Dr Yousuf Zafar Discusses the Burden of Financial Toxicity and Trends Over Time

Financial toxicity has been on the rise, but there has been movement toward reducing the burden through better communication and shared decision making, said Yousuf Zafar, MD, MHS, of the Duke Cancer Institute and a member of the Association of Community Cancer Centers Financial Advocacy Network Advisory Committee.

At what point after a cancer diagnosis do patients and families start to think about the financial costs?
The financial costs become an important part of the patient experience very early on. I think as soon as patients realize that their treatments are going to start, very soon after that, and in some cases even before that, they are exposed to their potential out-of-pocket costs. Which, for many people, can be in the range of thousands of dollars at a time. And those costs can be prohibitive to most patients.

How has financial toxicity changed over the last few years?
I think the trends that I have seen over time are concerning. And those trends in rising out-of-pocket costs and increasing financial toxicity for patients are due to a few points. First, cancer treatment is becoming more effective and more tolerable, which means more patients are on treatment for a longer period of time. Second, that treatment is expensive. And, third, because of the rising costs of drugs, in many cases, insurers are shifting more of that cost over to patients in the form of cost sharing. So, patients are on more expensive forms of treatment, for a longer period of time, and are shouldering a great proportion of that cost.

In turn, that financial toxicity, that out-of-pocket cost, is leading to nonadherence with medications, leading to patients spending their retirement savings, and in some cases selling their homes, and in a small number of cases, declaring personal bankruptcy.

Has a growing awareness of financial toxicity helped to change the trend so people can address it better?
I think we’re seeing some strong indications and movement toward reducing financial toxicity. Part of that has to do with good, early shared decision making between clinicians and patients. Strong conversations between clinicians and patients about not just the goals of treatment, but the potential cost that treatment might incur as well. And, in doing so, preparing patients for the likelihood that they’ll face out-of-pocket costs. And that preparation can actually go a long way.

Additionally, there are resources available for patients, in terms of financial assistance programs that, in some cases can be helpful. But, in all cases, I encourage patients often to communicate not just with their clinicians, but with their insurance companies to understand what, ultimately, will be covered.

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