Ryan Haumschild, PharmD, MSc, MBA: One of the very important things that I heard from you is to make sure that we catch colorectal cancer early, that we target the right interventions for those patients, because treatment is expensive. There are costs to patients, especially if: [a patient’s cancer is] Metastatic. We’re thinking about the total cost of care, not just to the health system and cancer center, but also to the payer. Think about hospitalizations, all kinds of surgical interventions and treatments, and the financial burden that can lead to on patients, health systems, and payers over time. So I think that’s one of the things that we really have to realize. Dr. Fenstermacher, I know you have done a lot of research and are very familiar with this disease condition. Could you elaborate further on the economic impact of metastatic colorectal cancer on individual patients and the economic harms, as well as on the health care system as a whole?
Dr. David Fenstermacher: This is an important question, especially in regards to what John brought up earlier. [how] The impact is different because more patients have early-onset colorectal cancer. But first, let me talk a little bit about the strain on the health care system. Looking at cancer treatment as a whole, we are currently forecasting that around 2020, approximately $200 billion will be spent annually on all cancer treatments. Looking at colorectal cancer, the cost associated with colorectal cancer is second only to breast cancer for women. So, as you can see, we spend $22 billion treating colorectal cancer. This is a huge burden not only on the health care system itself, but also on payer systems such as Medicaid, Medicare, and insurance companies. And this in itself becomes a real detriment because of the amount of care that has to be provided. And most of that treatment occurs within the first year of diagnosis. So if you look at the cost, probably 60% of the cost is in the first year.And of course it decreases over time [continuation of] illness and terminal illness. That is the reality we are facing.
But for patients, this is very different. When you think about the toxicity a patient experiences, whether or not the patient has full insurance is another matter. It’s either underinsured or uninsured. The cost of cancer treatment can be very expensive. It is very important to perform the biomarker tests mentioned above. By understanding the biomarkers of the tumor itself and understanding the genetics of germline DNA, we understand what the molecular mechanisms of cancer are. These tests can be expensive. They can also be a significant burden if you are underinsured or uninsured.But it also costs a lot of money [individuals] Don’t think about it. I have to take time off from work to receive IV treatment. Of course, now household incomes are decreasing. This creates a burden. You may not be able to pay your rent, electricity bill, or even buy food. So this is a real trade-off. As John said earlier, we’re working on a project trying to understand what these economic harms and other burdens are. [patients] We will ensure that we find ways to access treatment and reduce the inequalities that are occurring so that we can increase cancer treatment for everyone. But part of it is really, really understanding what the implications are for the patient financially, emotionally and medically so that we can treat them holistically and make sure they have the resources they need. That means you need to do it.
Ben George, MD: [W]When talking about economic impact [on] The real question that society as a whole, all of us, are asking is, when there is so much economic toxicity, not to mention the systemic toxicity associated with treatment, what can we do for early detection and prevention? I think.Divert costs when there are patients [receive a cancer diagnosis] You have to go through all the difficulties associated with treatment at a very late stage.
Dr. David Fenstermacher: But if you can catch it early in Stage I. [or] II, Basically, the cure rate for these cancers is 90%. And usually, a colonoscopy involves removing cancerous polyps. It may be possible to treat it on the spot without any other intervention.
Ryan Haumschild, PharmD, MSc, MBA: I like that we can catch it early and reduce some of the economic harm, and that we can also see when we’re screening patients to see if there’s economic harm. class Is it a mutation? [microsatellite instability]-expensive. This means that they are very important for choosing the right treatment early on for the best results. Speaking of reducing some of the costs of early detection, Dr. Marshall, I know you’re doing a lot of work on this effort and you’re having an impact on early detection and the importance of it. Masu. What is the significance of early detection of colorectal cancer? [I]Considering that we sometimes have [fewer] patient coming in [due to] of [COVID-19] Pandemic; some say it’s over, but some patients won’t come for a long time. How do we provide appropriate screening and early detection given new practice models where patients are more accustomed to telemedicine and may not be as compliant with physician visits?
John L. Marshall, MD: My answer to this is going to be a little controversial. Let’s step back for a moment and consider what screening is. If you are screening a healthy population rather than people who are at risk or have genetic problems or family history; [but] Ordinary people just come to get tested. Screening tests are considered non-invasive. They should be inexpensive and should have high sensitivity and specificity. And of the tests we have, the only one that I think fits the bill is the melanoma skin test. Everything else is invasive or expensive. When we talk about colonoscopies or some type of stool test for everyone, we’re saying that we understand that by intervening we can improve survival rates. We know that we can detect more cancers if we intervene and catch them early. Therefore, adoption of screening techniques increases incidence. But what we really need to prove is that [is] Will it get better? [individuals]• You would have to test 100 people to find one person with colon cancer.? There was no need to screen 99 [persons], this is a big cost. We have to do a better job.And double this with young people [patients] Get colon cancer. I’ve seen this bar move.It was always like that [age] 45 [years] for African Americans [patients], But some insurance companies didn’t cover it.And in response to these young people turned 45 [individuals] Get colon cancer. But what about people who are 40 years old? What if you are 30 years old? Our basic understanding of colon cancer biology and early detection is not very good. We need to go one step further and say we don’t really know the best way. There is a certain biology of the colon that colonoscopies and stool tests can detect and repair early lesions. But we’ve all had the case of a patient who had a perfectly normal colonoscopy two years ago and is now sitting in front of us with stage III colon cancer. To meet the criteria of cheap, non-invasive, high sensitivity and specificity, we need to get smarter.
Dr. David Fenstermacher:I completely agree with you. And what I think helps identify patients at risk is polygenic risk scores. As we sequence more and more patients, we will learn what the genetic determinants are that are not understandable from a Mendelian perspective, but certainly understandable from a polygenic risk score perspective.So hopefully you can reduce them [who] They undergo screening using invasive methods and focus on high-risk subgroups based on genetic risk scores.
Ryan Haumschild, PharmD, MSc, MBA: I think it needs to be the future. Because I think Dr. Marshall expressed it really well when you have these invasive methods of screening patients, not everyone may be able to come, or they may not be able to come. And maybe they’re doing routine screening and then suddenly they move on to the next stage. And the patient says, “Okay, what should I do?” How could we have prevented this? And I think this is a reality that we have to accept in colorectal cancer. How can we do better for our patients? How can we increase screening rates and early detection? Because…if someone comes in today, as you gave a good example of Stage III, Because there is a different prognosis and conversation with that patient.
Transcripts are generated by AI and edited for clarity and readability.