Department of Internal Medicine 5-Haematology/Oncology, University of Erlangen, Germany.
J Natl Compr Canc Netw. 2013 Jun 1;11(6):658-65. doi: 10.6004/jnccn.2013.0085.
Rising costs of cancer care and the growing burden of cancer in a world of finite resources seem to make rationing in oncology inevitable. Information is currently lacking about oncologists' strategies in responding to resource constraints and the prevalence of withholding costly treatments. An online survey was offered via e-mail to physician members of the German Society of Hematology and Oncology. Those actively practicing were asked to complete an online questionnaire asking how limited resources were currently affecting their clinical practice. Two-thirds of 345 participating oncologists reported withholding costly treatments in at least some instances. Regarding their rationale, 70% stated that evidence for costly intervention was not convincing enough, and 59% said that they rationed approved treatments because of an unfavorable cost/benefit calculation. Only 29% reported being explicit about their rationing decision if the patient did not know or inquire about the respective intervention. Withholding expensive procedures from individual patients was widespread among the respondents. Oncologists withheld treatments not only if they perceived the scientific evidence to be questionable but also if they perceived reimbursement prospects or the cost/benefit ratio to be unfavorable, a behavior that could be called rationing. Currently this mostly refers to costly procedures with limited additional benefits. Although this result may be interpreted as indicating that oncologists assume responsibility for spending the resources in a justified way, more transparency and an open discussion on cost-effectiveness and the just allocation of costly treatments is needed.
在资源有限的世界中，癌症治疗成本的不断上升和癌症负担的不断增加似乎使得肿瘤学领域的资源配给不可避免。目前，关于肿瘤学家在应对资源限制和昂贵治疗方法的普遍应用方面的策略的信息还很缺乏。我们通过电子邮件向德国血液学和肿瘤学学会的医师成员提供了在线调查。我们要求那些积极参与实践的医生填写一份在线问卷，询问有限的资源目前如何影响他们的临床实践。在 345 名参与调查的肿瘤学家中，有三分之二的人报告说，至少在某些情况下，他们会限制昂贵的治疗方法。对于他们的理由，70%的人表示昂贵干预措施的证据不够令人信服，59%的人表示，由于不利的成本效益计算，他们限制了批准的治疗方法。只有 29%的人报告说，如果患者不知道或询问各自的干预措施，他们会明确表示自己的配给决定。受访者中，有相当一部分人会对个别患者隐瞒昂贵的治疗程序。肿瘤学家不仅在他们认为科学证据有问题时会限制治疗，而且在他们认为报销前景或成本效益比不利时也会限制治疗，这种行为可以被称为配给。目前，这主要是指那些具有有限额外收益的昂贵程序。尽管这一结果可能被解释为表明肿瘤学家承担了以合理的方式使用资源的责任，但需要更多的透明度和公开讨论成本效益以及昂贵治疗方法的公平分配。
