July 10, 2019 Read Advisory Board's take: What you shouldn't overlook about cancer's financial toll

Premature cancer deaths cost the U.S. economy more than $94 billion in lost earnings in 2015, according to a study published last week in JAMA Oncology.

Get 17 tactics to help cancer patients manage their financial responsibilities

Study details

For the study, researchers estimated the total amount of earnings the United States lost in 2015 as a result of all premature cancer deaths among U.S. residents ages 16 to 84, as well as total lost earnings tied to the most common cancers in the United States nationally and by state. The researchers based their estimates on life expectancy and cancer mortality data from CDC's National Center for Health Statistics and annual median earnings data from the U.S. Census Bureau's 2016 Current Population Survey.

Findings

The researchers estimated that, in the United States, more than 600,000 people died from cancer in 2015. They estimated that more than 8.7 million years of life were lost that year because of cancer deaths among residents ages 16 to 84, which translated to $94.4 billion in lost earnings. According to the researchers, lung cancer resulted in the highest loss in earnings in 2015, at $21.3 billion in losses, followed by colorectal cancer, at $9.3 billion in losses:

The researchers found that the age at which an individual developed cancer, and the type of cancer they developed, had an effect on estimated lost wages. According to the researchers, lung cancer was tied to the highest amount of lost earnings among individuals ages 40 to 49, while leukemia was tied to the highest amount of lost earnings among individuals ages 16 to 39. Overall, the researchers found individuals ages 50 to 59 who developed cancer had the highest amount of lost earnings, at $31.5 billion, followed by individuals ages 60 to 69 who developed cancer, at $24.3 billion:

The researchers noted a "large variation" in cancer deaths and lost earnings across the United States, which they wrote "reflec[ts] disparities in the [economic] burden" of premature cancer deaths. For example, the researchers found Kentucky experienced the highest amount of lost earnings from cancer deaths, at $35.3 million per 100,000 people, while Utah experienced the lowest amount of lost earnings from cancer deaths, at $19.6 million per 100,000 people:

Discussion

The researchers wrote, "Our findings indicate large state variation in the economic burden of cancer and suggest the potential for substantial financial benefit through delivery of effective cancer prevention, screening, and treatment to minimize premature cancer mortality in all states." They continued, "All states could reduce the burden of cancer and associated geographic and other differences in the country" if their residents have "equitable access" to comprehensive cancer care. The researchers added, "Health care professionals can contribute to achieving this goal because they play a central role in the delivery of cancer prevention, screening, and treatment."

Cathy Bradley, associate dean for research and deputy director of the University of Colorado Cancer Center, said, "These types of analyses help us prioritize where to put our resources. We want to allocate the limited resources we have to diseases and conditions with the biggest impact. And productivity is one way of measuring the impact" (Flaherty, STAT News, 7/5; Japsen, Forbes, 7/3; Harrison, MedPage Today, 7/3; Islami et al., JAMA Oncology, 7/3).

Advisory Board's take

What you shouldn't overlook about cancer's financial toll

Of course, the impact of premature deaths from cancer on the economy is staggering. But just looking at those who have died risks overlooking the more important picture: the financial impact cancer has on those who are fighting or have survived it.

Several recent studies have begun to quantify the remarkable financial toxicity of cancer. In particular, a study last year found that cancer patients spend an average of 11% of their total household income on expenses related to their treatment (with some patients spending up to a third of their income). Another study revealed that cancer patients and their families are making significant changes to their lifestyle to afford treatment—over one-third cut back on essentials, such as groceries and clothing, and nearly 20% missed paying their rent or mortgage.

Nearly 20% of patients missed paying their rent or mortgage

Financial toxicity is not only devastating for the family of the patient, but also for the patient's health and outcomes. A recent study found that financial insolvency is a clear risk factor for mortality—cancer patients who declared bankruptcy had a 79% greater risk of death than those who had not. Other research has found that patients experiencing financial distress also report poorer physical health, mental health, and satisfaction with their relationships.

Policymakers have struggled to identify solutions to surmount this challenge successfully. One advance has been the "oral parity laws"—requiring insurers to provide equal coverage for both IV chemotherapy and oral cancer drugs—which have been passed in 42 states and Washington D.C. Other proposals, including the Trump administration's recent push to lower Medicare Part B drug prices, have the potential to lower costs for patients. Still, the impact of these national policies is largely unknown. 

In light of this uncertainty, cancer programs should focus on immediate solutions to help patients understand the cost of their care. Our research has found that providers can help to reduce financial toxicity by:

  1. Connecting patients to financial navigators. Financial navigators, who can help patients understand the cost of care and identify resources to help them offset these costs, are becoming a critical member of the cancer care team. There are many models for how cancer programs can incorporate these team members, but we've found that some of the most successful programs either embed a one-on-one meeting with a financial navigator into all new patient appointments or hardwire multiple financial checkpoints into the patient's care pathway, especially at times when patients are likely to have financial questions or challenges (such as when they receive their first bill or undergo a treatment change).
  2. Urging financial navigators to clearly explain and delineate costs. A startling amount of Americans lack basic insurance knowledge—and this can have devastating consequences for cancer patients who don't understand their treatment coverage. Therefore, as part of financial navigation, many progressive programs review each patient's insurance benefits prior to meeting with them and then use a template to guide them through which costs will be covered and an estimate of what they will owe. For instance, 21st Century Oncology has all financial navigators fill out a form for patients that lists definitions for basic insurance terms (like deductible, coinsurance, copay) and expressly indicates the patient's plan details and estimated financial responsibility.
  3. Destigmatizing conversations about costs with patients. A recent study found that 52% patients were interested in discussing the financial aspects of different treatment regimens with their oncologist, but only 19% had such conversations. If comfortable, doctors can bridge this gap by talking with patients about costs. At the least, they should all aim to destigmatize conversations about finances by connecting patients with financial navigators.

We have many more best practices about how programs can help patients manage their costs (while still protecting program's margins). To learn more, download our research report on Cancer Patient Financial Navigation. And be sure to look at the appendix which contains sample scripting for financial conversations and sample patient-focused worksheets and forms.

Get the Report

If you want to hear even more about reducing costs for patients on high-cost drug regimens, watch our on-demand webconference about how to Reduce Financial Toxicity or download the slides.

Access the Recording & Slides

Learn more: 4 strategies to help oncology programs build relationships with employers

As health care costs rise nationally, employers are examining how they can reduce their health care spend. Cancer makes up a significant portion of that spend, accounting for 12% of employers’ total medical costs, despite only making up 1% of their claims.

Due to the significant—and growing—financial burden of cancer care, employers are actively working to reduce these costs, and cancer programs are uniquely poised to help employers in this effort.

This new report outlines the following four strategies to help cancer programs establish meaningful partnerships with employers

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