In SuperFreakonomics, we write about how chemotherapy is ineffective for treating many forms of cancer, and that it is almost always very expensive. (We also write about the potential conflict of interest when clinical oncologists profit from the administering of these drugs, but that’s another topic for another day.)
Furthermore, it is commonly thought that the nearly-40-year “war on cancer” has largely been a failure, since the age-adjusted mortality rate for cancer is essentially unchanged over that time.
But that’s a deceptive metric. Consider this:
Believe it or not, this flat mortality rate actually hides some good news. Over the same period, age-adjusted mortality from cardiovascular disease has plummeted, from nearly 600 people per 100,000 to well below 300. What does this mean? Many people who in previous generations would have died from heart disease are now living long enough to die from cancer instead.
So how are we to think about the tremendous cost associated with fighting cancer these days?
In a fascinating and important paper new working paper called “An Economic Evaluation of the War on Cancer” (abstract here; pdf here), Eric C. Sun and five co-authors try to measure the degree to which spending on cancer R&D has proved efficient and worthwhile:
For decades, the U.S. public and private sectors have committed substantial resources towards cancer research, but the societal payoff has not been well-understood. We quantify the value of recent gains in cancer survival, and analyze the distribution of value among various stakeholders. Between 1988 and 2000, life expectancy for cancer patients increased by roughly four years, and the average willingness-to-pay for these survival gains was roughly $322,000. Improvements in cancer survival during this period created 23 million additional life-years and roughly $1.9 trillion of additional social value, implying that the average life-year was worth approximately $82,000 to its recipient.
Perhaps even more interesting:
Health care providers and pharmaceutical companies appropriated 5-19% of this total, with the rest accruing to patients. The share of value flowing to patients has been rising over time. These calculations suggest that from the patient’s point of view, the rate of return to R&D investments against cancer has been substantial.
This is good news, of course. It is also a reminder that if you hear a debate about health-care costs and it doesn’t heavily single out cancer costs, then the debate is radically incomplete.
and 
. You can also watch it on 
The statistics also don’t seem to take into account earlier detection. What if we are detecting cancers 4 years earlier? Not saying that is all of the 4 year difference, but it is a large chunk of it.
I’m curious: you guys live with statistics and you’re willing to bring up a paper that tries to estimate massive flows of money over time and yet I’ve seen no mention of studies that discuss the number of people who die because they don’t have health insurance. A very recent study by a group associated with Harvard found that nearly 45,000 Americans die each and every year because they don’t have health insurance. Given the volume of posts about health, why not discuss that? And given the ferocity of feelings about the issue, why not discuss how we’re so willing to spend vast amounts to save lives in one area, such as preventing a few hundred or few thousand lives lost or harmed by terror, and yet so many are unwilling to spend money to save 45,000 lives a year.
Cancer is for the most part a chronic disease which can be slowed considerably by treatment. Cancer medicines however are exceedingly expensive. It is a societal question to determine if the cost is justified. I take issue with your comment “clinical oncologists profit from the administering of these drugs” without mentioning the pharmaceutical industry which sets the astronomical prices and spends obscene amounts of money to market lobby for their use and coverage. This is the root of the cost issue, not the physician.
My wife is living proof that chemotherapy works on some people. There are many different types of cancer with many different response rates to chemotherapy. My wife was lucky enough (that is if you consider being diagnosed with breast caner at that age of 40 as “lucky”) to be diagnosed with a particular type of cancer that while very agressive, it responds well to a drug called Herceptin. Between the February biopsy and October surgery, Herceptin had reduced her tumor from something we could feel to what the pathologist called “a complete pathalogical response.” There was no trace of the tumor at all. She is here with us today because of chemotherapy, something my grandmother and aunt were not so lucky to have.
“Women with breast cancer treated with chemotherapy and after that with Tamoxifen had about 20% improvement in disease-free survival compared to women treated with tamoxifen only.” (www.isrameds.com)
There are two things a pharma/biotech company will take into account before deciding to dedicate billions of dollars to a research area: scientific doability and market attractiveness.
Gains in the understanding of how tumors can be attacked at a molecular level have been considerable, which is why more companies want to put more money at risk to develop new products in this area. However, the vast majority of these projects will fail due to the remaining high hurdles of scientific doability.
Without the market attractiveness i.e. high prices, there would not be such increased focus into product development. New products are what we need and will continue to need in this area for a very long time.
Are you including insurance under “health care providers”? If so, how can insurance be covering less than 20% of the costs? If that’s the case, they’re evading their responsibilities.
Thanks for this post! I’ve always thought that the proper question is not how many people die of cancer – since we *all* have to die of *something* – but rather, how long people are able to live with cancer and how comfortable those years are. For the same reason, I’ve always been confused and a bit frustrated by disease awareness campaigns that focus on how a particular disease is the “#1 killer” or “#3 killer” of a certain population. Even if great strides were made in eradicating the “#1 killer” disease, something else would be the #1 killer. The focus should be on improving the prognosis for a disease, not merely decreasing its prevalence.