Oncology Rounds

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

by Deirdre Saulet and Soleil Shah

More than a third of cancer patients with insurance spend more on out-of-pocket costs than they expect. This burden, increasingly referred to as the financial toxicity of cancer, negatively impacts patients' physical and social wellbeing. Keep reading for new research and our advice on how your cancer program can help.

Cancer patients spend 11% of income on treatment-related expenses

Soon after Andrew Ladd began his neuroendocrine carcinoma treatment around 2005, the bills became unmanageable. Less than a month after the diagnosis, Ladd had reached his $5,000 prescription drug limit and began paying $300 out of pocket each month. After Ladd died from his cancer, his family faced hundreds of thousands of dollars in medical debt that remained from his treatment.

After Ladd died, his wife, Fumiko Chino, became a radiation oncologist at Duke University to study the effects of financial strain on cancer patients. Her team's new study found that cancer patients spend approximately 11% of their household income on expenses related to their treatment—with some patients spending about a third of their income.

Financial distress has negative impact on physical and mental health

The financial toxicity of a cancer diagnosis is far-reaching. Another recent study found that cancer patients who declared bankruptcy had a 79% greater risk of dying than those who had not declared bankruptcy.  Patients experiencing financial distress also report poorer physical health, mental health, and satisfaction with their relationships.

Few effective policy solutions

Policymakers have struggled to create long-term solutions to help patients overcome the financial burden of cancer and other chronic illnesses. One advance has been so-called "oral parity laws," which require insurers to provide equal coverage for both IV chemotherapy and oral cancer drugs. These laws, which have been passed in 43 states and Washington, D.C., have helped patients afford oral treatments.

Other potential policies, which have not been enacted, include allowing CMS to negotiate prices with drug makers, developing policies that make it easier for generic, high-value drugs to compete in the pharmaceutical market, and encouraging payers to utilize a value-based insurance design that reduces or eliminates out-of-pocket costs for high-value drugs.

Short-term solutions begin in the cancer program

While it may be difficult to impact national policies, cancer programs can focus on immediate solutions, including changing provider behavior and helping patients understand their insurance plan and the cost of their care. The cancer care team should proactively discuss the financial aspects of different treatment regimens with patients. A recent survey of cancer patients found that half of patients were interested in discussing their treatment cost burden with their oncologist, but only 19% had actually had such conversations.

As patients continue to shoulder more responsibility for their health care costs, financial navigators (also known as financial counselors or financial advocates) are becoming a critical member of the cancer care team.  They have the expertise to help patients understand the costs of care and identify resources to help them offset those costs.



Four questions to ask about your retail pharmacy strategy

As of 2016, 47% of hospitals operate a retail pharmacy. Common goals include increasing patient access to medications, improving care continuity, and generating revenues.

With the transition to risk-based payment, these goals are taking on increasing importance, prompting many to revisit their retail pharmacy strategies and others to enter into retail pharmacy for the first time.

Regardless of whether your health system's retail pharmacy is well established or in start-up mode, the four questions in our infographic will help you evaluate and advance your strategy.

Get the Infographic