May 23, 2023
Cancer patients shouldn’t be responsible for out-of-pocket costs
By Ezekiel J. Emanuel
May 23, 2023 for STAT
In 2023, just under 2 million Americans will be diagnosed with cancer. Many will endure multiple CT and MRI studies and intensive medical care, including surgery, radiation, chemotherapy, or immunotherapy. Fortunately, advances in treatment and novel therapies have steadily improved survival following a cancer diagnosis. Cancer death rates have declined by 27% over the past 20 years.
Unfortunately, many American cancer patients also face an unexpected adverse effect: financial toxicity. The costs of cancer are literally killing patients. But there is a clear solution. Patients diagnosed with cancer should not be responsible for any deductibles, copays, or other cost-sharing.
Financial toxicity is the economic burden patients experience from the costs related to getting treatment for their cancer. Cancer care is expensive. By one 2020 estimate, the average cost of medical care and drugs is more than $42,000 in the year following a cancer diagnosis. To complicate matters, up to 85% of cancer patients leave the workforce during their initial treatment. Consequently, more than 40% of patients spend their entire life savings in the first two years of treatment, while roughly 30% of Americans with a cancer history report having had problems paying their medical bills, having to borrow money, or filing for bankruptcy protection because of their cancer. In addition, informal caregivers, often family members, also experience out-of-pocket and opportunity costs, estimated to be upwards of several thousand dollars per month.
As I have seen firsthand as an oncologist, financial toxicity significantly affects patient behavior and outcomes. Over a quarter of cancer patients delay medical care, go without care, or make changes in their cancer treatment because of cost. To afford their cancer treatments, many patients also cut back on food, utilities, and other necessities. Not surprisingly, patients experiencing financial toxicity report higher levels of anxiety and depression. In one study, cancer patients who declared bankruptcy (particularly those with common colon and prostate cancer) had a nearly 80% greater mortality risk than those who did not. Importantly, the higher mortality was not because the patients with financial toxicity had more advanced cancers — they had the same curable cancers and received the same treatments. Much of this financial toxicity, which is increasingly common, is occurring for patients with health insurance coverage.