The next frontier: Cancer detection and treatment innovation 

For decades, the standard of cancer care has included some combination of surgery, chemotherapy, and radiation. Today, advances in science, coupled with large investments from public and private entities, are driving innovations that could end cancer as we know it today. But as new products for cancer detection and treatment reach the market, employer plan sponsors will face tough decisions around what to cover, when, and at what cost.

Cancer-detecting blood tests currently detect eight types of cancers. Scientists are working to expand detection to 50+ types of cancer. They are creating next-generation sequencing and machine-learning algorithms to identify miniscule shards of cancer DNA, pinpoint the cancer’s location, confirm diagnosis and determine a treatment plan. In the future we could see sensitive screenings for a broad spectrum of cancer diagnoses administered to health plan members on an annual basis. But success is far from guaranteed: In addition to an annual price tag of close to $1,000 per test, there are concerns that the test may lead to overtreatment without saving lives.

Vaccines already play an important role in reducing the risk and prevalence of many different types of cancer. The COVID-19 pandemic accelerated the development of mRNA vaccines, including some that are targeted to cancer prevention and treatment. As these vaccines come to market, we may see the incidence of many types of cancer decline dramatically. It’s an exciting prospect, but a vaccine can take more than 10 years to develop and costs up to $500M.

Immunotherapies. Precision medicine is revolutionizing cancer care by treating an individual based on their genetics, environment, and lifestyle. A type of immunotherapy, CAR T, has already been approved by the FDA for treatment of some blood cancers and many clinical trials are underway exploring its use for other cancers and even other diseases. CAR T directly impacts cancer cells with limited damage to surrounding tissues, improving the effectiveness of treatment. And because CAR T utilizes the body’s immune system, it improves immunogenic memory which allows for continuous surveillance for cancerous tissues. In the future, targeted immunotherapies are likely to become the standard of care for all cancer treatments, including “off the shelf” versions that would dramatically reduce costs and increase access. For now, these potentially life-saving treatments are largely inaccessible, as only select medical centers can engineer this robust and complex treatment, the cost is high and clinical effectiveness remains unknown.

New technologies. Researchers have identified opportunities to use nanoparticles to identify cancer type and location to the single-cell level so that drugs and radioactive material can be delivered more precisely. Nanotechnology also has the potential to provide functional information to help clinicians avoid over-diagnosis or treatment and monitor cancer progression. We can imagine a future in which, intertwined with these innovations, artificial intelligence is leveraged to optimize care at every stage, from early detection to care plan recommendations.
 

Key takeaways for employers

As these transformative – and expensive – treatments become increasingly available, employers will be involved in decisions about making these interventions accessible, which may start with assessing whether the value they deliver is worth the steep price. Here are some questions to start thinking about:

• Is participation in clinical trials covered under the medical plan and, if so, to what extent? Are there opportunities to encourage and support employees to participate in clinical trials for which they might be a viable candidate?
• Does your medical plan cover genetic testing and, if so, to what extent? How will you approach newer testing options coming to market (direct to consumer or otherwise) that may not be FDA approved or covered by insurance? Employers should keep an eye on research findings on the value and efficacy of these tests; at some point it could be financially prudent to cover the cost of certain genetic testing if they can have an impact on healthcare costs and outcomes.
• Do medical plan designs (e.g. member cost sharing) support or hinder patient access to critical cancer care? Financial strain can slow patients’ recovery and can even inhibit patients from seeking care at all.
• Are there opportunities to collaborate with carrier and vendor partners on new payment models that reward stakeholders for getting the right patients the right medicine at the right time?
• Beyond cost, what does the employee experience look like in accessing any of these benefits or innovations? Are there navigation support services or access to clinical professionals to aid in interpreting cancer diagnoses and identifying next steps in cancer treatment?

While researchers, startups, and investors are diligently working to make this future of cancer care a reality, there will be significant developments along the way that will require tactical and strategic thinking by plan sponsors in the near term. There are actions employers can take now that will go a long way toward improving cancer care access and affordability as these innovations roll out so that everyone can reap the benefits.

This post is an excerpt from Mercer’s new series, The Next Frontier of Healthcare, exploring healthcare innovations and strategic considerations for employers. Learn more.