CHICAGO, Ill. -- By Kim Yun-mi/Korea Biomedical Review correspondent -- The American Society of Clinical Oncology (ASCO)’s annual conference is arguably the epicenter of cancer drug development. That’s because much of the research data presented here is a precursor to new drug approvals.

Korean cancer patients and their families also eagerly await news of new drugs announced here every year, often filing complaints with the government to get them approved and reimbursed quickly.

However, it is also true that the annual influx of expensive new drugs threatens the financial health of national health insurance. Some critics say that the current reimbursement system for expensive drugs is like "robbing Peter to pay Paul” and that unsustainable, showing-off entitlement programs are preventing authorities from supporting essential care.

On the sidelines of ASCO 2023, Korea Biomedical Review met with Professor Keam Bhum-suk of the Department of Hemato-Oncology at Seoul National University Hospital, who is calling for the introduction of palliative care as an essential medical treatment, to learn about palliative care for cancer patients, its effectiveness, and the benefits of establishing a palliative care system for society.

‘We spend 2 trillion won a year on cancer drugs, but little on palliative care’

"Right now at ASCO, many positive data on prolonging survival for cancer patients are pouring out,” Professor Keam said. “These are great news, as there are many good new drugs, and we're making medical progress.”

However, he cautioned against interpreting these positive data as having a clinical value in the real world of prescribing medications.

"Recently, when good data come out of ASCO, Korean cancer patients and their families are increasingly filing petitions with the government," he said. “I can't help but think that the government, in its rush to resolve complaints, easily overlooks the cost issue, too."

Keam pointed out that the government spends about 2 trillion won ($1.5 billion) a year on cancer drugs alone. “However, there is no social consensus on why this enormous cost should be spent for only a small number of patients and pharmaceutical companies,” he noted

It may be important to ensure access to treatment for expensive cancer drugs that individuals can't afford. Still, he emphasized that it's unacceptable if that leads to problems financing other essential care.

For example, Keam cited a situation where the government spends about 150 million won on immunotherapies for a terminal lung cancer patient but is reluctant to fund pediatric or neonatal intensive care units, which are running at a deficit.

"In the future, there will be no hospitals for children with cancer," he said. "Currently, the cure rate for childhood leukemia is over 80 percent, but in the future, many of those young cancer patients may likely die as there will be no doctors or hospitals to treat them."

Professor Keam went on to say, “The government spends 150 million on drugs for a single patient but not spend a dime on palliative care, which is an essential part of cancer treatment. If a drug extends a patient's survival by three months, we celebrate it as a great achievement. However, we don't pay attention to palliative care that has been proven to improve quality of life and extend survival."

In 2010, the New England Journal of Medicine (NEJM) published a randomized controlled trial, which found that aggressive palliative care upon diagnosis in lung cancer patients extended overall survival by about three months compared to a control group that did not receive palliative care.

Professor Keam and other medical experts convinced the government of the effectiveness of palliative care. They set up a palliative care team at Seoul National University Hospital to support the pilot project, but the government allocated only 900 million won to the project.

“The government allocated 360 billion won to immunotherapies during the same period," Keam said, sighing.

‘Palliative care is the path to truly patient-centered decision-making’

Professor Keam describes palliative care for cancer patients as follows. A dedicated palliative care team consisting of doctors, nurses, and social workers is assigned to the patient from the beginning of the cancer diagnosis to properly inform the patient about the current state of the disease, discuss treatment strategies with the patient, including the patient's financial situation, and help the patient make patient-centered decisions. In addition, when the patient is nearing the end of life, they are given the right to self-determine life or death, including life-sustaining treatment with care services, to help them achieve the "dignified" death they want.

"Let's say the government gives a terminal cancer patient 150 million won for treatment. If the end of your treatment is death, how many patients will spend that money on medication alone?” Keam said. “The closer you get to the end of life, the more you need care support, and the government is spending all the money on medication and leaving the responsibility for care to the patient's family.”

Keam explained that for a terminal cancer patient with limited mobility, a month's care costs about 3 million won. In a year, it is 36 million won. By using a caregiver, the patient’s guardian can work. He added that the responsibility for this care falls entirely on the family.

“So, do you think financial support for caregiving is not as effective as support for the cost of chemotherapy," the professor asked back.

Keam emphasized that giving self-determining rights to cancer patients through palliative care can help reduce healthcare costs and benefit individuals.

"Korea is a family-oriented society, and the responsibility for care is passed on to the family, so cancer patients are not free to make decisions about their death,” he said. “Cancer patients in Korea are known for staying on chemotherapy until the end. The truth is, they continue painful life-sustaining care for their children and other family members."

Keam pointed out that the same is true for physicians’ decisions on life-sustaining care.

“Many patients put off decisions and end up in the emergency room with a deteriorating condition and on a ventilator, but what is the likelihood that a patient with terminal cancer will recover after they entered the ICU,” Keam said. “As these patients fill the ICUs, patients who need to be in the ICU are dying on the street or in an ambulance.”

He explained that patients who have been in the ICU show considerable resistance to end-of-life care.

"If decisions about end-of-life care are made in consultation with the palliative care team from the outset, patients will not die painfully, and ICU beds will be freed up,” he said.

‘Palliative care difficult under a current system without concept of labor cost’

However, if palliative care is to become an integral part of cancer care, it must get insurance coverage.

"Above all, the Korean healthcare system has no concept of labor costs," the professor said. "Whether a doctor spends five minutes or an hour explaining to a patient, the difference is not recognized."

That forces hospitals to cover their labor costs through tests and drug prescriptions.

"Palliative care, of course, includes medication, but it's mostly about human care and touch," he says. "If the authorities continue to undervalue caregiving, and the reimbursement system does not consider care costs, palliative care is bound to be a long way off."