Guidelines from the National Comprehensive Cancer Network (NCCN) provide the foundation for treatment of breast cancer in the United States. However, as many as 1 in 5 patients receive treatment regimens that are not recommended by the NCCN, according to a recent study published in the Journal of the National Comprehensive Cancer Network. In this analysis, use of non-recommended treatment regimens was associated with a dramatic increase in the cost of cancer care. The study evaluated out-of-pocket patient costs for 3,709 women with breast cancer diagnosed between 2007 and 2013, and found that treatment with NCCN-recommended regimens had a median patient cost responsibility of $5,171 for the first year post-diagnosis, while treatment with guideline-discordant regimens had a median patient cost responsibility of $7,421 for the same year. In a model that adjusted for patient demographic and clinical characteristics, the difference in patient costs between concordant and discordant regimens in the first year post-diagnosis was significant (β = $1,841; 95% CI, $1,280–$2,401). This increase in cost was primarily due to higher out-of-pocket expenses from insurance deductibles and copayments.

High Altitude: Financial toxicity is a growing concern for patients and all other stakeholders interested in advancing cancer care. New complex treatment regimens are associated with rising costs, including out-of-pocket patient responsibility. Therefore, more emphasis is being placed on choosing treatment regimens that provide increased value to patients at lower cost. This study shows that using guideline-approved treatment regimens is one way to reduce costs, not because these treatments are less expensive, but because the out-of-pocket costs for patients are lower when using approved treatment regimens. This highlights the importance of seeking guideline inclusion for novel therapies as an important strategy to both increase the uptake of new treatments and decrease the financial burden on patients. Additional studies in non-breast cancer patients are needed to determine if similar findings are observed.

Ground Level: While emergence of new treatments has radically improved outcomes for patients with breast cancer, the use of novel therapies has increased the cost of care exponentially. Because of this, strategies to decrease the cost of care are of key interest for all stakeholders, specifically patients. Because the NCCN guidelines exert a major influence on treatment decisions, this study provides reassurance to the community oncologist that following NCCN recommendations will result in both optimal care and decreased cost for their patients with breast cancer.