16 March 2012

Cancer costs hit young and poor hardest

Colon cancer patients younger than 50 and those with low incomes were most likely to experience severe financial hardships as a result of the treatments meant to save their lives.

In a new survey, colon cancer patients younger than 50 and those with low incomes or unemployed were most likely to experience severe financial hardships as a result of the treatments meant to save their lives.

The study of Washington state residents who underwent colon cancer treatment found that compared with older people, patients under age 50 had more than 50-times greater chances of selling or refinancing their homes, having their income drop 20% or more, going into debt or having to borrow money from friends and family to meet expenses.

Poorer households hit hard

Patients with low household incomes were about eight times more likely to face those financial problems than those who were better off.

"I think most oncologist have heard these stories where people are spending a lot on their treatments," said Dr Veena Shankaran, the study's lead author and an oncologist at the University of Washington. "These anecdotes are things we always hear in clinics and I wanted to get a broader sense of what's going on."

The study also found that most patients didn't discuss the cost of their treatments with their doctors, and some even skipped or refused treatment because of the price tag.

To gauge the financial impact of cancer treatment, Shankaran and her colleagues sent a survey to 555 adults living in various parts of Washington State and diagnosed with advanced colon cancer between 2008 and 2010.

The questionnaire asked about the participants' financial situation, whether or not they had insurance and about their treatments Of the 284 people who responded, 104 reported at least one serious financial hardship related to their cancer treatment.

Having financial changes

Shankaran said that they did not go into this analysis with any specific expectations. But, she added, "To have nearly 40% of patients have these major financial changes was quite surprising to us." They speculate that those groups have less savings and other resources to fall back on when co-payments and denied reimbursement claims start adding up.

Another 27% of the survey respondents described lesser financial impacts, including having to sell stocks or withdraw from savings or retirement accounts, or experiencing a drop in income of less than 20%.

The researchers found a small number of the respondents who skipped or refused treatment because of costs – about 5% and 7%, respectively.

In an accompanying editorial in the Journal of Clinical Oncology, Cathy Bradley, a health policy researcher at the Virginia Commonwealth University School of Medicine, in Richmond, says there are several ways for the health care system to avoid financial hardships brought on by cancer treatments.

One long-term strategy would be to invest in prevention, she writes. For immediate action, she says Medicare should be able to negotiate cancer drug prices or pay for the least costly alternative if the outcome is known to be about the same.

Knowing for your bill

Other than that, Bradley says doctors should talk to their patients about costs and how much the patient would be expected to pay.

"They need to understand how much this is going to cost them and their families. They need to make an informed decision," Bradley said.

From their survey, Shankaran and her colleagues found only 42%of patients recalled talking about costs with their doctors. "I think there are a lot of barriers," she said. "People may be embarrassed and they think the doctors shouldn't have to worry about this." She added that patients may even think doctors might change their treatment recommendation if they mention costs.

"You wished they would have said something, because there are things we can do," Shankaran said. Bradley believes the problem should be addressed through policy. "I think this is a policy question, and the individual is caught in the middle... and I don't think there is much they can do about it." However, Shankaran said, most oncologist have a financial counsellor available in their offices and there are also resources available online.

(Reuters Health, Andrew M. Seaman, March 2012)

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