Lack of Discussion Around Cancer Treatment Costs Leads to Financial Toxicity

Earlier this week, 3 studies were released that investigated the financial difficulties seen in patients living with cancer. Such difficulties are referred to as “financial toxicity,” which was studied in patients with metastatic breast cancer and older patients, as well as the conversations about cost of care that women with breast cancer have with their physicians.

In the first study, a nationwide analysis of more than 1000 people living with metastatic breast cancer revealed that there is a significant cancer-related financial toxicity, particularly for uninsured patients.

Click here to read more about financial toxicity in cancer patients.

“While providers have little control over the cost of treatment, they should monitor the burden and stress that it can impose on their patients as a component of the care they provide,” said lead author Stephanie Wheeler, PhD, MPH.

Uninsured patients with metastatic breast cancer more often reported refusing or delaying treatment due to cost (96% versus 36%), and more often reported not being able to meet monthly expenses, not being satisfied with their financial situation, and not being in control of their financial situation.

For insured patients, this subset reported having higher cost-related emotional distress, including being “quite a bit” or “very” stressed about not knowing cancer costs (41% versus 24%), and a greater amount of financial stress on their families due to their cancer (36% versus 19%). Researchers concluded that it can help to guide future interventions to screen for, monitor, and alleviate the burden associated with cancer care.

The second study researched financial toxicity specifically in older patients with advanced cancer. According to researchers from the University of Rochester, 18% of older patients with advanced cancer are experiencing financial difficulties due to the cost of treatment that are negatively affecting their care, quality of life, and mental health.

The multicenter study enrolled 542 patients aged 70 to 96 years across the United States. “The majority of patients with cancer are older, which means they’re living on restricted incomes and often don’t want to burden either their caregivers or kids … this is a vulnerable group we haven’t paid enough attention to as a society, but really need to, especially as the older population continues to grow,” said senior author Supriya Gupta Mohile, MD, MS.

Patients experiencing financial toxicity had a higher prevalence of severe anxiety (18% versus 7%), and a higher prevalence of depression (27% versus 21%), as well as a higher prevalence of poor quality of life (41% versus 22%) than patients who do not report financial hardship. The authors noted that they see the next step as increasing interventions to help patients and caregivers through standardized support to help older patients find resources to help them supplement costs.

The final study revealed that while many women with breast cancer experience significant financial burden and most prefer to discuss the cost of care prior to beginning treatment, few are having these cost conversations with their cancer care teams.

“In an era of rising treatment costs, we don’t routinely discuss the financial implications of cancer care with women embarking on treatment. Many treatment options for breast cancer are comparable in their effectiveness but their costs can vary,” said lead study author Rachel Adams Greenup, MD, MPH.

In the study, 607 women with a history of breast cancer completed an 88-question electronic survey on their experiences with breast cancer treatment costs and their preferences for cost transparency. A majority of women in the study had either private insurance (70%) or Medicare (25%) and reported a higher annual household income ≥$74,000 than the general United States population.

Though 79% of women surveyed preferred to understand costs prior to starting treatment, 78% never discussed costs with their cancer care teams. Furthermore, the survey also asked women to characterize their financial burden using 1 of 5 categories, none, slight, somewhat, significant, and catastrophic. Approximately 15% of women reported significant to catastrophic financial burden.

In a reaction to the findings from these 3 studies, the American Society of Clinical Oncology (ASCO) expert and chair of the Quality Care Symposium News Planning Team Timothy Gilligan, MD, MSc, FASCO, commented that, “As oncologists, we see the burden of high treatment costs on our patients every day. Many of them are skimping on needed medication, liquidating their savings, and taking other extreme measures to control costs,” he said.

“These studies reaffirm the important role we can play in initiating and guiding conversations about cost of cancer care with our patients so that together we can make the best possible treatment decisions.”

The full findings of the studies will be presented at the ASCO Quality Care Symposium, taking place September 28-29 in Phoenix, Arizona.