By Diane Mapes
While many researchers at Fred Hutch are trying to find cures for cancer, Dr. Gary Lyman has an equally daunting task: finding a cure for cancer’s skyrocketing costs and the financial toll it can take on patients and their families.
“We know cancer is one of the most, maybe the most common cause of bankruptcy in the country,” said Lyman, an internationally recognized oncologist and health economist who joined Fred Hutch in January 2014 as co-director of the newly formed Hutchinson Institute for Cancer Outcomes Research (HICOR). “We’re trying to bring a greater awareness and a high level of science to the discussion of the cost and overall value of cancer care.”
HICOR, co-directed by Lyman and Dr. Scott Ramsey, both in the Public Health Sciences Division, was created to leverage the scientific excellence and oncology expertise of the Hutch to reduce cost and improve effectiveness of cancer prevention, treatment and therapy. To accomplish this, the Institute has partnered with a number of stakeholders including patients, patient advocates, physicians, providers and insurers to examine what cancer treatments and practices provide the greatest impact and the greatest value.
“We think everybody has an important perspective we can learn from and should consider if we’re going to make this work,” said Lyman. “We’re trying to optimize the quality of patient care, bring down the costs and ultimately provide the best overall value in cancer treatment.”
As an example, Lyman pointed out that doctors and patients often have choices with regard to the type of cancer treatment used.
“We may have two treatments that give you the same overall benefit but one is much less costly,” he said. “Therefore, it has a greater value in the sense that you’re going to get to the same place but you don’t need to go into bankruptcy or create enormous financial distress for yourself or your family.”
Part of the solution to the high cost of cancer care, which hit $125 billion in the U.S. in 2010 and is projected to reach $175 billion by 2020, is avoiding tests and treatments that have not been shown to be beneficial.
Lyman is on the board of directors of the American Society of Clinical Oncology, which recently published two sets of “Choosing Wisely” guidelines regarding tests, procedures and treatments whose common use and clinical value are not supported by available evidence.
“There are certain things that not every cancer patient needs or should have,” Lyman said. “There may be side effects or complications or they may come with an enormous price tag. If they’re not really improving longevity or quality of life for patients, we need to think again when to use certain interventions or certain strategies.”
The goal of HICOR will be to provide patients, providers, payers and policy makers with the necessary evidence and tools to make informed decisions about appropriate and effective cancer care.
“We’d like to get information in front of doctors about the comparative value of different choices so that they can make a more rational and beneficial selection of the right treatment for the right patient,” he said. “If patients can see that they’re paying for something that not only doesn’t have benefit for them but could cause them both physical and financial harm, they’ll understand why doctors may not recommend going in a particular direction.”
Patient care on a micro and macro level
Lyman brings a wealth of experience to his position with Fred Hutch. In addition to his work with the ASCO Value in Cancer Care Initiative, he’s an adviser to the U.S. Food and Drug Administration and has helped to make groundbreaking oncological recommendations. In 2012, he co-chaired a panel that found that obese breast cancer patients were often not given full doses of cancer drugs, a circumstance which likely contributed to a higher mortality rate. ASCO now recommends most cancer patients treated with the goal of cure receive doses based on their actual weight and height, a decision that may save thousands of patients a year.
A first big success for HICOR since his arrival in Seattle was HICOR’s Value in Cancer Care Summit, held in January. The summit brought together public and private insurers, patient advocates, oncologists and other health care providers to begin the discussion of value in cancer care.
“We have a tremendous opportunity to do something unique that will have impact far beyond the Pacific Northwest,” he said.
HICOR will soon begin gathering data from providers like Swedish, Virginia Mason, Group Health, Seattle Cancer Care Alliance and others to determine “what works, what doesn’t and what’s the most valuable approach when it comes to cancer care,” Lyman said. After analyzing the data – covering everything from biomarkers and molecular testing to end of life chemotherapy -- HICOR will design potential interventions that will help to improve care and reduce cost.
“Practices often don’t have the time and methodologic capability to do these types of analyses,” he said. “So Fred Hutch brings a very important component to the table. We’re glad to do the science, the analysis part of this, to make sure it’s rigorous and the results are valid. And if we show some things work, then I think others around the country are going to be very interested in looking at that and trying them out as well.”
Lyman’s work on behalf of patients won’t all be at the macro level, however. He plans to continue his practice as a breast cancer oncologist with Seattle Cancer Care Alliance one day a week.
“I really enjoy caring for patients and, even if it’s a fairly modest effort, I wanted to continue,” he said. “I don’t want to give up that patient contact. And it’s important for other doctors to know I’ll be having the same kinds of cancer care discussions with my patients as they do.”