TUESDAY, Oct 23 (HealthDay News) -- Although it can cost more than $1 million to give a lung cancer patient an added year of life, overall survival from the disease hasn't increased significantly, a new study finds.

On average, life-expectancy for Americans with lung cancer increased by less than one month between 1983 and 1997. At the same time, medical costs increased by more than $20,000 per patient, researchers reported in the Oct. 22 online edition of Cancer.

"We haven't made much progress in lung cancer survival, and what progress we have made has come at a significant cost," said Dr. Len Lichtenfeld, deputy chief medical officer at the American Cancer Society. He was not involved in the research.

"The concern is that as we move toward closer examination of survival of people with lung cancer and as our resources in this country become more strained, we are going to see more estimates about how much it costs to save a year of life," Lichtenfeld said.

Today, people diagnosed with lung cancer expect to get the full range of treatment, Lichtenfeld said. But as money becomes less available for health care, studies like this could impact on how health care providers make treatment decisions, he said.

"Right now, money isn't influencing our decisions," Lichtenfeld said. "But, when we look forward 20 years from now, we are going to make decisions about who we treat and how we treat them based on economic considerations," he said. "We are at risk in this country of moving in that direction."

Another expert is hopeful that type of system will never come to pass, however.

"This is America -- we don't ration health care," said Dr. Norman Edelman, chief medical officer at the American Lung Association, New York City.

In addition, Edelman is against pitting one disease against another. "Twenty-five percent of our health care dollars are spent on the last six months of life," he said. "And that's certainly not just lung cancer. Singling out lung cancer is not a useful approach."

According to Edelman, "The costs to treat lung cancer are not higher than the costs of anything else."

Lung cancer remains the leading cause of cancer death in the United States. This year 160,390 Americans will die from the disease.

In the study, a team led by Rebecca Woodward of the U.S. National Bureau of Economic Research drew on data from the National Cancer Institute's Surveillance, Epidemiology, and End Results database. They also looked at reimbursement data from Medicare Parts A and B.

The researchers tracked changes in both costs and outcomes for lung cancer patients from the early 1980s to the mid-1990s.

They found that an additional year of life for a patient with lung cancer cost an average of $403,142. The cost of each additional year of survival for people with local disease was $143,614. For people with metastatic lung cancer, each year of additional survival cost $1,190,322, Woodward's team found.

Each in the United States, more than $5 billion is spent on detecting, diagnosing and treating lung cancer. However, the one-year survival rate from the disease has increased only 5 percent from the late 1970s to 2002, the researchers noted -- between 1975 to 1979 the one-year survival rate for lung cancer patients was 37 percent and, in 2002, it was 42 percent, they said.

Over the same period, the five-year survival rate for those with lung cancer has remained about the same -- currently, it's only about 16 percent.

"The additional money spent on lung cancer treatment in the mid-1990s compared to in the early 1980s did not result in a favorable economic rate of return by conventional benchmarks," the researchers concluded.

To help reduce surging costs, more research is needed to develop better and more effective diagnostic tests and treatments, Edelman said.

"Clearly, we need a really good methodology for detection," he said. "We do need to figure much better ways to treat it," he added.

The most cost-effective way of bringing lung cancer costs under control is to prevent the disease in the first place, Edelman added, and that means "getting the government to spend more money to prevent smoking."

More information

For more on lung cancer, visit the American Lung Association  .

SUNDAY, Oct. 21 (HealthDay News) -- As women live longer lives, the number of breast cancer cases among older patients is rising, too.

Yet many older women are being under-diagnosed and under-treated for the disease, studies show. Often, age -- rather than health status -- is the deciding factor in determining how to care for the 80-and-older set.

"I think that the biggest problem to this point has been physicians' and patients' attitudes toward treatments," said Dr. David A. Litvak, a general surgeon and surgical oncologist for the Permanente Medical Group in Southern California.

Patients, on one hand, often have misconceptions about what the treatment involves. "They think it's going to be too disruptive to their daily lives," Litvak said. On the other hand, a lot of physicians have biases about treating anyone over 80, he added. Their thinking is, "How much time could they possibly have left?" As a result, many doctors assume a "leave-them-alone sort of attitude," he said.

Litvak led a study examining the medical records of 354 women, 70 and older, who were diagnosed with breast cancer at a community hospital in Michigan between 1992 and 2002. The study was published recently in the Archives of Surgery.

In all, 46 percent of the women had breast cancer that doctors could detect during a physical examination. Even though 72 percent of the women had mammograms, those tests were given mainly to verify the physical exams.

Seventy percent of the women were diagnosed when their cancer was in the early stages. But 36 of the women overall, and 56 percent of those 80 and older, were never closely evaluated to see whether the cancer had spread to their lymph nodes.

The study also revealed lapses in treatment. About half of the women had breast-conserving surgery, but fewer than expected received chemotherapy, radiation and hormonal therapy after surgery, and the rates of treatment were lowest among the oldest women.

The findings add to a growing body of medical literature examining the under-treatment of older breast cancer patients.

Dr. Rebecca Silliman, a professor of medicine and public health at Boston University and chief of the geriatric section at Boston Medical Center, noted that she and others have been reporting on this gap in care for many years. As a co-author of a recent article in the journal Cancer, she and her colleagues have even linked under-treatment to a higher risk of breast cancer recurrence in older women.

"What is really needed is better evidence for treatment efficacy in this age group, plus more accurate strategies for identifying those at risk of bad outcomes and matching treatment intensity to risk," she said. "This isn't being done as well as we would hope."

Dr. Arti Hurria, director of the aging and cancer research program at City of Hope in Duarte, Calif., is leading an effort to develop a geriatric assessment tool to improve the ability to predict how an older breast cancer patient will tolerate certain treatments and what the benefits of treatment will be.

"We've developed a geriatric assessment that's feasible to do within daily practice, and now we're looking to see how does the assessment predict how an individual will do if they receive a certain treatment, or if they don't," she said.

The tool is simple enough that most patients can provide the information themselves and complete the survey in less than 30 minutes, Hurria said. It asks about a patient's activity level, medical problems, social support, nutritional status, and psychological state, among other things.

The assessment seeks to gather information about a woman's life expectancy, tolerance to treatment and access to support systems that may be necessary to get through therapy, Hurria said.

For example, she explained, "If they don't have social support, can we get a visiting nurse in? If they are feeling depressed and anxious, should we be getting some physiological support as part of the treatment plan?"

Litvak supports geriatric assessments as a way to get past age discrimination. "We should be changing our way of treating older patients and not have absolute cutoffs for age," he said.

More information

Read the American Geriatrics Society's position statement on breast cancer screening for older women  .

FRIDAY, Oct. 19 (HealthDay News) -- A combination of the drug bevacizumab (brand name Avastin) and the standard chemotherapy agent irinotecan may benefit patients with a type of deadly brain tumor called glioblastoma multiforme (GBM), says a Duke University pilot study.

This treatment approach may extend the length of time GBM patients can survive without tumor growth and may improve overall survival, according to researchers at Duke's Preston Robert Tisch Brain Tumor Center.

The study included 35 patients whose GBMs returned after they'd had standard therapy, possibly including surgery, radiation and chemotherapy. After the patients received the combination bevacizumab/irinotecan therapy, almost half had no tumor progression after six months, and 80 percent were still alive six months after diagnosis.

The findings are published in the Oct. 20 issue of the Journal of Clinical Oncology.

"These results represent tremendous hope for these patient and their families," lead investigator Dr. James J. Vredenburgh, a neuro-oncologist, said in a prepared statement.

He noted that 75 percent of patients with recurrent GBM treated with standard therapy, such as chemotherapy alone, have tumor progression at six months, and fewer than 50 percent are alive after six months.

"We speculate that bevacizumab and irinotecan each attack a particular characteristic of the tumor independently, or they work together, with bevacizumab suppressing the growth of blood vessels which makes the tumor more susceptible to the chemotherapy," Vredenburgh said.

"Further studies will tease out the exact mechanism of the therapy's success, and we also hope to study the effectiveness of this treatment in patients with newly diagnosed GBM," he added.

More information

The U.S. National Cancer Institute has more about brain tumors.

FRIDAY, Oct. 19 (HealthDay News) -- Researchers say they've identified a protein that could play a key role in the development of pancreatic cancer.

According to a team at the Kimmel Cancer Center at Thomas Jefferson University in Philadelphia, the protein -- called pp32 -- is a tumor-blocker than normally inhibits a cancer-causing gene called K-ras.

However, pp32 is absent in the most aggressive form of pancreatic cancer, the researchers said. More research is required, but pp32 could eventually become a marker for this deadly form of pancreatic cancer and a potential drug target.

In laboratory experiments, the Jefferson team found that when pp32 is absent, mutations in the K-ras gene take over and turn cells cancerous. Adding pp32 to pancreatic cancer cells with K-ras mutations slowed the growth of the fast-growing cells. The researchers concluded that the loss of pp32 may be a key event in determining the aggressiveness of pancreatic cancer.

The study was published online in the journal Modern Pathology.

"If we are able to learn more about this molecule, this may be a potential target that we could turn on in aggressive types of pancreatic cancers," team leader Jonathan Brody, assistant professor of surgery, said in prepared statement. "In theory, if we could find a way to upregulate this molecule in these pancreatic cancers, we may be able to arrest these fast-growing cancer cells as we did in experiments in this study. As we understand its molecular interactions, we could also somehow find the things that regulate it and extend our molecular understanding of this devastating disease."

Previous research had also suggested a link between pp32 and prostate and breast cancer.

More information

The American Cancer Society has more about pancreatic cancer  .