U.S. Ranks First in Health Care Spending, but Cancer Outcomes Do Not Reflect the Investment, Study Finds
As published in JNCCN, researchers at The University of Texas MD Anderson Cancer Center found that, at the state level, wealth—not health expenditure—is a determinant for better outcomes in most cancers.
FORT WASHINGTON, PA — The U.S. health care system is characterized—on a global level—by its unsustainable health care spending, which does not necessarily correlate to better outcomes in patients with cancer. With $2.9 trillion spent on U.S. health care in 2013, the United States ranks first in health care spending among the world’s leading economies.
To investigate the implications of socioeconomic status (SES) and health expenditures on cancer outcomes and mortality, researchers at The University of Texas MD Anderson Cancer Center, led by Jad Chahoud, MD, conducted an ecological study at the state level for three distinct patient populations: breast cancer, colorectal cancer, and all-cancer populations. Dr. Chahoud and his associates found that high health care spending did not correlate with better outcomes and lower mortality in colorectal cancer and all cancers, but that state-level SES and wealth does have a positive impact on cancer outcomes and mortality.
The study, “Wealth, Health Expenditure, and Cancer: A National Perspective,” was published this week in the August issue of JNCCN – Journal of the National Comprehensive Cancer Network and is available free-of-charge at JNCCN.org through October 31, 2016.
“Our work provides a new perspective on cancer outcomes disparities in the United States, laying the groundwork for future research to assess the effect of the Affordable Care Act on cancer outcomes across states,” said Dr. Chahoud.
Dr. Chahoud and colleagues extracted gross domestic product (GDP) and health expenditure per capita from the 2009 Bureau of Economic Analysis and the Centers for Medicare & Medicaid Services (CMS), respectively. Using data from the National Cancer Institute (NCI), the investigators retrieved breast, colorectal, and all-cancer age-adjusted rates and computed mortality/incidence (M/I) ratios for each population. In addition to the association between GDP and lower M/I, the data showed a rift between northern and southern states in all three patient populations, with patients in southern states faring worse.
“Our study highlights regional disparities in terms of financial and cancer outcomes, indicating a potential inefficient allocation of resources in the efforts against cancer,” said Dr. Chahoud.
According to the study, the only cancer type in which high health care spending led to lower M/I was breast cancer. The authors suggest that this finding potentially indicates the effectiveness of screening mechanisms, navigator programs, and advocacy organizations, among other initiatives at the state level.
However, in one of a pair of complementary point/counterpoint editorials in the same issue, Melissa A. Simon, MD, MPH, and colleagues from Robert H. Lurie Comprehensive Cancer Center of Northwestern University and Rush University, warn against allowing the data to guide—or misguide—policy makers in states that have high health expenditures to cap or decrease spending for certain health issues.
“Increased spending does not necessarily improve quality of care, but capping or cutting spending on health care does not necessarily solve problems either,” Dr. Simon noted.
Dr. Simon and colleagues’ editorial further notes that the data in this study predate the Affordable Care Act and describes the need for further study and analysis to inform the “the complicated interplay of wealth, health expenditures, and their relationship to cancer screening.”
In the counterpoint, Dr. Chahoud and colleagues agree on that need. “The goal of our study is not to misguide policy makers; instead it is to highlight a problem of disparity and to fuel the discussion at the national level,” responded Dr. Chahoud. “We are not recommending the ‘capping’ of health care spending. Instead, we are advocating for smart spending because complementing financial resources with other community-based and low-cost preventive measures is critical, especially in prevalent cancers, such as breast and colorectal.”
To access the August issue of JNCCN, visit JNCCN.org.
About JNCCN – Journal of the National Comprehensive Cancer Network
More than 23,000 oncologists and other cancer care professionals across the United States read JNCCN–Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside Press. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.asp
About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 of the world’s leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers.
The NCCN Member Institutions are: Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.
 J Natl Compr Canc Netw 2016;14(8):972–978
Katie Kiley Brown, NCCN