CAD Patients With Cancer Diagnosis Face Significant Financial Burden

Patients with coronary artery disease (CAD) who are also diagnosed with cancer have significantly higher short-term expenses related to CAD than similar patients without cancer, investigators found.

That situation is even more financially problematic for CAD patients diagnosed with colorectal cancer, as their CAD-related expenses increase by more than 150% compared with their counterparts without cancer, reported Ishveen Chopra, PhD, of West Virginia University School of Medicine in Morgantown, and colleagues.

“The diagnosis of cancer in patients with preexisting CAD is a unique challenge for effective disease management, because it involves multiple chronic conditions,” Chopra told MedPage Today. “And both are life-threatening conditions that have unique management challenges. So, what our findings show is there is a need for more patient-centered and coordinated care among these patients, as well as an interdisciplinary and integrated approach to management of both conditions by multiple healthcare providers or specialists.”

As the team noted in their study, published in the Journal of the National Comprehensive Cancer Network, there has been a lack of research on the impact a cancer diagnosis can have on CAD-related expenditures. However, the researchers explained, estimating the effect that incident cancer has on CAD-related expenditures can help payers as they adjust to emerging healthcare delivery reform initiatives. Furthermore, new payment models are likely to require risk adjustment for patients, which means identifying patients at risk for higher costs, which has become increasingly important.

Chopra and co-authors used the SEER-Medicare registry, along with a 5% noncancer sample of Medicare beneficiaries, to compare the costs of treating 12,095 patients with CAD who were also diagnosed with colorectal, breast, or prostate cancer, with the costs of treating patients with CAD (n=34,237) who didn’t have cancer.

Patients’ healthcare expenses were measured every 120 days during the 1-year pre- and post-index periods (index date defined as the date of cancer diagnosis for the cancer group and pseudo-diagnosis date for the noncancer group).

The researchers determined that CAD-related mean expenditures in the pre-index period accounted for 32.6-39.5% of total expenditures among women, and 41.5-46.8% among men.

All of the cancer patient groups had higher outpatient and CAD-related expenditures than those patients without cancer. Inpatient expenses were higher for patients with colorectal cancer, but not breast or prostate cancer, compared with patients without cancer.

Men and women with colorectal cancer had much higher CAD-related expenditures (166% and 153%, respectively), compared with those patients without cancer. And CAD-related expenses were considerably higher for men and women with colorectal cancer (57% and 55%, respectively) than CAD patients with breast or prostate cancer.

“Based on our study findings, it is apparent that resource allocation for CAD-related expenditures should be higher for patients with [colorectal cancer], followed by prostate and breast cancer,” Chopra and her colleagues wrote.

Chopra suggested that the cancer treatment, rather than the cancer itself, accounts for the increased CAD-related expenses in colorectal cancer patients: “With colorectal cancer the treatment usually involves cardiotoxicity,” Chopra pointed out. “For example, FOLFOX has been shown to be cardiotoxic. Therefore, the management for CAD becomes difficult for these patients. Sometimes they have to be taken off medications before cancer therapy, or if they are undergoing surgery. That really affects their preexisting CAD.”

The researchers also found that CAD-related inpatient expenditures accounted for two-thirds of the overall CAD-related healthcare expenditures, and suggested that “future research needs to focus on collaborative care models, such as the patient-centered medical home, because such models have been shown to reduce inpatient use.”

“For many years clinicians have recognized the impact of cancer chemotherapy treatments on the cardiovascular system,” said John Fanikos, MBA, RPh, executive director of Pharmacy Services at Brigham and Women’s Hospital in Boston, and a member of the panel that develops and updates the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology for Cancer-Associated Venous Thromboembolic Disease, in a press release.

“With the explosion in new therapies and treatments for cancer, this relationship has magnified. In the recent publication by Dr. Chopra, et al., the authors show that health care spending for CAD-related services in elderly Medicare beneficiaries is higher for those with cancer than those without,” Fanikos continued. “It highlights the importance of maintaining collaborative relationships between cardiovascular and oncology practitioners for patients that require prevention, early detection, or optimal management when these two conditions intersect.”