Cancer and Comparative Effectiveness

In cancer care, patients are paying more and getting less. Spending for oncology services is increasing by over 15% annually, faster than the background growth in overall expenditures. Next-generation “precision-therapies” carry the promise of identifying and targeting specific molecular alterations in cancer cells, but many also carry extremely high price tags – some reaching six- and even seven-figures. Expensive technologies like robot-assisted surgery have become ubiquitous, alongside molecular diagnostic tests and advanced imaging modalities. Despite this influx of resources and expensive new technological advances, the death rate from the most common cancers has only slightly declined. This has led some researchers to state that we face a “value crisis” in oncology.

This program aims to improve the value and effectiveness of cancer care by identifying drivers of high and low-value care. We focus on policy and health systems-based changes to better understand how to improve access to high-quality cancer care that makes a difference, including: screening, vaccinations, tobacco cessation, appropriate genetic testing and more, while protecting patients against high cost-sharing requirements.

Our work touches on a variety of topics with key relevance to today’s pressing questions in health policy. By drawing on our expertise in big data analysis, we provide insights on how policy changes may impact patients. As the repeal of the Affordable Care Act (ACA) was being debated in Congress, we published research assessing how the ACA impacted cancer screening and detection of early stage cancers. As states took Medicaid expansion to the ballot box, we provided valuable insights into the role of Medicaid expansion on utilization of surgical care and cancer screening.

Other work focuses on nationwide patterns of self-reported prostate-specific antigen screening; racial differences in the surgical care of patients with prostate cancer; effects of androgen-deprivation therapy; changes in low value care with the adoption of alternative payment models, variations in costs, and the impact of technological advances in cancer care.

The impact has already been realized: our work was cited in a 2016 Medicare rule change regarding payments for robotic surgery and has been featured in high impact journals including JAMA, JAMA Oncology, and the Journal of Clinical Oncology. Because many of our research topics have key pertinence to issues of public policy, we have also published academic work targeted specifically at the lay public, including articles in STAT Opinion and The Boston Globe.