the cost of cancer?
We are likely to agree that such a deep probing question is exquisitely difficult to answer; the murkiness of the water increases as we move from tangible to intangible costs.
A link to the CNNMoney report
on physicians (not the least of whom are oncologists) struggling to make ends meet in their practices was featured in my January 6 edition of Cancer in the News
. We are, and perhaps uncomfortably so, aware of the difficulties of the current system in place, and the equitable financing of cancer care is a prevailing thought on our minds. The dense fog of billing issues and how much (or how little) will be reimbursed seems nearly insurmountable to us at times as providers.
But what about the patient’s perspective?
An increasing amount of attention is being channeled to this vital area, and the accounts from patients are distressing. For example, the following patient statements were reported in the research by Zafar et al (Abstract
; Virtual Meeting)
“I have had to go without groceries in the house just to get my medicine.”
“I became homeless and our entire family has had to live with a friend several times.”
And in the Winter 2011 issue of CURE
, the impact of financial toxicity
is explored through the eyes of several patients, one of whom stated, “I called my oncologist and said, ‘OK, shall I pay for this pill or shall I eat?’”
I suspect there are many more such stories out there and fear more to come.
Who truly anticipates that the loss of health may be linked to loss of any financial stability one has worked to establish over the course of time? Many of us are looking at absorbing more of the cost of our health insurance in some fashion; cost sharing is on the rise in the heart of the economic down turn.
Ramsey et al (Abstract
; Virtual Meeting
) presented their work on cancer diagnosis as a risk factor for personal bankruptcy at the 2011 ASCO Annual Meeting. A number of notable findings were reported, including that the highest risk of bankruptcy occurred in patients with cancers of the lung and thyroid followed by those with leukemia or lymphoma. Furthermore, bankruptcy rates approximately quadrupled at 5 years from diagnosis in these patient groups.
The work by Zafar et al (Abstract
; Virtual Meeting
) on the impact of out-of-pocket expenses on cancer care was also presented at the 2011 ASCO Annual Meeting. Although 99% of the patients in their study were insured, the mean out-of-pocket expenses incurred by patients was $712 a month. Such expenses were a catastrophic burden for 11% of the patients in their study, and for 69%, these out-of-pocket expenses were either a moderate or significant burden.
Ways in which patients in this study coped with the costs of their cancer care included foregoing recommended tests or procedures, increasing the time interval between (or skipping altogether) clinic or chemo appointments, not filling prescriptions, taking less than the prescribed amount of medication, and taking medications prescribed for another person. The lifestyle changes the patients made in this study included using a portion of or all of their savings to pay for their care, selling their possessions or property, and spending less on basics like food and clothing.
There are many difficult discussions in medicine; we can add discussions of affordability of care options to this list.
I am thankful that ASCO underscores the importance of this terribly significant issue for patients by making information available on managing the cost of cancer care
on the www.cancer.net
web site. Financial discussions are difficult and even seemingly taboo, and the resources here provide a framework in which these discussions can be held.
Incomplete treatment of disease or financial ruin are not the endpoints that we or our patients envision.
I encourage us all to overcome the stigma of discussions of affordability of care. In the words of Dr. Lichter
, “Bringing that information in as part of the discussion is as important as the physical or emotional side-effects.”
As always, I welcome your comments.