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Who Is Responsible for Financial Toxicity in Oncology Patients?
Arlington, VA—Breakthroughs in oncology often come with a hefty price tag. The moment the diagnosis of cancer is given, patients understandably rush to accept any treatment option, regardless of cost. This may seem the right choice until the cost of the drugs leads to bankruptcy or the patient begins skipping doses to stretch out their prescriptions.
At the ACCC 41st Annual Meeting: Cancerscape: Policy, Value & Quality, S. Yousuf Zafar, MD, MHS, gastrointestinal medical oncologist, health services researcher, and associate professor of medicine, Duke Cancer Institute and Duke Clinical Research Institute, addressed the issue of financial burdens endured by oncology patients. Dr. Zafar focused on the perspective of the patient and how healthcare providers can work to alleviate some of the financial trauma inherent in most cancer treatment regimens.
Dr. Zafar began with a case study cited from his own experience. A patient named Chris was started on an oral cancer drug, but at the end of this first course of treatment, the cancer had metastasized to his liver. Although Chris had health insurance, he did not have prescription drug coverage and had to pay thousands of dollars in out-of-pocket costs to maintain his treatment. When Dr. Zafar recommended another course of treat- ment, much to his surprise, Chris was reluctant. Chris explained that this first round of treatment nearly wiped him out financially and he was unwilling to risk debt or bankruptcy to continue.
Dr. Zafar admitted that he never even discussed the topics of cost or coverage with Chris before prescribing this first course of treatment. He learned that if the healthcare provider took the time to broach these subjects at the point of determining a course of treatment, patients like Chris could be spared from significant financial distress. The figure of Chris haunted Dr. Zafar’s presentation as he urged healthcare providers to take the extra step of cost analysis as part of the overall journey of care. The average cost that cancer patients pay per year out-of-pocket is $4800 and this cost can increase if newer agents are utilized. Approximately 50% of Medicare beneficiaries spend 10% of their income on medical costs and 28% spend more than one-fifth of their income on cancer treatments.
Despite discounts being offered, patients are paying more and more out-of-pocket expenses and insurance has greatly increased in cost as well. Dr. Zafar rhetorically asked the audience, “Does cost impact the patient’s well-being?”
The numbers are compelling. According to a study referenced by Dr. Zafar:
• 46% of patients were spending their savings to cover medical costs
• 46% of patients were cutting back on food, clothes, and other necessities
• 70% of patients had a higher likelihood of nonadherence
• 45% of patients reported themselves as nonadherent
Does financial toxicity affect survival rates? Dr. Zafar admitted that this would be a very difficult study to design, but knowing that high costs can compromise adherence, it is a question worth asking.
“It is time to stop describing financial toxicity; it is time to address,” Dr. Zafar continued as he urged health cost literacy in healthcare providers and patients alike. Phyisicans need to let their patients know that it is okay to ask about costs. Resources should also be provided for the patient so that they can make informed decisions about their treatment pathway.
Healthcare providers should take a more active role in identifying at-risk patients—and this includes patients who have insurance. As was demonstrated in Chris’s story, a patient can have health insurance, but can lack the coverage they need for treatment.
In addition to understanding their own insurance, patients also need ac- cess to price transparency. Dr. Zafar recommended Castlight Health (www. castlighthealth.com) as a good tool to help patients with this.
Dr. Zafar is also working on a tool called Financial Assistance, Naviga- tion, and Communication Education (FinANCE): Development. The goal of this project is to help patients with their financial concerns.
Dr. Zafar ended his presentation with this final thought, “You would never ask someone to go to a car dealership and buy a car without knowing how much it will cost. That is what we ask people to do with their healthcare.”—Lisa A. Tomaszewski, PhD
