Oncologists confront "financial toxicity" of cancer care

The toxicity of chemotherapy and other drug treatments for cancer has extended beyond side effects such as nausea and nerve pain. It has now extended to a patient's ability to pay the mortgage and buy groceries while undergoing care, said the author of a study looking at the financial impact of cancer treatment.

Amy Abernethy, MD, associate professor in the Division of Medical Oncology at Duke University Medical Center, helped write one of a handful of studies presented at the June meeting of the American Society of Clinical Oncology that found the rising cost of cancer care could impact treatment decisions and even lead to patients forgoing treatment because they cannot afford it.

At ASCO, discussion turned toward the need for physicians to talk frankly with patients about the cost of care -- and whether patients believe the amount of life it buys is worth a bill they might not be able to pay.

"Overall, this study provides a patient-centered view of a reality of modern-day cancer care -- something that we call 'financial toxicity,' " Dr. Abernathy said of the joint study between researchers at Duke University Medical Center in North Carolina and Dana-Farber Cancer Institute in Boston.

Researchers surveyed 216 cancer patients from across the country who sought help from the HealthWell Foundation to pay for their cancer care. Although this study focused mostly on older women undergoing treatment for breast cancer who were covered by Medicare (83% also had prescription drug coverage), other studies have found that financial burdens are felt by patients with private insurance as well.

Though the impact is less severe for those with private group insurance and public insurance, the number of patients in each category is significant, said Neal Meropol, MD, chief of the Division of Hematology and Oncology at University Hospitals Case Medical Center & Case Western Reserve University School of Medicine in Cleveland.

Dr. Meropol was not involved with either study but participated in the sessions at the ASCO meeting where the findings were discussed.

"The move toward increased cost-sharing in high-deductible health plans, increased premiums and tiered formularies all shift the cost burden to patients and force them to make day-to-day decisions on how to integrate health care costs with other discretionary spending," he said.

Is bankruptcy cancer's side effect? « Petri Dish

Study finds average insolvency rates rise fourfold within five years of cancer diagnosis  By Colleen Steelquist, Hutchinson Center Science Editor

I fought back tears as I interviewed Deirdre last November. Though trying mightily to be valiant and optimistic, the 57-year-old oral cancer survivor was heavily burdened by worry. She had never been without health insurance in her life, but when her cancer was diagnosed in 2009, Deirdre was between jobs and uninsured.

Treatment has left Deirdre unable to eat, taste, chew, talk for long periods, hear in one ear, or return to her previous career. Her health care bills are enormous and her home has been foreclosed. She is living with one of her adult children and desperately wants to not be a burden.

Deirdre would not be at all surprised by recent Hutchinson Center findings that show a successful battle against cancer not only exerts a terrible physical toll, but a financial one, too. The study suggests the longer the survival, the higher the rate of insolvency.

Dr. Scott Ramsey, a physician and health care economist, and his colleagues at the Hutchinson Center, University of Washington and University of Bristol linked federal bankruptcy court records to cancer registry data from nearly 232,000 adult cancer cases in western Washington from 1995 to 2009 and found a hidden cost to survival: bankruptcy rates increased fourfold within five years of diagnosis.

“Patients diagnosed with cancer may face significant financial stress due to income loss and out-of-pocket costs associated with their treatment,” said Ramsey, who presented the findings at the American Society of Clinical Oncology’s annual meeting.

The National Cancer Institute-funded study found that compared to the general population, bankruptcy rates were nearly twice as high among cancer patients one year after diagnosis, and that the median time to bankruptcy was two and a half years after diagnosis.

“The risk of bankruptcy for cancer patients is not well known, and previous studies have relied on individual self-reports about medically related reasons for bankruptcy filing,” Ramsey said. “By linking two irrefutable government records of cancer and bankruptcy, we are able to determine how financial insolvency risk varies by cancer type, treatment and other factors.”

Like Deirdre, likely none of us is too surprised by these study results. We probably all know people who have been financially ruined by illness. In 2005, about half of the bankruptcy filings in the U.S. were due to medical expenses, according to the Health Affairs Journal. Cancer is a very costly disease to treat.

West's federal reporter, cases argued and determined in the United States courts of appeals and Temporary Emergency Court of Appeals

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