Sponsored by the HealthWell Foundation, the study found considerable financial burdens related to chemotherapy. Although 90% of the survey participants had health insurance, most were underinsured with a mean monthly out-of-pocket expense of $712 (median $459). Most said this represented a financial burden that they described as moderate (39%), significant (30%) or catastrophic (11%).
As a result, 70% reduced leisure activities, 48% turned to their savings, and 18% sold possessions. Because of the cost of their drugs, 26% didn’t fill prescriptions.
Among their coping mechanisms for dealing with drug costs, patients asked for samples, requested cheaper drugs, sought out drugs from another country via the Internet, and shopped for lower prescription prices. To pay for their drugs, 43% borrowed money or used credit. When their cancer symptoms brought them to the hospital, many asked their doctors to let them stay for the night in the hopes of ensuring that their insurance would cover the hospital care.
These patients were less happy with their care and reported a reduced quality and standard of living. Most said they had talked to their doctor about costs, but perhaps too late in the course of their care, Dr. Zafar said.
The findings were seen among respondents who kept diaries and completed a monthly survey for 4 months. Most were white women: 76% had breast cancer. The survey was national, but 23% of the respondents resided in North Carolina. Over half were retired, 33% were college educated, and 65% earned less than $20,000 per year.
Dr. Zafar acknowledged that the findings are limited by the size of study, that all participants were on chemotherapy, and that most participants were breast cancer patients. Also, disease outcomes were not assessed.
Talk to Patients About Costs
According to Dr. Neal J. Meropol, who was the discussant of the papers at the ASCO meeting, these studies drill down from the macroeconomic to the individual cancer patients feeling the burdens of increased insurance costs and more cost sharing for their treatment. Cancer diagnosis is associated with the greatest individual burden for health care costs, with more than 13% of patients spending more than 20% of their income. Additionally, the Kaiser Family Foundation reports 20% of cancer patients use all of their savings on their cancer care.
More 50 million Americans are uninsured, and ample data show that lack of insurance is associated with late diagnosis of cancer. Additionally, every 1% increase in unemployment results in another 1 million citizens losing health insurance, said Dr. Meropol, chief of hematology-oncology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland. As the numbers of uninsured and underinsured increase, the divide grows between the haves and the have-nots in our society. The disparities will result in more delays in seeking care, decreased access to treatment, and more financial burdens including more personal bankruptcies.
Trends in health care spending threaten our nation’s health. In 2010, the NIH estimates that we spent $264 billion on cancer, $103 billion of that on direct medical costs. We need more patient-physician discussions about the costs of care, as well as educational and support tools to promote effective communication about costs and to guide patients’ evaluations of treatments and their impact on outcomes. We need a better understanding of the factors that drive the costs of cancer care and how the cancer care system can be modified to ensure that all Americans have access to high-quality, cost-effective care.
Dr. Meropol is an advisor or consultant to AstraZeneca, Genentech, Genomic Health, and Helsinn.