A cancer diagnosis results in a lifelong medical relationship between the patient and his or her oncologist. With the average total cost of treatment at roughly $150,000,1 in addition to taking an immense toll on one’s health, cancer can also have a significant—and potentially devastating—financial impact on patients as well. From the initial diagnosis to survivorship or end of life, the patient-doctor relationship focuses on disease management and the treatment’s effect on the patient’s quality of life and survival.
Financial Toxicity a Side Effect of Cancer Therapy
Oncologists are trained to understand and manage the disease and the medicines available to treat different types of cancer, with the goal of giving their patients the best chance for a successful outcome. However, the high cost of cancer therapies often results in a significant financial burden, or financial toxicity associated with the high costs of cancer treatment.
Financial toxicity has become an integral part of cancer management. However, according to a recent study, only about 50% of people affected by cancer who are struggling financially have raised their cost concerns with their oncologists.2 And according to the National Cancer Institute, between 33% and 75% of cancer survivors exhaust their own savings to pay for expenses related to their cancer treatment, which can be tens of thousands of dollars a month.3
Financial toxicity begins with insufficient insurance coverage and large patient copays for their treatment, which also includes loss of employment, family disruption, and reallocation of family resources. The goal of all oncologists should be to help their patients to manage the cost of treatment and minimize financial toxicity with the same skill and knowledge they manage drug toxicity.
Are You Avoiding Cost Discussion with Your Doctor?
When faced with the realities of a life-threatening cancer, a natural response for the patient is to say, “Do the best you can for me, regardless of cost.” No one wants money to stand in the way of their chance for survival. Unfortunately, the options in cancer treatment today come with a steep price tag.
Initially, the person diagnosed with cancer should concentrate on receiving the most effective life-prolonging and life-saving treatment. This is not the time to compromise on any medication that can improve your health. At this stage, cost considerations are secondary.
However, if cost prevents you from receiving the best treatment for your diagnosis, financial considerations should be addressed with your doctor.
Patients have different reasons why they hesitate to discuss cost issues with their doctors, such as a fear of taking up precious time in the office (time thought to be better spent discussing medical treatments), and fear of receiving less effective medicine or being perceived as having the wrong priorities. Some people feel that if they can’t afford the treatment, they may be referred directly to a hospice, without a chance for prolonging their survival.
Although these fears are understandable, it’s the responsibility of all doctors to ensure that people in their care receive the treatment that can achieve the best result, regardless of what they can afford. It’s also important for patients to feel free to discuss with their doctors any concerns about their treatment plan, including concerns related to cost.
The Evolution of Cancer Therapies: Then and Now
Early cancer chemotherapy relied on intravenously administered drugs given in several cycles, usually every 3 to 4 weeks. These drugs were expensive but were covered fully by insurance. In 1983, the Orphan Drug Act was passed by Congress to encourage drug development for rare conditions, including rare cancers, and provide financial incentive to drug companies to develop drugs for rare diseases that affect relatively few people.
Today, this orphan drug model has encouraged companies to develop such orphan drugs and the FDA to approve many oral drugs that target rare cancers and cancer subtypes that affect a small percentage of patients. Furthermore, the FDA approves these novel drugs based on their clinical benefit but with no regulation of their cost—to patients or to insurance companies.
The result is that successful and, in certain instances, cancer-altering and life-saving therapies, have been developed, but at great expense. Although oral treatments today typically don’t have the severe side effects seen with chemotherapy, they are still toxic, often not easily tolerated by patients, and may have limited success in curing cancer.
Targeted therapies can cost tens of thousands of dollars a month, which can have serious financial toxicity for patients.
Financial Resources for Patients with Cancer
In addition to discussions with their oncologists to address the cost of their treatment, other resources are available to help navigate the financial side effects of cancer treatment. Some cancer centers today also have a financial counselor or a social worker who is designated to help patients navigate costs.
Furthermore, many foundations and national organizations, as well as the cancer companies themselves, offer some support for patients to pay for those drugs. Asking for help can make all the difference for patients in avoiding financial toxicity.
Additional resources are available through nonprofit sources, from government organizations to local charities closer to home.
The National Cancer Institute has a searchable list of organizations that offer cancer support services, from access to care and copay assistance to help with medications and free financial guidance.
Another good source is the Annual Patient Guide to Cancer Support Services published by CONQUER magazine that lists the financial support for each cancer drug provided by the drug maker, as well as nonprofit foundations and organizations; this resource includes direct contact information to locate support available for each cancer drug.
One other source for patients who have large expenses and needs for discretionary spending are companies such as Fifth Season Financial, which provide patients with funds by leveraging their existing life insurance policies. This advance on their life insurance has no restrictions on the patient—the money can be used for medical bills, living expenses, as well as travel, home renovations, or other uses to enhance quality of life.
Geoffrey King, who was diagnosed with late-stage metastatic prostate cancer in October 2018, approached Fifth Season Financial for help with his financial burden related to his cancer treatment.
“Fifth Season Financial’s staff members were all so attentive. They helped guide me through the process and have been really pleasant to work with,” said Mr. King.“I’m grateful to have discovered them shortly after my diagnosis. Although my cancer is aggressive, Fifth Season has made a huge difference in helping me out financially,” Mr. King added. Every patient’s situation is different, but those who find themselves dealing with great financial needs should look for the right help for them.
Self-Advocating for Your Needs
All patients should be able to focus on their specific needs when dealing with a cancer diagnosis and work toward their treatment goals, without adding unnecessary financial stress.
Raising cost concerns early on, exploring available resources, and self-advocating throughout the process can have a positive impact on preventing undue financial hardship in an already extremely difficult situation. Addressing financial issues with your care team can help you get the best treatment you need.
Key Points
- Many patients with cancer avoid discussing their financial concerns with their doctor or nurse for fear of not getting the best treatment
- No one wants money to stand in the way of their chance for survival, but the options in cancer treatment today come with a steep price tag
- If your doctor or nurse is not asking about potential financial concerns, it’s important for you to discuss any concerns about your treatment plan, including concerns related to cost
- Many patients are not aware of financial support that is available from different foundations, nonprofit or government organizations, as well as the drug companies
- Addressing financial issues with your care team can help you get the best treatment you need
References
- Moore P. The High Cost of Cancer Treatment. AARP The Magazine. June 1, 2018. https://www.aarp.org/money/credit-loans-debt/info-2018/the-high-cost-of-cancer-treatment.html.
- Cavallo J. 2018 quality care: older patients with advanced cancer experiencing financial difficulties have worse quality of life and mental health. ASCO Post. Updated September 25, 2018. http://ascopost.com/News/59290.
- National Cancer Institute. Financial toxicity and cancer treatment (PDQ)–health professional version. Updated August 2, 2019. www.cancer.gov/aboutcancer/managing-care/track-care-costs/financial-toxicity-hp-pdq.
