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The New Cancer Challenge: “Financial Toxicity”
The medical community is growing alarmed about a creeping malady that can diminish the quality of life for cancer patients and even shorten their lives, according to Yousuf Zafar, MD, MHS, a medical oncologist at Duke University. It’s found everywhere in the United States, but not to the same degree in other developed countries. It’s called “financial toxicity.”
A cancer diagnosis more than doubles an American’s chance of declaring bankruptcy, Zafar said during a lecture sponsored by the Duke Center for Community and Population Health Improvement. And that bankruptcy, in turn, has been shown to reduce survival rates.
In addition to treating cancer patients, Zafar studies access to care and the cost of care at the Duke Cancer Institute, the Sanford School of Public Policy, and the Margolis Center for Health Policy.
Zafar told personal stories of two patients who declined treatments because of the financial hardship they feared.
One of them had a job in health insurance but no prescription drug coverage, which put him on the hook for $4,000 in medications to treat his rectal cancer for a few weeks. Had either the patient or Zafar brought the topic up, the costs might have been avoided, but they never talked about money, he said.
The other patient passed up another round of treatment for his pancreatic cancer for fear of the bills his family would be saddled with when he died.
Today, cancer chemotherapy in the U.S. can cost “tens of thousands per month,” Zafar said.
“Pricing in the European Union and the rest of the world is a completely different picture,” he added. In the U.S., pricing “simply reflects what the market will bear.”
Another source of the steep price climb is the advent of biologic drugs, which are expensive to develop, use, and store, but offer more-targeted therapy for individual patients, Zafar said. One of the most successful of these drugs is imatinib (Gleevec, Novartis), an oral chemotherapy that became 158% more expensive between 2007 and 2014.
In the face of rising costs and questionable benefits, a cancer treatment team in many cases can help patients find other means of support or alternative treatments to achieve the same end with less financial damage, according to Zafar. But they have to have the conversation, he said.
To help enable those discussions at Duke, Zafar has developed a mobile app called Pathlight that assists patients in making more-informed decisions and in planning for the financial burden of treatment. To create the app, Zafar partnered with a software company called Vivor, which has found ways to help patients navigate to financial-assistance programs. That part of the project was supported by the National Cancer Institute.
Even for people not receiving cancer treatment, drugs have become more costly, Zafar said. Health care premiums rose 182% from 1999 to 2013, with workers paying an increasing share of the cost of their employee health plans.
Source: Medical Xpress; May 12, 2017.