The financial toxicity of treating cancer

(Stat News)  Today, a study followed 380 patients being treated at community oncology groups across the U.S. after they were diagnosed with metastatic colon cancer. They told the researchers that insurance didn’t protect them from serious money problems. While 98% of them had insurance, 71% fell deeper into debt, took out a new loan, sold or refinanced a home, or experienced at least a 20% decline in income — or a combination of these over the year they answered quarterly surveys.

According to the study “financial hardship or “financial toxicity” is an increasingly recognized consequence of cancer treatment that results from high out-of-pocket medical costs (e.g., copayments and deductibles), nonmedical fees (e.g., transportation), and indirect expenses (e.g., lost work and income). Patients who experience financial hardship during cancer treatment are at higher risk for treatment nonadherence, poor quality of life, and worse survival. The National Cancer Institute (NCI), the American Society of Clinical Oncology, and other organizations have advocated for interventions that lessen financial hardship in cancer patients and their families. However, several gaps in our current understanding of this problem limit the development of highly effective solutions.

Financial hardship in cancer patients has been shown to be associated with decreased treatment adherence, poorer quality of life, and worse survival. Cancer patients may struggle to pay out-of-pocket expenses due to the high expenses incurred, the medical debt, or loss of work.

Some cancer patients may face out-of-pocket costs of nearly $12,000 a year for one drug. In 2014, cancer patients paid $4 billion out-of-pocket for cancer treatment. Newly approved cancer drugs cost an average of $10,000 per month, with some as high as $30,000 per month. Just over a decade ago, the standard was $4,500.

National costs for cancer care were estimated to be $190.2 billion in 2015 and $208.9 billion in 2020 (2020 U.S. dollars), an increase of 10 percent that is only due to the aging and growth of the U.S. population. These cost estimates include cancer-attributable costs for medical services and oral prescription drugs.

According to a team of Penn State College of Medicine researchers, care for the 15 most prevalent types of cancer in the U.S. cost approximately $156.2 billion in 2018. The team also found that medication was the biggest expense and that medication expenses for breast, lung, lymphoma, and colorectal cancers incurred the most costs.

The FDA says it has used innovative research shortcuts to speed up the availability of medicines for desperately ill patients. But many researchers say it has failed to crack down on medications that don’t deliver on their early promise, leaving a glut of expensive, unproven cancer drugs on the market.

The real question is how much is three of four months of life worth, and will insurers and the FDA say the drugs that only provide mild efficacy are not worth the money? Pharma companies are aware that insurers will rarely say no to new cancer therapies, but increased scrutinization of early approvals is on the horizon.