“The confluence of very high-cost treatments, erosion of health insurance coverage, and my interest in the underlying causes of treatment disparities led me to look closer at financial hardship and what could be done at the practice level,” lead study author Cathy Bradley, PhD, deputy director of the University of Colorado Cancer Center, tells Verywell.
Because cancer is a chronic disease, treating it can range anywhere from $10,000 to $20,000 a month, says Sameek Roychowdhury, MD, PhD, medical oncologist and associate professor at The Ohio State University Comprehensive Cancer Center.
“Depending on your copayment and coverage, even a 10% copayment can become very expensive,” he tells Verywell. Roychowdhury was not involved with the paper.
High medical bills are also a reality for cancer survivors, who may spend up to 20% of their annual income on health care. According to the National Cancer Institute, the resulting financial toxicity—problems a patient has from paying for expensive treatments—can come from being unaware of just how high cancer treatment costs can be. Roychowdhury says that most patients and loved ones focus initially on cancer-related health problems such as prognosis, loss of appetite, and physical pain. However, the unanticipated costs from a bill months later, he says, can be a significant stressor for the family and the patient.
For this reason, some patients may choose to discontinue or opt for a cheaper but less effective treatment option. “It’s unfortunate when someone says that they would rather not take a chance to extend my life or have a good quality of life because I’m worried about the financial toxicities for my spouse,” Roychowdhury says.
Proposal to Reduce Financial Toxicity
Bradley and her team proposed more doctor involvement in the decision-making process for cancer treatments, with the aim of making doctors more conscious of treatment’s financial burden.
“Many oncology providers are unaware of the extent to which patients may experience financial hardship, which can affect treatment initiation, adherence, and outcomes,” Bradley says.
Her team suggests doctors having “financial checkups”— or screening tools to measure the following:
Does the patient have insurance?Is the patient at risk of losing their insurance?What is the patient’s level of financial literacy?How much the patient will have to pay out-of-pocket for their medical expenses?How much the patient will have to pay out-of-pocket for making accommodations to go for treatment?How will the treatment option impact the patient’s ability to work?
“Screening identifies patients at risk for financial hardship and offers an opportunity to discuss other treatment options,” Bradley says. “Financial screening also offers the oncology team an opportunity to connect the patient with resources that can alleviate financial distress.”
Screening would require a multidisciplinary team where patients at a higher risk for financial burden could be referred to community and professional resources, such as:
Social servicesCompassionate care programsLegal aid societiesFinancial management services
Adding routine screenings is possible, Bradley says. In fact, it’s been done before.
“Practices screen for smoking, psychological distress, and other measures of well-being. If these conditions are detected, patients are referred to resources to help them,” she says. “For example, a patient that continues to use tobacco products is referred to cessation services. Patients who are experiencing depression or anxiety are referred to mental health counselors or provided with pharmacological treatments.”
Who Would Most Benefit From Routine Financial Screenings?
While the paper suggests every cancer patient could benefit from routine screenings of financial hardships, it would be most helpful for people with no health insurance.
According to Roychowdhury, uninsured cancer patients are most at risk for financial toxicity because of high out-of-pocket costs.
“No insurance means no safety net for out-of-pocket costs,” he says. “So, if a surgery costs $50,000 and the copayment is $1,000, if you don’t have insurance, then you may be liable for the full amount.”
According to the American Cancer Society, racial/ethnic minority populations are more likely to have limited or a lack of coverage, which has shown to affect survival rates compared to white cancer patients.
Younger cancer patients are also more likely to experience financial hardship. About 35% of cancer survivors aged 18 to 49 have trouble paying their medical bills.
Patient Advocacy May Avert Financial Toxicity
Preventative health care, like routine cancer screenings, can help save costs and lives, Roychowdhury says.
“Diagnosing and treating cancers earlier could save on costs and healthcare resources rather than waiting to be treated when the cancer is in a more advanced state,” he says. “Catching cancer earlier also means you have a better chance for a cure. This gives a couple of incentives for screening, and you can probably extend this to other things like heart health, lung disease, stroke health.”
Roychowdhury recommends financial discussions pertaining to cancer treatment include at least your doctor, your insurance, and a social worker. “Having more answers may alleviate some stress,” he says. “Understanding and anticipating the costs will also be better than being surprised by it later.”
