Targeted drug side effects add to cancer costs

Painful rashes and other skin-related side effects of newer targeted cancer drugs may jack up treatment costs, suggests a new study.

The average cost of treating each cancer patient who came into a dermatology clinic with skin, hair and nail complaints was almost US$2,000 (S$2,592), researchers reported this week. That included expenses related to doctors' appointments, dermatology medications and lab tests.

Some patients with skin problems may have to delay or alter their treatment regimen if side effects are too severe, researchers said.

"Dermatologic side effects including skin irritation and dry skin are the two topmost concerns that patients have that they did not expect during therapy," said Dr. Mario Lacouture from Memorial Sloan-Kettering Center Center in New York, who worked on the study.

"They were prepared to get hair loss, they were prepared to get some nausea and diarrhea, but they weren't expecting to get all these skin issues," he told Reuters Health.

Lacouture and his colleagues from the Northwestern University Feinberg School of Medicine in Chicago tracked costs related to skin reactions in 132 patients being treated with targeted cancer-fighting drugs at their dermatology clinic between 2005 and 2008.

The majority of those patients had colon or lung cancer and the most common drug treatments included cetuximab (marketed as Erbitux) and erlotinib (Tarceva).

Patients came in with a range of dermatology-related complaints -- including painful acne, lesions and blisters on the hands and feet and nail infections. Those conditions cost anywhere from US$21 to almost US$11,000 to treat, depending on the patient.

The average total cost of medications, clinic visits, treatment procedures and lab tests such as blood work and wound culturing for each patient was US$1,920. Dermatology drugs accounted for the greatest chunk of that, costing an average of about $840 per patient, according to findings published in the Archives of Dermatology.

Lacouture said that more than half of patients may have skin, hair and nail reactions to newer drugs that treat some of the most fatal types of cancer. That's because along with their cancer-fighting action, the drugs also attack proteins on the skin.

If skin reactions are severe, especially with certain cancer drugs including sorafenib (Nexavar) for kidney cancer, doctors may have to adjust dosages or take patients off those drugs for a period of time.

"In the majority of cases, we manage the toxicity and go ahead with the treatment, but in a small percentage of patients it does interfere," said Dr. Barbara Burtness, who has studied skin side effects of cancer treatment at Fox Chase Cancer Center in Philadelphia but wasn't involved in the new study.

Lacouture said that while most of the extra costs would be covered by patients' insurance, skin problems also mean more time and transportation for appointments and co-payments.

"It adds to the out-of-pocket costs for the patient, but also it adds to the already ballooning (societal) cost of cancer," he said.

Burtness said that in the future, those costs should be taken into consideration when evaluating new cancer drugs. But she also suspected that as cancer doctors get more comfortable with the medications, they'll get used to managing any skin side effects themselves, which will cut back on patients' need to visit specialty clinics.

Researchers disagreed as to whether cancer patients should be taking anti-inflammatory medications and antibiotics to prevent any skin side effects.

Lacouture said the most important thing is for patients to be aware of how common these problems are, and to know that the sooner they are diagnosed and treated for side effects, the less likely they are to interfere with cancer treatment and patients' quality of life.