Q&A: More research, policies needed to ‘curb the rising costs’ of liver cancer care
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Patients with hepatocellular carcinoma carried a “significantly higher” cancer-related financial burden compared with those with cirrhosis, according to data published in Clinical Gastroenterology and Hepatology.
To analyze patient liabilities and Medicare payments in the first year following HCC diagnosis, Amit Singal, MD, medical director of the liver tumor program and clinical chief of hepatology at UT Southwestern Medical Center, and colleagues used the Surveillance, Epidemiology and End Results program-Medicare database to identify 4,525 adults diagnosed with HCC between 2011 and 2015. Researchers also generated a propensity-matched cohort of patients with cirrhosis to serve as the comparator group.
Results showed patients with HCC had higher incremental patient liabilities (median, +$7,166) and Medicare payments (+$50,110) in the year after diagnosis, as well as higher inpatient, outpatient and physician service costs compared with the cirrhosis cohort. Conversely, compared with patients who had a later stage HCC diagnosis and larger tumors, patients with early-stage HCC had lower incremental patient liabilities ($4,195 vs. $8,238) and Medicare payments ($28,207 vs. $59,509).
Healio spoke with Singal to break down how these results might inform research and patient care going forward.
Healio: Why did your team undertake this investigation?
Singal: Financial burden has been well-characterized for most other types of cancer but has been understudied for primary liver cancer, one of the fastest increasing causes of cancer related death in the United States.
Understanding the financial burden of cancer care is important to understand given potential consequences, including forgoing medical care and competition with other necessary expenses such as housing or food.
Healio: What were the key study takeaways?
Singal: Patients with HCC, the most common type of primary liver cancer, had high insurance-related and out-of-pocket costs in the first year after cancer diagnosis. Costs were higher in patients with comorbid illnesses or decompensated cirrhosis.
Healio: What additional research is needed?
Singal: Our study highlights the high financial burden of cancer care in patients with liver cancer, but additional research is needed to better understand how these costs directly impact patients, including potentially forgoing medical care.
Our study also focused on the direct costs of cancer care. Additional studies are needed to characterize indirect costs of cancer care, including transportation costs and lost wages from missed work.
Finally, prior data have suggested the impact of financial toxicity from cancer care can disproportionately impact racial and ethnic minorities, and studies are needed to see if the same is true for liver cancer.
Healio: How do these results inform patient care going forward?
Singal: Our data highlight the need for policy measures to curb the rising costs of liver cancer care.
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