Continuing advances in cancer treatment are a double-edged sword for many patients: New drugs, surgical techniques and other innovations help them battle their disease, but better health and longer lives may come at a hefty cost, even for people with health insurance.
Recent research spells out what patients are facing. A study by the Agency for Healthcare Research and Quality estimated that between 2001 and 2008, 13.4 percent of adults younger than 65 who had cancer spent more than 20 percent of their income on health care, including premiums. That compared with 9.7 percent of people with other chronic conditions and just 4.4 percent of those with no chronic conditions.
Researchers from the Duke University Medical Center and the Dana-Farber Cancer Institute examined the cancer spending of 216 patients, most with breast cancer, and found their out-of-pocket costs averaged $712 a month. The biggest chunk of that outlay, apart from insurance premiums, went to prescription drugs, at $174.
Long term, cancer treatment costs can have a devastating effect on people's financial well-being. A study by researchers at Seattle's Fred Hutchinson Cancer Research Center found that in western Washington state, 0.5 percent of cancer patients declared bankruptcy in the first year after their diagnosis. Five years following diagnosis, the percentage was 1.9. By comparison, just 0.28 percent of the general population declared bankruptcy over a 10-year period.
Most people have job-based insurance, but cancer treatment can take up to a year and employees risk losing coverage if they can't keep working, says Dr. Scott Ramsey, lead author of the bankruptcy study and a member of the public health sciences division at Hutchinson. "The combination can put a severe financial strain on them," he says.
Self-employed people have it no easier. In fact, because individual policies often have higher deductibles and cost-sharing than employer-based plans, they may face even tougher financial challenges.
Ellen Jacobs runs an Internet advertising business from her home in Shelbyville, Ky. When she received a diagnosis of breast cancer in May, she had to meet her individual policy's $3,500 deductible before the plan paid much of anything. Even now, although the policy covers her chemotherapy and pays a portion of her costs for doctor visits and the like, Jacobs, 46, has significant out-of-pocket costs.
Co-payments for specialists whom she must see several times a month are $40. And while many of her medications require only a $15 co-payment, there are some big exceptions. During her first chemotherapy treatments, for example, she spent $680 on a single anti-nausea drug. (Now she has qualified for assistance from the nonprofit Patient Advocate Foundation's Co-Pay Relief Program, which has helped cover $600 so far in drug bills.)
After chemotherapy shrinks the tumor in her breast, Jacobs will have surgery. But she is concerned that she might not be able to do so until after the first of the year, when she will face another $3,500 deductible.
Meanwhile, she lives with her mother and her sister, and is gratefully accepting a financial hand from her parents. “Even having insurance, I could never afford this without my mom and dad helping me out,” she says.
The American Society of Clinical Oncology encourages oncologists to discuss treatment costs with patients. But that's easier said than done, say some oncologists. More than half of the income of many oncology practices comes from administering the drugs they prescribe, says Ramsey, so oncologists are not entirely disinterested parties. In addition, the timing is often
Patients are "already scared and they have cancer," he says.
But oncologists can routinely do some simple things, according to Dr. Yousuf Zafar, lead author of the Duke study, who says he always asks his patients if they have drug coverage. Some drugs for breast and colon cancer can be administered either in pill or IV form, and an IV infusion in a doctor's office might be more affordable for someone without a good policy. Or he might prescribe a different, less expensive anti-nausea drug if he knows drug coverage is a problem.
Patients are speaking up as well, he says. If they're traveling to see doctors following an early-stage cancer diagnosis, for example, patients sometimes ask to come in less frequently for checkups, saving travel costs. Depending on the situation, Zafar may agree. "There's no good evidence that bringing them in more often will help them live longer," he says.