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ASCO 2016

Understanding and Mitigating the Financial Burden of Cancer Patients

Surabhi Dangi-Garimella, PhD
Drug costs are a significant contributor to rising healthcare costs, along with the cost of healthcare services. How can providers and patients work together to find a solution to this problem?
Healthcare is getting expensive by the day, and there’s growing awareness among patients as well as providers of the unsustainable nature of this growth. Drug costs are a significant contributor, and have developed into the fastest growing segment of healthcare costs—however, the cost of healthcare services is also a burden on the patient’s wallet. So what can providers do? What can patients do? An Education Session on the second day of the annual meeting of the American Society of Clinical Oncology, being held in Chicago, June 3-7, 2016, delved into these problems, their impact on patient behavior and clinical outcomes, and suggested potential solutions.   

The session was chaired by Veena Shankaran, MD, MS, a health policy researcher at the University of Washington. She was joined by Dawn L. Hershman, MD, MS, who heads the Breast Cancer Program at Columbia University Medical Center, and Yousuf Zafar, MD, MHS, a health policy researcher at Duke University Medical Center.

Shankaran, who authored an article on financial toxicity in Evidence-Based Oncology last year, spoke about Risk Factors and Clinical Implications of Financial Toxicity.

“Cancer drug spend, as well as cancer care spending surpasses overall healthcare spending, and simultaneously, annual insurance costs are rising at a steady pace,” Shankaran said. She showed data that the combination of premiums and out-of-pocket (OOP) costs rose from about $3000 in 2008, to more than $5000 in 2015. Patients are facing higher copays and coinsurance, while access to treatment has barriers, defined by restrictive prescription plans and 4-tier drug formularies. “This is particularly important in oncology where there’s been a sharp rise in the approved of oral anticancer agents.” Shankaran shared data that showed the total annual spending per user is significantly higher in cancer ($80,466) over non-cancer ($21,048) treatments, and the average annual beneficiary cost share for cancer patients is about $6000 greater.

When comparing the out-of-pocket spending for cancer patients, a study by the LIVESTRONG foundation found that across a variety of insurance plans, a greater percentage of cancer patients spent more on their medical expenses compared with patients with other chronic conditions.1

“Financial toxicity is a constellation of symptoms. Patients face difficulty meeting household expenses, they face financial stress/strain, loss of employment and income, debt, and bankruptcy.” This can also take a psychological toll on the patient and impact their quality of life.

It’s important to consider what factors predispose cancer patients to financial toxicity. Research by her own group at Fred Hutch has identified several such risk factors:
  • Younger age
  • Lower income
  • Non-white
  • Advanced/aggressive cancers
  • Comorbidities
  • Lack of supplemental insurance.
She stressed that younger age seems to be the most significant risk factor!! And what this could ultimately lead to are the impact on clinical outcomes, resulting from issues with adherence, access, and trial participation, finally resulting in reduced survival.

According to Shankaran, we need a multifaceted solution to this problem, and lowering drug prices alone cannot mend the damage. A combination of short- and long-term interventions that include policy makers, to patients, to providers, and payers are necessary. These would include addressing:
  • Sustainable drug pricing
  • Cost transparency
  • Communication on costs
  • Financial counseling/navigation
  • Medical debt reform
  • Changes within the Affordable Care Act.

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