New research in the February 2019 issue of JNCCN—Journal of the National Comprehensive Cancer Network calls for much greater integration between cardiologists and oncologists for patients with coronary artery disease (CAD) who are diagnosed with cancer. CAD—commonly referred to as clogged arteries—is the most common type of heart of disease, and the leading cause of death in the US. The researchers found that CAD-related medical expenses were considerably higher for patients with this chronic condition who were also diagnosed with cancer, particularly colorectal cancer.

“Heart problems that needed to be treated with in-patient hospitalization accounted for the highest added expenditures; representing two-thirds of the total costs,” explained lead researcher Ishveen Chopra, PhD, MBA, Department of Pharmaceutical Systems and Policy, West Virginia University. “There is a need for more coordinated and patient-centered care among older adults with multiple chronic conditions. An interdisciplinary and integrated approach to cardiovascular management in the elderly diagnosed with incident cancer would improve cardiovascular outcomes.”

The study used the SEER-Medicare registry as well as a 5% non-cancer random sample of Medicare beneficiaries to compare costs for 12,095 CAD patients diagnosed with breast, colorectal, or prostate cancer, against the costs of 34,237 CAD patients with no cancer. All were continuously enrolled in traditional, fee-for-service Medicare plans. Every individual was 68 years old or older and remained alive during the entire 48-month study period. Health care expenses were measured every 120 days during the 1-year pre- and 1-year post-cancer diagnosis, and were adjusted by the Consumer Price Index for medical services and expressed in 2012 dollars.

The results showed that CAD expenses post-cancer diagnosis increased approximately three times over pre-cancer costs, for people with colorectal cancer. The post-cancer diagnosis expenses were twice as high for women with breast cancer, and one-and-a-half times higher for men with prostate cancer. At the same time, CAD costs in the noncancer group remained steady for the entire time period. The authors speculated that some of the cost increases could stem directly from cancer treatment.

“Treatment regimens used for colorectal cancer may increase cardiotoxicity and therefore increase the CAD management cost to patients,” said Dr. Chopra. “In addition, non-adherence to CAD medications during cancer treatment may also contribute to higher CAD complications and total overall costs.”

“For many years clinicians have recognized the impact of cancer chemotherapy treatments on the cardiovascular system,” said John Fanikos, MBA, RPh, executive director, pharmacy, Brigham Health, and member of the panel that develops and updates the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) for Cancer-Associated Venous Thromboembolic Disease. “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. 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.”

The authors concluded that providers can reduce many costs by preventing inpatient encounters. They suggest that more research is needed to determine how emerging payment reforms and collaborative care models can lower costs while maintaining high-quality care.

To read the entire study, visit JNCCN.org. Complimentary access to “Impact of Incident Cancer on Short-Term Coronary Artery Disease-Related Healthcare Expenditures Among Medicare Beneficiaries” is available until May 10, 2019.