Cancer's Unrecognized Toll: the Hours Sitting in Waiting Rooms and
Getting Treatment
January 2, 2007                  13:29
By LAURAN NEERGAARD

WASHINGTON --  The hours spent sitting in doctors' waiting rooms, in
line for the CT scan, watching chemotherapy drip into veins: Battling
cancer steals a lot of time - at least $2.3 billion worth of time just
in the 1st year of treatment.  This from the first study to try to put
a price tag to the time that people spend being treated for 11 of the
most common cancers.

Even more sobering than the economic toll are the tallies, by
government researchers, of the sheer hours lost to cancer care: 368
hours in that first year after diagnosis with ovarian cancer; 272 hours
being treated for lung cancer, 193 hours for kidney cancer.

That doesn't count the days spent home in bed recovering from surgery
or weak from chemo, just time spent actively getting care - chemo or
radiation therapy, blood tests or cancer scans, surgery or checkups,
driving to medical appointments and waiting your turn.

It's a study, to be published Wednesday in the Journal of the National
Cancer Institute, that sheds new light on the human costs of cancer.

"What we see here is a measure of the patient's burden of commitment,"
wrote Drs. Larry Kessler of the Food and Drug Administration and Scott
Ramsey of the Fred Hutchinson Cancer Center, in an accompanying
editorial.

"Cancer is more than the just the dollars and cents for the medicines
and the treatments and the doctors. It's also the lost opportunities
for the patients," added Dr. Len Lichtenfeld of the American Cancer
Society, who praised the research for attempting to quantify that often
overlooked reality.

How much a disease costs society plays an important role in
policy-making, such as how much to invest in medical research, but it's
hard to calculate the value of a patient's time spent getting care.

NCI epidemiologist Robin Yabroff and colleagues culled the records of
763,000 cancer patients covered by Medicare, the government's insurance
program for those 65 and older, and estimated the time involved in
traveling to, waiting for and receiving both in-hospital and outpatient
care.

Although most of these patients were retired, the researchers assigned
a monetary value to their time _ $15.23 an hour, the median U.S. wage
rate in 2002. Then they estimated the national toll by including the
number of patients diagnosed with cancer in 2005.

It is almost certainly an underestimate, the researchers said, noting
that younger cancer patients often receive more intensive treatment.

Whatever the dollar figure, the study showed something important to
patients' day-to-day lives, Lichtenfeld noted: Cancers that often are
diagnosed early, when they're more curable, require less treatment
time.

Men with prostate cancer spent just 55.3 hours on treatment in the
first year after diagnosis, and breast cancer patients spent 66.2 hours
- both including about four days in the hospital.

Compare that to cancers with worse survival rates, largely because
they're usually caught late: Ovarian cancer patients struggled the
most, spending about 21 days in the hospital that first year and 368
hours overall getting care. Gastric cancer and lung cancer patients
fared almost as badly, spending about 21 days and 15 days in the
hospital, respectively, and 351 and 272 overall hours in treatment.

The difference shows that investing in research for better early
detection of cancer "has real benefits," Lichtenfeld stressed.

The study also highlights the importance of newer "targeted" cancer
treatments that promise fewer severe side effects and often allow
patients to be treated with pills at home instead of in a clinic, added
Kessler and Ramsey. The pair called on manufacturers to do research on
patients' time toll, and for insurers to better cover new drugs that
reduce it.

One puzzling finding: The shortest treatment time was for melanoma, the
deadliest form of skin cancer, at 17.8 hours the first year.
Early-stage melanoma can be surgically removed with good survival, but
it's often discovered late. The study didn't address if the shorter
treatment time was because melanoma patients had fewer treatments to
try, or some other reason.

Differences in patients' treatment times persisted during their last
year of life, largely because of increased hospitalization, longest for
gastric, lung and ovarian cancers _ 35.4, 32.4 and 31.9 days,
respectively.