Living with cancer: financial toxicity and the cost of treatment

Living with cancer: financial toxicity and the cost of treatment

Another bill from a radiologist came in the mail today. My state of Illinois insurance is just now getting around to paying bills from 2015, and the clinics are going to keep sending me bills until the State catches up. Still, they always take my breath away. I wonder how people without insurance cope.

The cost of health care when you have a cancer diagnosis is mind boggling. If the disease is chronic, recurring, or metastatic, out-of-pocket costs can be devastating, even for people with good insurance and higher than average income.

Researchers are putting the financial impact of cancer into focus. They call it “financial toxicity,” and list it as another side effect of cancer treatment.

According to the Washington Post, people with cancer are 2.65 times more likely to file for bankruptcy than those without and the JNCI reports that cancer patients pay more out-of-pocket than those with other diseases.

People sometimes minimize the impact of these financial burdens. For the well-insured and employed, treatment decisions may not be based on price. But for the elderly, the uninsured, and those with below average income, price most definitely makes an impact.

Financial toxicity causes harm in at least three ways: it decreases well being; impairs quality of life; and causes sub-par quality of care.

Those who declare bankruptcy have a 79% greater risk of death and half of all elderly are underinsured. When the out-of-pocket price for a prescription from the pharmacy rises, people are more likely to delay their purchase or to avoid the medication all together. In addition, stress from financial toxicity causes physical and mental illness.

What are the solutions? Honestly, a total overhaul of our health system would be a good place to start. When new drugs come on the market they are priced according to what the market will bear rather than on their value to health. I have to wonder if it’s a good idea for medicine to be an industry like software or car manufacturing, an area of commerce where millionaires are made.

In this anti-ACA moment, when Republicans are trying to take away the few safety nets we have, the best we may be able to do is to ask doctors to include financial impacts in their conversations about treatment.

The JNCI recommends three things:

  • Doctors and patients should choose care based on impact. We need to balance the effectiveness of a treatment with its price. Just because there is a new drug or a new procedure doesn’t mean it will greatly improve our health
  • Docs need to initiate conversations with patients about financial concerns and need to provide patients with resources and support in coping with insurers and debt
  • Patients need to become literate in the financial aspects of healthcare.

See these three sources for more detailed information about financial toxicity. 

Washington Post

Journal of the National Cancer Institute

The Oncologist

 
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