Wednesday, February 25, 2015

Facing the (Very Real) Financial Fears of a Cancer Diagnosis

 Interesting subject that doctors should be more aware of when planning treatments with their patients

 Facing the (Very Real) Financial Fears of a Cancer Diagnosis



Updated January 30, 2015.

Written or reviewed by a board-certified physician. See's Medical Review Board.
Hearing “You have cancer” unleashes a tornado of fears.  Will my hair fall out?  Will I spend days dry-heaving over the toilet?  Will I need surgery?  Will I die?  But when first hearing the diagnosis, many cancer patients and their loved ones don’t immediately fear financial ruin.  But, sadly, the enormous financial threat that faces many cancer patients is all too real, and the statistics and implications of financial stress are tragic.
If you have cancer, you’re more than twice as likely to file for bankruptcy as someone without cancer.  Among cancer patients, this bankruptcy risk is even more pronounced for young adults, who are likely to have less income, greater expenses (kids, school loans), and private insurance payment obligations than are Medicare age patients.  In fact, bankruptcy rates in the youngest adults can reach ten times that seen in the older cancer population.  Bankruptcy risk of is also increased in women and non-Caucasians with cancer.  Overall, about six out of 1,000 cancer patients ultimately declare bankruptcy.

And while people can eventually recover financially, bankruptcy has additional implications which are potentially even more devastating, as it is unlikely that bankrupt patients can afford to complete their recommended cancer treatment.
Severe financial stress on cancer patients and their loved ones causes significant damage in the many who don’t go the bankruptcy route.  An astonishing 10% to 20% of cancer patients may ultimately choose to not receive the recommended therapy or may deviate from the recommended treatment plan due to personal financial constraints…10% to 20%!
Why does this happen?
For the many cancer patients not yet of Medicare age, a major portion of treatment payment obligation falls directly on them.  Out of the $20.1 billion annual cost of care, non-Medicare cancer patients personally pay more than $1.3 billion (6.5% of total cost).  On average, cancer patients pay about $9,000 annually for treatment, with some paying significantly more.

The main driver of this massive and accelerating cost of cancer care is new cancer drugs.  And simply replacing newer agents with older generics doesn’t always make clinical sense, as newer drugs are often significantly better, providing targeted killing of malignant cells and reduced toxicity.  Thus, patients may have not clinically equivalent but cheaper alternative, and breakthrough drugs now routinely cost $10,000 per month of treatment, twice the cost of newer agents only a decade ago, with patients regularly paying a portion, including some who must cover up to 20% of costs.

We can bash the pharmaceutical industry for these seemingly outrageous prices, and many have.  Cancer physicians have led the vocal outcry, depicting drug manufacturers as profiteering off the desperation of cancer patients.  Backing their accusations are up to 40% lower costs abroad for the same chemotherapy agents.  Drug manufacturers fight back, countering that their companies spend billions on drug research, only a small percentage of which eventually translate into commercialized products which, therefore, must cover the significant cost of the many dead ends.
There are several ways to seek help if your cancer treatment or treatment of a loved one is causing significant financial stress, and I encourage you to pursue them long before deciding to alter or abandon the treatment most likely to be of benefit.

First of all, speak with your oncologist to learn if there are less expensive treatment alternatives that offer similar potential clinical benefit in treating your malignancy.  Ask to receive your chemotherapy in the doctor’s office rather than at the hospital, as hospital chemo administration is routinely more expensive.  Next, reach out to the drug companies that manufacture the chemo agents you are receiving.  Several pharmaceutical companies have financial assistance programs for patients who specifically need their drugs but are financially stressed.  In addition, many U.S. states offer State Pharmaceutical Assistance Programs for financially stressed patients.  And for those enrolling in a new health insurance plan or changing plans through a state health insurance marketplace (as part of the ACA, or “ObamaCare”), you should definitely use the Cancer Insurance Checklist to guide your decisions before we reach the February 15th enrollment deadline.
Finally, although it is an additional expense, getting advice from a qualified financial advisor is often a good investment.  These specialists can quickly understand your assets and projected expenses (including treatment-related) and offer guidance on managing your financial risk, protecting you and your family.
In following any of these paths, remember that you are the cancer owner and, therefore, you must drive the process.  At times while searching for financial alternatives and support, you may become frustrated, even angry.  Take a deep breath, try to be patient and, when necessary, be assertive (while remaining respectful).  In the end, you will hopefully discover real options to reduce your financial exposure without giving up your best chance at fighting your cancer.

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