Living on the Edge: Patients, Financial Toxicity and Proposed Solutions

Rick Bangs, a bladder cancer survivor celebrating his Neobladder's 10th birthday gave a real and moving talk discussing the reality of financial toxicity in bladder cancer patients. Financial barriers are an increasing concern in cancer care with the development of new cancer therapies, investigations and increasing patient visits.

Patient factors include sick leave, insurance difficulties after a cancer diagnosis and financial uncertainty with regards to knowing how much health care will cost and how long the course of treatment will last. The financial stress is an unnecessary burden to patients who are dealing with major emotional stress. 62% of Americans have less than $1,000 in savings (, and the average care of bladder cancer  $100,000-200,000 per lifetime per patient.

He describes critical success factors for patients to overcome the burden. They include: help navigating financials and embedding value in shared decision making with discussions around the quality of life, outcomes and cost between the patient and the caregiver team. A key message from his talk was the importance of value to the patient. He defined value as the balance between cost, quality of life, outcomes and side effects from therapy. He advocates for seeking solutions that include financials but are not overwhelmed by them. 

Banks defined patient and caregiver solutions. He urged patients to ask financial questions, get estimates upfront, include outcomes and side effects in discussions, and to shop around amongst different providers as cost is highly variable amongst them. Physician based financial solutions to advocacy included encouraging the physician to be a catalyst for further dialogue and solutions, and to lobby payers to reimburse treatments that add real value to the portfolio and abandon treatments that do not earn their place in treatment. He clearly outlines that solutions will require collaboration amongst patients, physicians, industry, advocacy network, insurance companies, research design and government.

Bangs offered a simple message that is critically important to the patients’ well being and a goal that should be achievable through transparency and communication. 

Presented By: Rick Bangs, Patient Advocate

Written by: Michael J Metcalfe, MD. Fellow of Urologic Oncology Urology, MD Anderson Cancer Center, Houston TX

Ashish M. Kamat, MD, MBBS, FACS
President, International Bladder Cancer Network
Chair, Society of Immunotherapy for Cancer (SITC), BCTF
Director of Urologic Oncology Fellowship
Professor of Urology
Attending Surgeon, Division of Surgery
The University of Texas, MD Anderson Cancer Center