How Do Patients Define Value in Cancer Care?

In the United States healthcare system, discussions of value are almost always associated with the equation of quality over cost. However, patients don’t necessarily think that way, explained Yousuf Zafar, MD, MHS, associate professor of medicine and public policy at the Duke Cancer Institute.

In his presentation at The American Journal of Managed Care’s 4th Annual Patient-Centered Oncology Care Meeting, Zafar explained that what’s most important to a patient is the cure, or how the care they are going to receive will help them achieve a long, healthy life.

“They value quantity of life, they value quality of life and somewhere in there, maybe if I ask, cost comes up,” he said. “Now it only comes up if I ask; it doesn’t mean that it’s not there as an important part of what they value, but many times, and particularly the first time that patients meet me as an oncologist, they don’t want cost on the list. And the question is: at what point does it become a part of the decision making and when does it become important?”

With this in mind, Zafar said that patients are willing to do anything it takes to receive cancer care. He explained that nearly half of cancer patients are willing to declare bankruptcy, 39% are willing to sell their home, and 73% of individuals are willing to spend less on food and clothing in order to have the means to pay for the care that they need. He explained that studies have also showed that patients with insurance and who also had a cancer diagnosis were more likely to forgo vacations, cut grocery expenses, and tap into their savings and retirement funds in order to meet the financial demands of cancer care.

Much of these economic struggles stem from high out-of-pocket costs for medications, as well as the fact that insurance itself has grown to become very expensive—deductibles have nearly doubled over the last 7 years.

“A recent study found that about 50% of Americans don’t have enough cash on hand to meet the deductibles for these high-deductible plans, so already our patients are entering into the health system unprepared and unable to afford their care, even if they have insurance,” Zafar said.

As a result, it’s not just a person’s bank account that’s being impacted by these financial pressures, but the individual’s well being as well, he added.