LONG BEACH, Calif--Neoplasms account for more than 5% of the $675
billion in direct annual US health-care expenditures, Thomas C.
Tucker, MPH, said at the 1995 Quality of Life Symposium, sponsored
by St. Mary Medical Hospital. This figure, derived from a 1990
National Center for Health Statistics Survey, does not include
indirect costs, such as loss of wages, associated with morbidity
When the less malignant neoplasms (basal and squamous cell skin
cancers and in situ carcinoma of the cervix) are excluded, the
cost burden for cancer is about 4% of the direct expenditures.
Cancer accounts for an even larger proportion of US health-care
expenditures when both direct and indirect costs are combined.
"It is not a small proportion of the burden," said Mr.
Tucker, associate professor of health services management and
associate director for Cancer Control, University of Kentucky
Markey Cancer Center, Lexington.
The cancer care costs break down to about 65% for hospital care,
24% for physician services, and 4% for nursing home care, with
drugs and other services making up the remaining 6% or 7%. He
noted that the 65% for hospital care is much higher than the 40%
hospital expenditure for all diseases. Nursing home costs and
drug expenditures for cancer patients are also higher, but the
physician expenditures are similar to those for the total of all
Mr. Tucker described a 1989 study based on Medicare's Continuous
Medical History sample file (about 5% of all Medicare cases),
which includes all the expenditures related to care of patients
in the file who ultimately died of their disease. This study sorted
out direct expenditures into three parts: the first 3 months of
care, the monthly cost of continuing care, and the terminal phase
of care, ie, the last 6 months of life.
Initial costs for patients with the same cancer varied considerably,
he said, depending on the stage at diagnosis and initial treatment.
Surgery, for example, has a major impact. Continuing cost also
varied, since it was determined by multiplying the monthly expense
by the number of months the patient lived. The cost of the last
6 months of care did not vary much for patients with the same
Using the Medicare data, the US expenditure on the treatment of
breast cancer in 1990 was estimated at $6.5 billion, followed
by colon cancer, lung cancer, prostate cancer, and bladder cancer.
More than two thirds of the cost are accounted for by these five
tumors, Mr. Tucker said, and, in fact, well over half are accounted
for by only the first four tumors.