For the past decade, I have been researching and writing about financial toxicity in cancer care. As a practicing oncologist, I recognized the negative impact of burdensome cancer-treatment costs on patients and how detrimental the economic repercussions could be. Ten years ago, physicians consulted with patients about their plan of care, but had little training on how to manage conversations about the costs associated with treatment.
Reflecting on the past decade, there’s much broader awareness about the cost of cancer care and its impact on patients. Still, I remain concerned. The rising cost of healthcare nationwide is a worrisome trend. In 2021, national health spending grew nearly 3% to $4.3 trillion and accounted for 18% of our gross domestic product. Out-of-pocket spending grew 10% to $433 billion, and prescription drug spending increased 7.8% to $378 billion.
Tough conversations about cancer-care costs
Each year, almost 2 million people are diagnosed with cancer, with nearly 600,000 dying from it, making it the second-leading cause of death in the U.S. Considered one of the most expensive medical ailments to treat, cancer treatment is expected to cost Americans $240 billion annually in care by 2030.
When someone is diagnosed with cancer, discussing how to pay for care isn’t easy. Concerns about out-of-pocket costs can influence a patient’s behavior, including nonadherence to prescribed treatment.
Patients confront a complexity of treatment, including surgery, radiation therapy, and drug therapy. And cancer treatments are not the sole source of the costs patients face — Emergency deparment visits and hospital admissions are common and expensive. And after recovery, care may require regular screenings and subsequent treatments. While lifesaving and life-extending, the treatments come with a financial toll. Health insurance offsets some of the cost, but cancer patients with insurance are on the hook for copayments, deductibles, and coinsurance.
Over the years, physicians have increasingly accepted the responsibility of discussing treatment recommendations and pocketbook trade-offs. But they admit that while transparency is the aim, the conversations can be challenging. Many feel uncomfortable discussing finances and worry that it could embarrass their patients or, worse yet, give the appearance that they are rationing care. And financial burdens combined with the physical and emotional toll of a cancer diagnosis means physicians must bring empathy and care to these complex conversations.
The reality is that calculating the cost of cancer care can be elusive, and pinning down all the factors necessary to have an informative conversation with your patient will require preparation and training. An accurate calculation of care requires knowing the procedures, negotiated price options, the patient’s insurance benefits, and calculations associated with copay or coinsurance.
Financial toxicity exacerbates disparities
All of these factors contribute to health disparities. The system requires the patient to take on an outsized level of responsibility. They are tasked with overseeing all items of care, including financial management, and to be self-aware enough to fill knowledge gaps and to voice concerns when needed–All this while under duress from cancer and its treatment.
One can understand how crowdfunding sites have sought to fill the affordability gap. In 2019, a survey from NORC at the University of Chicago found that one in five Americans reported they or a household member had contributed to a crowdfunding campaign to help with someone’s medical bills or treatment.
Lawmakers are aware of this, and they are seeking solutions. The Affordable Care Act, passed in 2010, took a step in the right direction by improving access to care for millions of Americans. And more recently, the Inflation Reduction Act might help to reduce the cost of care, particularly around pricing and access to certain drugs.
But more needs to be done. And this is where innovative solutions are key.
Technology as a solution
Nearly 60% of patients with cancer visit the emergency department within six months of diagnosis and upon their visit, and cancer patients who visit the ED are admitted to the hospital 60% of the time. Predictive analytics could be utilized to identify which patients are at the highest risk of an emergency department visit and intervene early, thus allowing better care, at the right site of care, and at a reduced cost. This method would rely on artificial intelligence (AI) and electronic patient-reported outcome measures (ePROM) to identify high-risk patients. And algorithms that are transparent, accountable and developed in diverse populations are more likely to support equitable health outcomes.
No family should have to drain college funds, sell their home, or declare bankruptcy to afford cancer treatment. We have harnessed technology to save lives with the development of new drugs and treatments. Ultimately, we must harness the same commitment to innovation in cost savings as we have for combating disease.
Yousuf Zafar
Yousuf Zafar, MD, MHS, FASCO is a practicing oncologist and Senior Vice President, Medical Informatics, at Change Healthcare. He is driven to optimize patient outcomes while lowering healthcare costs. Prior to joining Change Healthcare, Yousuf was a professor of medicine and the chief quality & innovation officer at the Duke Cancer Institute. With more than 20 years of clinical research experience, he has over 100 peer-reviewed publications in high-impact journals, including the New England Journal of Medicine and Journal of Clinical Oncology. His research was funded by the National Institutes of Health and the American Cancer Society, among others. His work has been covered by the New York Times, Forbes, Wall Street Journal, NPR, and Washington Post.
