Treatment options for cancers have changed considerably over the last two decades. Today there are more options of treatment than they were 20 years ago or even 5 years ago. This is due to tremendous advances that have been made about our understanding of cancer and the development of new drugs and strategies of diagnosis and treatment based on that understanding.

Development of a new drug, procedure, radiotherapy machine or an investigation is a time, cost and labour-intensive process.

To understand more about this, we could take the example of Lung cancer treatments.

In the early 2000’s if a patient had stage 4 non small cell lung cancer, the options of treatment were limited. There was a debate as to whether chemotherapy was beneficial or not. As treatment options with chemotherapy were limited at that time and there was no biological or immunotherapy for lung cancer at that time, all the patients used to have was some radiotherapy to control symptoms and possibly some chemo. The cost of treatment for the condition was not much at that time and survival was not good either.

In the next 15 years, there has been a sea change with the development of a number of treatments that have a significant impact on lung cancer patients. These newer treatments work on specific areas of the cancer cell, work better than chemotherapy, produce less side effects than chemotherapy but more expensive than standard chemotherapy. The cost of these drugs is high because of the amount of research, time and money involved in developing these drugs. These drugs are developed in the public and private sector and the companies will try and recoup the cost that they have spent to develop the drug and a profit on top of that. Drug development is a long process that can take up to 15 years, starting from the lab to testing on animals and then human and then on to randomised clinical trials. All of this costs money.

Significant advancements in computing technology has also revolutionised the way radiotherapy in used in treating cancer. For example, SBRT is a form of radiotherapy used in early lung cancer that provides results as good as surgery without the need for an operation.

There has been a change in surgical techniques with advances in equipment available for such surgeries to make more complex surgeries possible with lesser side effects.

Improvements in diagnostic technology in the form of faster scans, better scanners which give more detailed images than ever before, functional scans (PET-CT) which help in more accurate staging of cancers, all provide better care to the patient but at an increased cost.

The development of immunotherapy with checkpoint inhibitors over the last few years has completely changed how lung cancer is treated nowadays and has almost pushed chemotherapy to the side in the treatment of advanced lung cancer.

All these advances have significantly improved the survival, quality of life of patients with lung cancer compared to 20 years ago. This above improvement is associated with an increased cost which the patient bears.

We have used lung cancer as an example here, but the same thing can be said for all cancers.

It is important that a proper and honest discussion between the doctor and the patient happens to decide on the best course of treatment by weighing the pros and cons of these investigations and treatments taking into account the benefits, risks, costs, the wishes and financial condition of the patient to get the maximum benefit with minimum cost.