Insurers could reduce long-term costs with precision oncology in cancer treatment: expert

A no-stone-left-unturned approach can prevent unnecessary expenses and greatly prolong lives, says Cancer Treatment Options and Management

Insurers could reduce long-term costs with precision oncology in cancer treatment: expert

Even with Canada’s public healthcare system, cancer remains a hugely costly disease for people in this country. A 2010 study by McMaster University estimated that Canadian cancer patients lose approximately 26% of their income, before having to pay for expensive cancer therapies.

What’s even worse is that patients frequently undergo treatments that don’t work — all because they were diagnosed incorrectly.

“By and large, Canadian oncologists identify cancers based on their location in the body,” said Michelle Morand, co-founder of Cancer Treatment Options and Management (CTOAM), a Canada-based personalized cancer care and precision oncology service.

The problem with location-based diagnoses, she said, is that they’re highly inaccurate; ultrasounds and MRIs, for example, are only 60% accurate in determining the type of cancer a patient has. That’s because cancer arises from genetic mutations, which means the correct treatment depends less on a tumour’s location and more on the “broken” genes that caused it.

“A lot of rudimentary diagnostic techniques involve guesswork and have high false positive and false negative rates,” Morand said. “That can lead to oncologists incorrectly recommending treatment or surgery for healthy individuals, or mistakenly giving cancer patients a clean bill of health.”

Traditional cancer therapies can also fall short. An ideal treatment would target only the cancerous cells in the patient’s body. However, frequently adopted treatments like chemotherapy and radiation have serious side effects, including a heightened risk for more genetic mutations.

“There was a time when standard chemo and radiation were the best we had and they saved a lot of lives,” Morand said. “But not enough professionals recognize that we have other, more precise and beneficial ways to detect and fight cancer now.”

Because of these gaps, she said, insurers frequently end up paying for therapies that are too often chosen on the basis of low cost than effectiveness — only to later pay for even more therapies and, in the worst cases, paying out death benefits sooner than expected.   

CTOAM aims to solve that problem through precision oncology, which involves four basic steps. The first is precision diagnosis – the cancer is detected within the patient’s body through a PET-CT scan and a biopsy is collected. CTOAM then performs a broad genetic panel — a test designed to look at 400 genes for possible cancer-causing mutations. The PET-CT and genetic tests together, according to CTOAM, have an accuracy of over 99%.

Next, there’s the medical review; the company looks at medical databases, as well as the patient’s medical records, family history of illness, and other information. After that, a targeted therapy or set of targeted therapies — which could include antibody-based treatments or small-molecule drugs — is prescribed.  Finally, liquid biopsies are collected and tested for cancer markers during treatment to determine for sure whether the regimen is working.

Precision oncology’s reliance on state-of-the-art testing means that it’s costly compared to what the public health system offers, but patients have a limited but expanding set of options to mitigate out-of-pocket costs. Numerous boutique insurance firms include precision oncology as part of a high-end insurance add-on for serious illnesses. Certain mid-tier policies cover a few thousand dollars for a medical review and second opinion provided by CTOAM; top-tier plans also cover genetic tests as well as recommended targeted therapies.

Morand hopes precision oncology will become a more typical feature in health insurance policies. But more importantly, she said, plans should include precision oncology coverage only if all four elements of the program are followed.

“It’s foolish for insurance companies to cover any sort of targeted therapy or immunotherapy if the proper diagnostic tests weren’t performed beforehand,” she said.