A cancer diagnosis is physically, mentally, and emotionally devastating for the patient and everyone close to him or her. Conversations following the diagnosis often include deciding on where to get treatment and the best treatment options. One topic that is seldom discussed, but can have major implications to the patient, is the medical and employment cost of their cancer care.
Currently insured patients can expect to pay 24 thousand to 36 thousand dollars a year for their cancer drugs according to an article from U.S. News and World Report.
“Those numbers do not account for people that are under-insured, have high deductibles, or have no insurance,” says Cathy Bradley, PhD, associate director for population sciences at the University of Colorado Cancer Center. “For those patients, the cost of cancer care can be astronomical. However a cancer diagnosis can be financially devastating for a family, no matter what their socioeconomic status is.”
Although a good majority of the cost of cancer can be attributed to drugs that patients need, there are many other factors that affect the financial burden of the disease.
“Many times cancer patients have to take time off work during their treatment due to negative side-effects such as fatigue, nausea and vomiting, and so on. Often times cancer treatments are long term- it is not like treating a common illness where a patient can feel better in a few days. It can take months or years,” Bradley explains. “Currently there are approximately 14 million cancer survivors who make up a large population of the workforce in the United States. Trying to balance work and treatment plans can be a very big challenge for them.”
Studies have shown that cancer survivors have increased absenteeism at work for three to five years after diagnosis. Although there are laws in place such as the Family Medical Leave Act (FMLA), that protects a person’s position at a company for up to 12 weeks, it may not be enough time to go through the necessary treatments, and the time afforded by the FMLA is without pay.
“Patients often need their jobs to have medical insurance and to pay for medical expenses,” says Bradley. “However increased absenteeism can make it difficult to keep their employment. It is a real source of stress for the whole family.”
Additionally there are many other costs that add up over time.
“Many out-of-pocket expenses can take patients by surprise,” says Bradley, “Trips to the drug store for additional medication that is not covered by insurance, transportation costs, and even child care can add up very quickly.”
Why is cancer so expensive?
While many factors contribute to the high price of cancer, the cost of medication tops the list.
“Drug costs are astronomical for patients,” says Bradley. “Drug companies can charge essentially whatever they want for cancer treatments because large payers such as Medicare and providers do not have the ability to negotiate with pharmaceutical companies. We are the only country that provides government assisted medical care where this negotiation does not happen.”
Additionally, the surveillance care required following cancer treatment can add to expenses even after cancer is considered in remission.
“Unfortunately patients are not ‘done’ with their cancer once treatments are over. They may have to get screened on a regular basis,” explains Bradley. “Sometimes the negative side-effects from surgery, radiation and chemotherapy will be a cause for additional treatment ten or 20 years later. Patients do not have the ability to walk out of their last appointment and never think about the cancer again.”
As the conversation about the “financial toxicity” associated with cancer care continues (?) many believe that something has to be done to aid patients and their families.
“There has been an increase in policies aimed to help patients with chronic disease,” explains Bradley. “For example, The Affordable Care Act helped patients get insurance, but it does not eliminate financial burden.”
Oncologists have also been encouraged to talk to patients about the financial burden of cancer as soon as they are diagnosed.
“This is approach allows patients to make financial decisions prior to getting the bill,” says Bradley.
Despite some changes that are taking place to benefit patients, Bradley believes that as a society, we need to decide what the next steps will be to alleviate medical financial burden, particularly those costs associated with cancer treatment.
“There is going to have to national policy changes in order to reduce the cost of cancer care and its burden to patients and families,” she explains. “Some physicians have already started protesting the high prices of cancer drugs, but it is going to take a more widespread effort. As a society, we need to decide how much coverage patients will receive and how we will make positive changes to provide more equitable and less costly care.”