The true costs of cancer in Europe revealed

"Here we have two studies of enormous importance," noted Prof Peter Boyle, President of the International Prevention Research Institute in Lyon, France, Member of the ESMO Faculty group on Cancer Prevention, who was not involved in the studies. "It is essential to have knowledge of the total costs of cancer and Dr Luengo-Fernandez and colleagues have performed a great service in preparing such a detailed report".

"The remarkable study of Dr Gilloteau and colleagues provides unique information on the impact of cancer on care-givers. This again is key information and is almost unique. These studies provide a background on which logical funding decisions can be made," Prof Boyle concluded.

Total cost 124 billion Euros each year... highest costs in Germany

Cancers cost the European Union 124 billion Euros each year, according to the first ever estimate of the economic burden of malignancies in the region. Lung cancer is responsible for the highest overall burden, the new study shows.

Dr Ramon Luengo-Fernandez from the University of Oxford, UK, and colleagues included direct health costs such as primary care, hospital care and medications, as well as the cost of informal care and losses in productivity in their calculations. Their data came from a variety of sources including the WHO, the OECD and national ministries of health.

"Cancer poses a considerable economic burden not only to healthcare systems but to other areas of the economy, including productivity losses through early mortality and time-off-work, and relatives who have to forego work/leisure to care for cancer patients," Dr Luengo-Fernandes said.

"Healthcare systems will have a good idea, I expect, of the healthcare costs of providing cancer care to their patients. However, the productivity losses and informal care costs associated with cancer will be less well understood and their magnitude less appreciated."

The researchers break their figures down by country, and by cancer. The lowest per-capita healthcare cost for cancer was 32 Euros per year in Lithuania, while the highest was in Germany where an average of 165 Euros was spent on healthcare for every person in the population.

"The countries with the highest per-capita costs in terms of cancer healthcare tend to be Northern and Central European countries. Those with the lowest per-capita costs tend to be member states who joined the EU in 2004 and have lower national income levels," Dr Luengo-Fernandez said.

Breast cancer had the highest healthcare costs, at 6 billion Euros each year, accounting for 13% of the total cancer healthcare costs in the EU. However, the highest total economic burden was attributable to lung cancer, a total of 19 billion Euros, of which 10 billion due to premature mortality.

"One of the purposes of studies such as this one is to enable comparisons to be made between the burden of different diseases, aiding decision makers to prioritize scarce research funds," Dr Luengo-Fernandez said.

"In order to be in a better position to inform policy decisions there is a great need for improved information on epidemiology, healthcare resource use and unit costs across the EU."

Commenting on the report, Prof Peter Boyle said: "It is essential that the economic impact of cancer on a community is known, understood and placed in its perspective. The greatest single economic cost was 6 billion Euros for breast cancer. This should be placed in the perspective that the economic cost of pneumonia in the EU is 10 billion Euros each year. The cost of cancer is not just the cost of drugs and hospital stays and this has been taken into account by Dr Luengo-Fernandez."

Caregivers are hidden patients themselves

Looking after a person with cancer is associated with a variety of statistically significant impairments compared with non-caregivers.

Dr Isabelle Gilloteau from Bristol-Myers Squibb and colleagues obtained data from the 2010 and 2011 EU National Health and Wellness Surveys, self-administered online surveys of 105,581 adults in France, Germany, Italy, Spain and the United Kingdom.

They found that relative to non-caregivers, people who cared for cancer patients reported that they experienced worse physical (47.6 vs. 48.9) and mental health (43.7 vs. 46.9), were more likely to be absent from work (8.1 vs. 4.8), were more impaired in their activities (28.7 vs. 21.8), and had twice as many hospitalizations during the past 6 months (0.22 vs 0.11). The reports indicate that they were 50% more likely to be diagnosed with depression and had twice the odds of anxiety and insomnia, as well as higher odds of suffering from migraines (OR = 1.663), headaches (OR = 1.369), or gastrointestinal problems (OR = 1.626), compared with non-caregivers.

"The levels of burden seen in the current study for mental quality of life and absenteeism impairments are similar to those observed elsewhere among adults with hepatitis C virus in the EU, or adults with osteoarthritis pain in the US," Dr Gilloteau said. "They are also similar to mental quality of life impairments seen among adults with rheumatoid arthritis in the EU."

"The vital role played by unpaid caregivers in supporting cancer patients is well recognized, but the health burden and economic impact on these caregivers is poorly understood," Dr Gilloteau said.

"Caregivers of cancer patients reported statistically significantly poorer overall health status, physical and emotional health status, more healthcare resources use, and their work productivity and daily activity were also statistically significantly impaired. They were also at greater odds of being diagnosed with comorbidities. Importantly, this study specifically quantifies the extent of the burden attributable to each of the components mentioned above, and specifically examines comorbidities likely to have been affected by the caregiving experience. Estimating the financial impact of caregiving in cancer is essential as a future research step, especially given that the current findings indicate that this cost will be high."

The researchers call for greater recognition of the unmet caregiver needs. "This study underscores the importance of recognizing caregiver burden, not just because of the direct implications for the well-being and quality of care of the patient with cancer, but also due to the extra burden it brings to society overall," Dr Gilloteau said. "Because caregiving is a vital part of cancer patient management and providing this care incurs substantial burden for the caregiver, it is crucial to consider what can be done to minimize this burden, especially in the current context of containment, combined with an aging population and increasing incidence of cancer."

Provided by European Society for Medical Oncology