UroToday

Phoenix, Arizona (UroToday.com) Financial toxicity is a term popularized in 2015 to describe the problems that cancer patients have that are related to the costs of their cancer treatment. Recent studies show that cancer patients are more likely to have financial toxicity than people without cancer, and there are implications for quality of life, perceived quality of medical care, and financial security. Patients with financial burdens have generally lower satisfaction with health care and with satisfaction with the technical quality of care, implying that financial toxicity has far reaching implications affecting patients’ trust in their providers and healthcare systems. It has important implications for health outcomes. Medication nonadherence has been reported at 27%; of those 22% of patients did not fill their prescription due to cost, 14% skipped doses to make their medications last longer, and 5% of patients who skipped, took less or didn’t even fill their chemotherapy prescriptions.

Financial toxicity increases personal and family burden, risk of bankruptcy and even risk of mortality. A 2.65x increased risk of bankruptcy was associated with a cancer diagnosis. Reasons for this striking association can be explained by rising health care costs. For example, in the US, health care costs rose from $75 billion in 1970 to $3.3 trillion in 2015. The near-exponential rate of growth in costs is striking and clearly unsustainable. Other causes have been attributed to rising costs of cancer medications and underinsurance, with patients paying more than 10% of their income for out of pocket healthcare costs. This has led 1/6 patients to have high or overwhelming financial distress, meaning that 1/3rd of their income is spent on health care and most of the costs were unexpected. Technical advances in treatment (e.g. use of CT and MRI grew > 15% annually between 2000-2004) and use of expensive technologies (new technology is responsible for 40-50% of annual costs) have also been proposed as significant causes, and unfortunately, studies in cost-effectiveness of new treatments are limited.

So, where do we go from here? Dr. Chino discusses reform from the perspectives of policy makers, providers, and patients; solutions exist within systemic, interpersonal, and personal frameworks. She asserts that a broad set of stakeholders must contribute their efforts to make cancer treatment affordable, taking into consideration health outcomes, market success, costs accessibility, and costs and payments. National health care initiatives such as the affordable care act (ACA) and ASCO choosing wisely are important components of reform. ACA in medical expansion states, for example, has provided the most benefits for patients at highest risk of healthcare disparities. ASCO choosing wisely initiatives such as avoiding PSA screening for patients with < 10 year life expectancy and reduced abiraterone doses, for example, have had significant impacts on costs over time. Focusing efforts on primary, secondary and tertiary prevention will have lasting implications. Dr. Chino discussed reducing the effects of financial toxicity as part of tertiary prevention. Normalizing discussions about financial toxicities is an important start because studies have shown that 50-80% of patients want to talk about their healthcare costs but most don’t. One very significant finding is that over 50% of patients who had a conversation about their costs were able to reduce them; healthcare-specific financial counselors and case workers may have an important role. In conclusion, while financial toxicity is a growing problem, mitigating it is possible and warranted as cancer outcomes and quality of life outcomes are at risk.

Presented By: Fumiko Chino, MD, Duke University Medical Center

Written by: Selma Masic, MD, Urologic Oncology Fellow (SUO), Fox Chase Cancer Center, @selmasic, at the 19th Annual Meeting of the Society of Urologic Oncology (SUO), November 28-30, 2018 – Phoenix, Arizona

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