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Cancer treatment costs cause financial toxicity, warrant discussion
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Women with breast cancer faced significant financial hardships and wished their doctors had discussed and considered costs before initiating treatment, according to two studies scheduled for presentation at the ASCO Quality Care Symposium.
“In an era of rising cancer treatment costs, we don’t routinely discuss the financial implications of cancer care with women embarking on treatment,” Rachel Adams Greenup, MD, MPH, director of the breast fellowship and associate professor of surgery and population health sciences at Duke University Medical Center, said in a press release. “Many treatment options for breast cancer are comparable in their effectiveness, but their costs can vary. As women consider various cancer treatment options, information about costs could help them make more informed decisions about which therapies are best for them.”
Financial toxicity prevalent
In one study, Stephanie B. Wheeler, PhD, MPH, associate professor of health policy and management at University of North Carolina Chapel Hill, and colleagues revealed significant cancer-related financial harm and stress among patients with breast cancer.
The analysis included 1,054 women with metastatic breast cancer who completed a survey on health insurance status, post-treatment financial burden and emotional well-being.
About one-third of survey respondents were uninsured.
Uninsured patients appeared more likely to identify as a racial/ethnic minority, have lower income and work full time.
About 96% of uninsured respondents reported delaying or refusing treatment due to cost, compared with 36% of insured respondents (P < .001). Uninsured patients also appeared more likely than insured patients to skip nonmedical bills (40% vs. 16%; P < .001), to stop working after diagnosis (65% vs. 46%; P < .001) or to be contacted by a collections agency (77% vs. 36%, P < .001).
“While providers have little control over the cost of treatment, they should monitor the burden and stress that it can impose on their patients as a component of the care they provide,” Wheeler said in the release. “Clinicians should be attentive to how financial toxicity may be differentially experienced by patients with metastatic disease, where treatment failure and rapidly changing treatment plans may add complexity and stress. Initiating conversations about treatment costs can be an important way for providers to help monitor how patients are faring and discuss solutions to mitigate financial distress.”
Emotional distress was not limited to uninsured patients. Results showed 41% of insured patients were “quite a bit” or “very” stressed about not knowing cancer costs compared with 24% of uninsured patients. More insured patients reported financial stress on their families due to cancer (36% vs. 19%).
“Having health insurance doesn’t protect patients from the psychosocial impact of high cancer costs,” Wheeler said in the release. “High co-insurance and deductibles mean that many patients are still shouldering an enormous financial burden out of pocket and feeling anxious about what it will mean for their own and their families’ finances and financial legacy.”
Patients want to discuss costs
In another survey-driven study, Greenup and colleagues evaluated 607 women (median age, 49.6 years; median time from diagnosis, 6.7 years) with a history of breast cancer.
The participants completed an 88-question electronic survey about their experience with treatment costs and preference for transparency.
Seventy percent of participants had private insurance and 25% had Medicare.
Researchers found 43% of participants reported considering costs when making treatment decisions and 40% preferred their clinicians consider costs before making treatment recommendations.
Overall, 79% of women preferred to understand the cost of treatment prior to initiation. However, 78% reported never discussing costs with their cancer care team.
Those who did report discussing costs appeared more likely to have stage II or III breast cancer (56% vs. 40%; P= .02), less likely to be depressed (24% vs. 30%; P = .03) and had less insurance coverage (P for trend = .02).
When asked to categorize their financial burden, 15.5% of participants reported it as significant to catastrophic.
Out-of-pocket costs also appeared significant:
- 25% of women reported costs of $8,000 or greater;
- 10% reported costs of $18,000 or greater; and
- 5% reported costs of $30,000 or greater.
Women diagnosed at more advanced stages or those who had extensive surgery appeared more likely to report financial harm.
Women who discussed treatment costs with their doctors also appeared more likely to report financial harm. The researchers suggest this may be because proactive patients were more vulnerable financially.
The study was limited by the fact that most of the participants were well-insured, well-educated and white, researchers noted.
“As oncologists, we see the burden of high treatment costs on our patients every day. Many of them are skimping on needed medication, liquidating their savings and taking other extreme measures to control costs,” Timothy D. Gilligan, MD, MSc, FASCO, oncologist at Cleveland Clinic and ASCO expert, said in the press release. “These studies reaffirm the important role we can play in initiating and guiding conversations about cost of cancer care with our patients so that together we can make the best possible treatment decisions.” – by Cassie Homer
References:
Wheeler SB, et al. Abstract 32. Scheduled for presentation at: ASCO Quality Care Symposium; Sept. 28-29, 2018; Phoenix.
Greenup RA, et al. Abstract 207. Scheduled for presentation at: ASCO Quality Care Symposium; Sept. 28-29, 2018; Phoenix.
Disclosures: Wheeler reports no relevant financial disclosures. Greenup reports honoraria from Novartis and research funding from Pfizer, as well as an immediate family member with employment and stock/other ownership with GlaxoSmithKline. Please see the abstracts for all other authors’ relevant financial disclosures.