For our upcoming lung cancer tweetchat (hashtag #lcsm) on Thursday, August 22nd at 8 PM Eastern, 5 PM Pacific, we're going to be covering the important topic of costs of cancer drugs and procedures, how that's affecting patient care, whether pricing is fair, and whether there is a sense of value in the drugs and treatments being offered.

The first question we'll cover is whether the rising costs of cancer drugs and procedures is affecting patients, and if so, how? I have my own perspective, but are patients and caregivers unable to receive medications because of copays? Is this overwhelmingly for oral drugs and not IV medications? I can see how insurers are increasingly limiting the treatments they'll cover, but how are patients and families feeling the effect of rising drug costs?  And as a related topic, are there procedures that aren't being done because of cost?  Even if treatments aren't being placed out of reach, how much time and effort are doctors offices and families spending fighting insurers to get recommended treatments?

The second topic is whether the rising cost of drugs and procedures for cancer is "fair".  If there are treatments that deliver a very high probability of prolonged response with minimal toxicity, perhaps it should cost 3 times what far less effective treatment costs.  If biotech companies or proton beam radiation companies can change "whatever the market will bear", is there any need to provide value of what is delivered for the cost?  

Finally, we reach the question of where cost and value intersect.  There are a growing number of molecular marker tests being offered for thousands of dollars, offering the promise of new potential markers that have theoretical beneficial effects but often little or no actual clinical evidence of such a benefit. As new possible but unproven markers and drugs are suggested as being treatable with expensive but untested drugs, will payers cover these based on just a reasonable rationale? It is fair to expect them, the thousands who are paying higher premiums, and taxpayers paying for Medicare costs to foot the bill for unproven therapies? If they aren't covered, would patients/caregivers consider these options important enough to pay much or all of the cost out of pocket?

Cost of care and the new need for a remote sense of value for what treatments cost is only beginning to get injected into the conversations about cancer management, and it's only going to become more relevant. Please share your opinions, whether here or ideally as part of our live tweetchat discussion on Thursday evening -- just filter for the #lcsm hashtag and add it to your comments.