Mileshkin Linda, Schofield Penelope E, Jefford Michael, Agalianos Emilia, Levine Michele, Herschtal Alan, Savulescu Julian, Thomson Jacqui Ann, Zalcberg John R
Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria, Australia.
J Clin Oncol. 2009 Dec 1;27(34):5830-7. doi: 10.1200/JCO.2009.22.7793. Epub 2009 Sep 28.
Many new cancer treatments are available only at significant financial cost to the patient. We previously reported that Australian medical oncologists commonly do not discuss unsubsidized, expensive anticancer drugs (EACD) because of concern about causing distress. We argued that this position was not consistent with modern ethical principals but wanted to seek the community viewpoint.
A cross-sectional telephone survey of the Australian general public was performed. Respondents' views were sought about three hypothetical scenarios in which they were diagnosed with incurable cancer and an EACD treatment (out-of-pocket cost US$25,000) was available.
Responses were obtained from 1,255 respondents (response rate, 43%). One hundred thirty-seven (11%) had a prior cancer diagnosis. Ninety-one percent of respondents wanted to be told by their doctor about an EACD that could improve survival by an additional 4 to 6 months, with 51% prepared to pay for it. People were more willing to pay if the drug could improve quality of life (71%) or if there was no effective standard treatment (76%). Sixty-eight percent believed the government should pay. Cost would be a significant financial burden for 31% of those willing to pay. Those more likely to want to be informed were younger, employed, better-educated, or had higher income levels (P < .05). Responses did not vary with the person's personal experience of cancer. Of the 9% who did not wish to be informed, half of these were concerned about the information causing distress.
The Australian general public wants to be informed about EACD as potential treatment options, even if they are not willing or readily able to pay for them.
许多新型癌症治疗方法对患者来说费用高昂。我们之前报道过，澳大利亚肿瘤内科医生通常不会讨论未获补贴的昂贵抗癌药物（EACD），因为担心会给患者带来困扰。我们认为这种立场与现代伦理原则不符，但希望了解公众的看法。
对澳大利亚普通公众进行了一项横断面电话调查。针对三种假设情景询问了受访者的看法，情景中他们被诊断患有无法治愈的癌症，且有一种EACD治疗方法（自付费用25,000美元）可供选择。
共获得1255名受访者的回复（回复率为43%）。其中137人（11%）曾有过癌症诊断。91%的受访者希望医生告知他们有一种能使生存期再延长4至6个月的EACD，其中51%愿意为此付费。如果药物能改善生活质量（71%）或没有有效的标准治疗方法（76%），人们更愿意付费。68%的人认为政府应该支付费用。对于31%愿意付费的人来说，费用将是一项重大的经济负担。更有可能希望得到告知的人群为年轻人、有工作、受教育程度较高或收入水平较高者（P < 0.05）。回复情况不因个人癌症经历而有所不同。在9%不希望得到告知的人中，一半担心信息会造成困扰。
澳大利亚普通公众希望了解EACD作为潜在的治疗选择，即使他们不愿意或无法立即支付费用。
