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News Analysis contains excerpts from the For Expert Comment service. The service, which provides timely faculty comments to media across the country, is distributed by the Office of University Communications.
In Missouri and in most states, the cost of cancer clinical trials is borne by pharmaceutical companies, the federal government or patients and their families. Timothy J. Eberlein, M.D., director of The Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and the School of Medicine, argues that medical insurers in Missouri should follow the example recently set in New Jersey and some other states and voluntarily cover cancer clinical trials.
"As a surgeon who has spent more than 20 years caring for cancer patients, I was encouraged to hear of the recent commitment by some medical insurers to pay for clinical trials of experimental cancer treatments," Eberlein said. "Here's why.
"Virtually every improvement in cancer care during the last several years, from improved therapy combinations for testicular cancer to new chemotherapy combinations for acute leukemia to better surgical options for breast cancer, has resulted from clinical trials. Without them, advances in cancer care would grind to a halt.
"Imagine if the computer industry had decided a decade ago to stop investing in new technologies, and we had to manage with the computers of yesteryear or without the Internet," he said. "When patients' lives hang in the balance, the scenario becomes much more tragic.
"Nationally, only about 3 percent of adults with cancer participate in clinical trials," he continued. "The percentage is significantly higher here at The Alvin J. Siteman Cancer Center, yet some eligible patients cannot gain the funding to participate.
"I would encourage the Missouri Association of Health Plans to embrace the need for cancer-trial coverage," Eberlein emphasized. "The benefits of clinical trial participation become clear when you consider our progress against childhood cancers in recent decades. More than 95 percent of children with cancer in the United States now participate in these trials. As a result, 80 percent likely will survive compared to a 20 percent survival rate 25 years ago.
"In addition, clinical trials often lead to dramatically reduced overall costs," he said. "Twenty years ago, for example, women with breast cancer routinely received mastectomies, resulting in hospitalizations of up to two weeks. Today, such patients frequently are treated as outpatients using new treatment options that proved their worth in clinical trials. Similarly, patients with leukemia now benefit from protocols for high-dose chemotherapy that have improved survival while markedly reducing insurers' costs.
"By supporting carefully designed clinical trials that minimize patient risks, the Missouri Association of Health Plans would make a bold statement," Eberlein concluded. "State medical insurers would initially share the financial burden for cancer clinical trials. However, the long-term reward -- improved care that can add years to peoples' lives -- is a goal that we should not compromise."
