Patients With Cancer Face Both Disease and Financial Toxicity

There’s a national health and economic crisis hiding in plain sight that causes patients and families fighting cancer to be unable to adhere to their treatment plans and instead drives them to financial ruin and shortens their lives: cancer-related financial toxicity (CRFT). The pervasive effects of CRFT as a result of disease-related income loss and increased out-of-pocket (OOP) costs associated with cancer treatment are explored in a new white paper, “Cancer-Related Financial Toxicity and its Pervasive Effects on Patients and Families: Solving a National Health and Economic Crisis Hiding in Plain Sight,” produced by Family Reach, a national nonprofit organization dedicated to alleviating the financial burden of cancer, with the support of Xcenda.

Direct medical expenditures for cancer are projected to total at least $158 billion by 2020, and patients and their families pay about $4 billion per year in OOP costs associated with cancer treatment. The substantial financial effect on families can be catastrophic; CRFT is a debilitating side-effect of cancer treatment, the white paper suggests, and occurs when the OOP costs of treatment are high relative to a family’s already diminished income, as treatment often requires patients and families to reduce work hours significantly. Part of the fallout from CRFT, in addition to the social and clinical consequences of cancer, such as reduced quality of life and increased psychosocial hardship, are poorer treatment adherence and decreased survival.

CRFT is widespread among patients with cancer and their families. Up to 73% of adult patients with cancer experience some sort of CRFT, which causes a chain-reaction of ill effects:

• Higher levels of CRFT are associated with decreased quality of life, poorer treatment adherence, and poorer survival for adult patients with cancer.
• Financial burdens lead 38% of adult patients with cancer to postpone filling or not fill drug prescriptions to reduce costs.
• Adult patients with cancer are 2.65 times more likely to file for bankruptcy than patients of similar ages without cancer. Patients who filed for bankruptcy have a 79% greater risk of early mortality than patients who do not file for bankruptcy.
• In a survey of patients diagnosed with cancer, 20% take less prescription medication than was prescribed, 19% reported partially filling a prescription, and 24% reported not filling the prescription altogether to defray treatment costs. 

It is not just uninsured patients who face catastrophic financial burdens. Even insured patients are vulnerable to CRFT because many have insurance plans with high levels of cost-sharing. Many patients, especially lower-income patients, are attracted to insurance plans with lower monthly premiums, but learn later that they have to pay high OOP costs for cancer care. Compounding the situation, OOP costs for cancer recurrence can be up to 3 times greater than OOP costs experienced for the initial treatment.

The need for interventions to alleviate CRFT is increasing, in part because of a steady rise in cost-sharing health insurance plans. Premiums for family coverage have increased 20% since 2011 and 58% since 2006. Other forms of cost-sharing, such as deductibles, copayments, and coinsurance, have also increased.

Family Reach concludes that a multicomponent approach to financial interventions will help to address CRFT. “Financial navigation, financial planning, education, and financial assistance provided to patients early and throughout their cancer journey will likely have the greatest impact on reducing financial barriers to treatment adherence and improving disease outcomes.”