The “financial toxicity” of cancer

We’ve all heard the phrase “cancer kills.”

But guess what? So can the high cost of treatment.

I just read about a study that came out of the Fred Hutchison Cancer Research Center here in Seattle.

The results won’t surprise anyone familiar with how much cancer treatment costs (a lot!), but researchers found:

…cancer patients who go bankrupt are nearly 80 percent more likely to die than patients who don’t, and some cancers had significantly higher mortality rates. Prostate cancer patients who filed for bankruptcy were almost twice as likely to die; bankrupt colorectal cancer patients were 2.5 times more likely to die as those not done in by debt.

The study linked cancer treatment records with bankruptcy filings.

The lead researcher, Dr. Scott Ramsey, who is both a physician and a health economist, uses the term “financial toxicity” to describe this negative impact of cost on health outcomes.

Related posts: Six resources to help with the high cost of cancer care

Medical debt is a leading cause of personal bankruptcy, and another study by Dr. Ramsey in 2013 found that cancer patients were especially at risk.

Not only are the initial diagnosis and treatment of cancer expensive (scans, surgeries, chemo), but cancer is often a chronic condition with patients being treated for years and years with more scans and more chemo.

Chemotherapy costs have skyrocketed in recent years. Newer, more effective drugs are coming on the market, but like so many new drugs the prices are crazy high, some costing over $60,000 per month!

Hospitals have bought up oncology practices and are taking advantage of a pricing loophole that lets them buy chemo drugs at a lower cost, but they aren’t passing on those savings to the patients.

Many people also have to cope with losing their jobs after a cancer diagnosis.

So exactly how does financial hardship or bankruptcy put cancer patients at greater risk of dying?

The researchers aren’t sure and want to do more studies, but certainly the physical effects of stress might play a part.

More likely is that these patients are either delaying care or going without recommended followup treatments because of cost.

While it’s true that the Affordable Care Act (ACA) has allowed for more people to get access to health insurance, it’s also true that because of increasingly high deductibles and cost sharing, many are still underinsured.

Related post: How “lump sum” cancer insurance policies work

Narrow networks, especially in more rural areas, limit access to quality NCI-designated cancer centers, or the costs of transportation/housing may be an issue. More insurance companies this year are refusing to pay anything towards out-of-network care.

Fred Hutchison offers the following financial tips for cancer patients:

  • Talk to your health insurance company and make sure you understand their deductible and copay requirements.
  • Take a friend, family member or advocate of some kind with you to your doctors’ appointments so you will have someone who can bring up the cost question on your behalf, if necessary.
  • Don’t be afraid to mention to providers that cost is a potential issue.
  • Discuss various therapy options – and their cost – with your provider. Beyond the issue of choosing a lower cost therapy, avoiding low value tests and procedures  can save a lot of money (click here for ASCO’s Choosing Wisely recommendations).
  • Consider hiring a financial counselor right away to help guide the family through this aspect of cancer care.
  • Look into patient access or patient assistance programs offered by pharmaceutical companies such as Astellas Access Program, Genentech’s Access Solutions, or Roche Pharmaceuticals’ Rxhope.
  • Take advantage of organizations such as the Patient Advocate Foundation, which provides arbitration, mediation and negotiation services to help patients with access to care, medical debt and job retention during cancer and its treatment.
  • Other good organizations offering help with financial issues related to cancer care:Family Reach, which collaborates with hospital social workers to help with the overwhelming financial and emotional burdens of cancer and the Cents Program, a nonprofit founded by federal bankruptcy judge Karen A. Overstreet, a coauthor of the bankruptcy/mortality study, which provides education and navigation around financial literacy and bankruptcy and has a program especially designed for cancer patients.

Dr. Ramsey and his co-researchers want to learn more.

“Nobody plans for cancer,” he said. “You’re just living your life and you get cancer and then you have to deal with the cancer and potential financial devastation. We can’t have a system where that’s happening.”

Amen to that.

Sláinte,

Frugal Nurse

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