy also varied by cancer site.

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Direct medical expenditures are only one component of the total economic burden of cancer. The indirect costs include losses in time and economic productivity resulting from cancer-related illness and death. Using earnings to value lost productivity caused by premature cancer deaths in the United States, mortality costs associated with an approximately 600,000 cancer deaths in 2005 are estimated to be $134.8 billion . Lost productivity because of cancer deaths is greatest for lung, colorectal, and female breast cancers. Based on projected growth and aging of the U.S. population, productivity costs will increase if cancer mortality rates are constant in the future.

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