For decades, the United State has spent more per capita on health care than any other country. U.S. health care expenditures almost doubled from $1.9 trillion in 2000 to $3.8 trillion in 2019. Spending on cancer care in the United States has followed a similar pattern, surpassing $200 billion in 2020. These expenses impose a substantial burden on patients, with annual out-of-pocket spending on cancer care estimated at $16 billion. Furthermore, many cancer survivors report being in debt because of their treatment.

In this cross-sectional study of 22 high-income countries, cancer care spending was not associated with age-standardized cancer mortality rates. Although the United States spent more on cancer care than any other country, this expenditure was not associated with substantially lower cancer mortality rates. "In other words, countries that spend more on cancer care do not necessarily have better cancer outcomes," lead author Ryan Chow said.

In fact, six countries — Australia, Finland, Iceland, Japan, Korea and Switzerland — had both lower cancer mortality and lower spending than the United States.

Smoking is the strongest risk factor for cancer mortality, and smoking rates historically have been lower in the United States compared to other countries. When researchers controlled for international variations in smoking rates, U.S. cancer mortality rates were no different than the average high-income country. Nine countries — Australia, Finland, Iceland, Japan, Korea, Luxembourg, Norway, Spain and Switzerland — have lower smoking-adjusted cancer mortality than the United States.

"Adjusting for smoking shows the United States in an even less favorable light, because the low smoking rates in the U.S. had been protective against cancer mortality," Chow said.

More research is needed to identify specific policy interventions that could meaningfully reform the U.S. cancer care system, the authors said. However, they point to lax regulation of cancer drug approvals and drug pricing as two key factors contributing to the high cost of U.S. cancer care.

"The pattern of spending more and getting less is well-documented in the U.S. health-care system; now we see it in cancer care, too," said Elizabeth Bradley, president of Vassar College and professor of science, technology and society. "Other countries and systems have much to teach the U.S. if we could be open to change."