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July 12, 2022

The 'crippling' financial toll of cancer care in the US

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    Although new innovations in cancer treatments have helped more patients survive the disease, many of them also end up with "devastating" medical debt and must make difficult decisions between paying for care or other basic needs, Noam Levey writes for Kaiser Health News.

    The financial toxicity of cancer is harming patients. How can your program help?

    Cancer patients face thousands in medical debt

    Cancer is one of the leading causes of death in the United States, killing roughly 600,000 people every year. Currently, breakthrough medications and therapies have helped reduce cancer's death rate, but the high costs of these treatments have "left millions with a devastating financial burden," Levey writes.

    According to a poll from the Kaiser Family Foundation (KFF), around 20% of adults who have personally had cancer or have a family member who had cancer said they owe $10,000 or more in medical debt. This debt has been fueled in part by the "eye-popping price tags" of new lifesaving treatments, Levey writes.

    For example, the National Cancer Institute found that the average cost of cancer care and medications was more than $42,000 in the first year after a cancer diagnosis. In addition, some treatments can cost more than $1 million.

    Although most costs are covered under insurance, many patients are left with large bills due to deductibles and other types of cost-sharing. According to an analysis by consulting firm Milliman, the average leukemia patient with private insurance may owe more than $5,100 the year after being diagnosed, and the out-of-pocket cost can rise to more than $17,000 for leukemia patients covered by Medicare.

    In addition, ongoing tests, surgeries, and medications can lead to high out-of-pocket costs for patients year-after-year as their deductibles and out-of-pocket limits reset. Although cost sharing was originally proposed as a way to encourage patients to shop for care, it can be "devastating" for cancer patients, Levey writes.

    "The problem is that [cost-sharing] model doesn't work very well with cancer," said David Eagle, an oncologist at New York Cancer & Blood Specialists.

    The high financial toll of cancer on patients and their families

    According to Veena Shankaran, an oncologist at University of Washington, cancer patients are 71% more likely than other patients to have bills in collections, experience tax liens and mortgage foreclosures, and face other financial setbacks.

    In addition, Shankaran and other researchers analyzed bankruptcy records and cancer registries in Washington state and found that cancer patients were 2.5 times more likely to declare bankruptcy than patients who did not have cancer. Cancer patients who went bankrupt were also more likely to die than those who did not.

    "It's crippling," Shankaran said. "Even if someone survives the cancer, they often can't shake the debt. … Sometimes it's tough to think about what the system puts patients through."

    Faced with high medical bills, many cancer patients often have to make difficult choices between the care they need and other necessities, Levey writes.

    For example, KFF's poll found that roughly two-thirds of adults who have had cancer or have a family member with cancer have had to decrease their spending on food, clothing, and other household basics. In addition, around 40% said they have had to take money out of retirement, college, or other long-term savings accounts, and around 30% have had to change their living situations, including moving in with family or friends.

    According to Kashyap Patel, CEO of Carolina Blood and Cancer Care Associates, many patients at his practice have turned to food banks and other charities to get by. Overall, Patel estimated that half of the clinic's cancer patients need some kind of financial aid, but even those who receive aid often still end up in debt.

    Some cancer patients have also limited or skipped care due to high costs. For example, a 2017 analysis found that almost 20% of cancer patients taking oral chemotherapy stop the treatment due to cost, while around half stop the treatment when their out-of-pocket costs exceed $2,000.

    "People tell us they won't get follow-up care because they can't take on more debt," said Nikki Yulli, who oversees the call center at the Leukemia & Lymphoma Society, which helps patients with health insurance, food, housing, and other nonmedical needs. "It breaks your heart." (Levey, Kaiser Health News, 7/9; Levey, "Shots," NPR, 7/9)

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