Financial Toxicity a Reality for Many Needing Cancer Care

Pam Harrison

December 17, 2021

Most cancer patients and survivors in the US say it's somewhat or very difficult to afford their cancer care, a recent survey from the American Cancer Society Cancer Action Network (ACS CAN) shows.

According to the survey, published on December 15, patients and survivors across all insurance types reported challenges paying for their cancer care, with more than 80% of respondents making "financial sacrifices" to cover healthcare expenses, including going into credit card debit, skipping medical appointments or procedures, and not paying household expenses.

"It is unacceptable that some patients have to choose between cancer treatment and paying rent or incurring huge amounts of debt," Lisa Lacasse, president of ACS CAN, said in a statement. "Patients need to be able to make decisions about their cancer treatment based on the best medical care for their diagnosis, not based on cost."

The results of the online survey, conducted between October 22 and November 19, 2021, add to a growing literature highlighting the financial burden of cancer care.

The survey, which included 1248 patients and survivors diagnosed and treated for cancer in the past 7 years, reported that overall, 61% of participants found it "difficult" to afford their care. More than 40% indicated they took money out of savings, 36% went into credit card debt to pay for their care, and 24% delayed an appointment or procedure because of cost.

Not surprisingly, the most economically vulnerable faced the greatest challenges. Over half of families earning under $70,000 a year acknowledged cost was one of — sometimes the — most important factor dictating their treatment decisions. About 15% of families with annual incomes less than $35,000 called cost the "top" factor, with 33% admitting to canceling or not scheduling an appointment or procedure and 29% delaying an appointment or procedure because of cost.

Prescription drug costs are also a significant financial burden. Overall, 47% of respondents found it "difficult" or "very difficult" to afford their prescription drug costs. When breaking down by income, 75% of earners in the $35,000-year group reported prescription costs being "difficult" or "very difficult" to afford, compared to 22% of those with annual household incomes above $125,000. In the $35,000 earner group, 18% said they cut pills in half or skipped doses to manage expenses compared to 11% of participants overall.

Nearly half of respondents noted they have faced insurance-related delays or difficulties when trying to access their prescribed medications or treatments. For instance, 29% of respondents were told their insurance plan would not cover a medication or treatment prescribed by their doctor.

Many respondents also expressed dissatisfaction with their pain management. Almost 60% said they live with pain that limits their work or other activities, and 70% said their pain management options only somewhat met their needs (44%) or did not meet their needs very well or at all (26%).

"The main reason for dissatisfaction is that pain sufferers often don't want to take an opioid pain medication, but they can't find an effective alternative," the survey authors commented.

However, the US Senate is currently considering several provisions in the Build Back Better Act that would diffuse some of the financial stress patients face when they need cancer care.

These provisions include extending increased subsidies for purchasing private insurance on the marketplace, providing access to affordable health coverage for more than 2 million people in a dozen states that have yet to expand Medicaid, and capping Medicare enrollee's out-of-pocket drug costs.

"Congress is on the cusp of making significant improvements for cancer patients and their families," Lacasse said. But "this data once again makes clear how much patients are relying on their lawmakers to do the right thing."

Lacasse has disclosed no relevant financial relationships.

ACS CAN. "Survivor Views: Affordability, Prescription Drugs, & Pain." Full text

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