The estimated total cost of cancer care in the United States in 2020 is expected to be $158 billion assuming the most recent observed patterns of incidence, survival, and cost remain the same. This represents a 27% increase from 2010 due only to the projected aging and growth of the US population, according to a study published online January 12th in TheJournal of the National Cancer Institute. However, the authors also note the cost of cancer care could rise even more quickly under some reasonable assumptions such as a 2% annual increase in costs of the initial and final phases of cancer care.

Cancer disproportionately affects the elderly population, which is expected to increase from 40 million in 2009 to 70 million in 2030. With changes in risk factor prevalence and stage at diagnosis, and development of new diagnostic tools and treatments for cancer in the 1990s, in general cancer incidence declined and survival improved, but cancer care became more expensive. Under a different scenario of continuing trends in cancer incidence, survival, and costs of care, the total cost of cancer care in 2020 is expected to be $173 billion, an even larger increase (39% from 2010).

To estimate the national medical cost of cancer care through the year 2020 for 13 cancers in men and 16 cancers in women, Angela Mariotto, Ph.D., and colleagues from the National Cancer Institute, analyzed data on cancer incidence (the rates of newly diagnosed cancer in any given year) and survival from the (SEER) Surveillance, Epidemiology, and End Results database and Medicare expenditures associated with cancer from the linked SEER-Medicare database They combined prevalence (the population rates of people alive with cancer in any given year) and cancer costs by phase of care and used US Census population projections to calculate cancer care costs through the year 2020.

The researchers projected prevalence by phase of care under different assumptions about future incidence and survival. Incidence is decreasing for most of the cancer sites. But even with declining incidence rates, the absolute number of individuals diagnosed with cancer will continue to increase because of population changes. The researchers also projected costs by phase of care under different assumptions about future trends.

The authors write, "Costs of care for cancer patients who die of their disease follows a "U-shaped" curve, with the highest costs in the initial phase following diagnosis and the phase before death, and the lowest costs in the period in-between, the continuing phase."

Although the per person cost of cancer care varies tremendously by cancer site, the overall national burden is driven by prevalence. For example, the per person cost of female breast cancer care in each phase is among the lowest, but the total cost of breast cancer in 2020 is projected to be the highest ($20.5 billion) ), because of the large number of women living with breast cancer in each phase of care. The highest increases in costs for cancer care between 2010 and 2020 are projected for female breast cancer (32%) and prostate cancer (42%) patients in the continuing phase, representing a higher proportion of long term survivors.

Looking ahead, the authors write that, "To investigate the impact of specific cancer control strategies on cancer survivorship and to estimate the societal return on investments in cancer research, more complex modeling approaches are necessary."

One such approach is a cooperative study funded by the National Cancer Institute with the Cancer Intervention Surveillance Modeling Network, which uses micro-simulation models to investigate the impact of interventions on population-based cohorts of patients with breast, colorectal, prostate and lung cancers. The authors note that while these types of projections are "undoubtedly more reliable" than the projections used in their article, the models require substantial additional research effort, extensive data on populations in the U.S., and could only be done for a limited number of cancer sites.

Source: Journal of the National Cancer Institute