Paying for Cancer Care at All Costs

Cancer care does not come cheap. Although insurance coverage, Medicare and Medicaid cover some expenses, many patients must still dig deep into their own pockets, creating financial strain.

Now a study reveals just how much individuals would give up to meet those bills. Nearly half of patients surveyed were willing to declare bankruptcy, and more than a third said they would sell their home, according to a study conducted by researchers from Duke University Medical Center, Duke Cancer Institute and Massachusetts General Hospital Cancer Center.

“Being willing to sell their home was really shocking, because you think that’s a big sacrifice that not only affects (an individual) but also (their) potential spouse and children,” said Fumiko Chino, M.D., a radiation oncologist at Duke and author on the study.

The research team examined financial distress among insured adults who had solid tumors and were receiving chemotherapy or hormonal therapy for a month or longer.

Initially, the study included 300 patients; 245 participated in a three-month follow-up survey. Questions addressed financial distress, out-of-pocket costs, expected financial burden, and willingness to pay for treatment and to sacrifice for it.

Most patients (76 percent) had stage 4 disease, and the median age was 60. Median annual income was $60,000, and median monthly out-of-pocket cancer-related expenses were $393 (ranging from $0 to $26,586), dropping to $328 (from $0 to $8,210) at follow-up.

Also at follow-up, 30 percent of patients stopped receiving active treatment, and 8 percent (19) reported changes to their insurance.

The results revealed that many patients were prepared to make considerable sacrifices. At least 65 percent were willing to spend less on vacations and basic needs and borrow money, 49 percent would declare bankruptcy, and 38 percent would sell their homes.

That attitude toward personal sacrifice persisted at follow-up. However, fewer participants were OK with declaring personal bankruptcy than at the start (49 percent versus 42 percent).

“If people are first on in their treatment, they maybe had different expectations, but as they settled into their treatment, they become more realistic,” Chino said. “(At follow-up), we see a small decline of people’s willingness to sacrifice. I think that maybe points to another aspect that needs to be addressed in terms of shared decision-making and patient and provider communication.”

Financial concerns vary among individuals, Chino noted. “I had one gentleman who was spending down his kid’s college savings, so he could be there for when his kid graduated (from) high school,” she said. “Other patients were living out of their cars because they had lost their home because of cancer costs.”

Although patients can turn to pharmaceutical companies and nonprofit organizations for financial assistance, Chino said she feels that more substantial resources and government regulations are needed. Normalizing the conversation could help, too: “Historically, patients are uncomfortable talking about their costs, and providers are uncomfortable, too. That’s two barriers on both sides of the conversation. I think some of it is education and awareness. Studies like ours open doors to talking about these issues.”

Chino plans to explore both individual tools for patients and systems-based tools, such as decision-making models, to move the research forward.

“We talk a lot in abstract concepts about how costs are important, but the first steps should be really to just ask patients what they want,” she said. “How do they feel about these sacrifices? The first step in the ultimate solution is to do an assessment of who is being affected the greatest, and those are patients with cancer.”