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Financial Toxicity: The Hidden Cost of Cancer

The physical side effects of cancer treatment are well known – nausea, fatigue, discomfort. But what about the financial side effects? In recent years, the medical community has identified an increasingly common side effect of cancer treatment: financial toxicity, also known as financial distress due to costs related to cancer treatment. While the financial impact of cancer has long been identified as a source of tremendous stress, patients are paying more and more out of pocket due to the rising costs of treatment that are typically passed onto the patient.

What is Financial Toxicity?

Financial toxicity is the emotional, mental, and more often physical side effects brought on by grappling with the exorbitant costs of cancer treatment and other treatment-related costs. This relatively recent phenomenon affects patients currently undergoing treatment and struggling to make ends meet, as well as cancer survivors who are still feeling the devastating financial effects of receiving treatment. Because cancer treatment costs are ongoing and only partially paid for by health insurance (still leaving tremendous out-of-pocket costs or factoring in insurance premiums), many cancer patients find that receiving treatment is financially disruptive. Many patients scramble to find new sources of income, sacrifice household expenses that were previously not considered a luxury, and even forgo certain treatments just to avoid having to declare bankruptcy.

The Rising Costs of Cancer Treatment

In recent years, the costs of cancer treatment have skyrocketed due to the rising societal costs of care. A The combination of an aging population, more patients having access to treatment, medical innovation, and overutilization have all contributed to this rise in costs. So as the population gets older, more people are at risk of being diagnosed with cancer. Since medical innovation has developed less toxic treatments and better supportive care, more of these patients are eligible to receive treatment safely, and therefore more patients are receiving treatment than ever before. However, as cancer drugs and treatments become ever more expensive (and with a growing population requiring these treatments), society shoulders the costs. This phenomenon is explained at length by Dr. S. Yousuf Zafar MD and Dr. Amy P. Abernethy in their journal article “Financial Toxicity, Part 1: A New Name for a Growing Problem”.

These rising costs do not exclusively affect patients without health insurance or with plans that cover the bare minimum. Even patients with “good” private insurance plans feel the effects of financial toxicity, since even covering 10% of treatment costs (the average rate under the best platinum plans) can still result in a hefty monthly bill.

A study conducted at the Duke Cancer Institute revealed that while on average cancer patients were paying 11% of their household income on cancer treatment related expenses, there were patients who were spending up to 30% of their household income on health care. According to the study authors, anyone devoting more than 10% of their income to health care should be considered underinsured.

This dramatic increase in out-of-pocket costs is due to several factors, but few of which a patient feels like they can control. Financial toxicity affects every aspect of a patient’s life – from the sheer stress of managing co-pays, deductibles, and coinsurance, to the financial burden it places on a patient’s family members who are managing treatment costs on top of household bills.

The Damaging Financial Impact of Cancer

The costs of cancer and the impact it has on patients and their families is so profound that some patients are forced to file for bankruptcy. In 2013, Dr. Scott Ramsey, MD conducted a study that found people diagnosed with cancer were 2.5x more likely to declare bankruptcy than those without cancer, and that rate only increases as time passes after a diagnosis. Since a cancer diagnosis is an unexpected event, it heightens the risk for bankruptcy and severe financial distress, especially if patients had prior debts (such as mortgages or credit card debts) and were income earners in the household.

An even more troubling 2016 study conducted by Dr. Ramsey, found that bankrupt cancer patients are nearly 80% more likely to pass away than patients who don’t file for bankruptcy. For certain cancers, that rate can be even higher. Mortality rates for prostate cancer patients who filed for bankruptcy nearly doubled, and colorectal cancer patients who filed for bankruptcy were 2.5x more likely to pass away.

There are numerous reasons why financial toxicity may be so devastating to cancer patients and the effects only compound one another. For instance, the physical side effects of cancer treatment leave many patients unable to work and earn income, which only make shouldering cancer costs even harder as less income is coming in. Many cancer patients in financial distress may even refuse or miss a treatment because the costs are too frequent and too expensive. This stress caused by financial toxicity can cause a patient’s health to deteriorate at a faster rate and threaten a positive prognosis.

Fighting Financial Toxicity

Every treatment plan for cancer should also include a financial plan. While a cancer diagnosis is an unexpected and sudden event, there are steps patients and their families can take to mitigate some of the financial burden and the stress that comes along with it. Talk to your insurance provider, your healthcare provider, and your financial planner so that you and your family are educated and armed with options before treatment even starts.

If the financial burden of terminal illness prompts you and your family to look at your assets as a way to afford treatment, consider talking to Fifth Season Financial about the Funds for Living Program – a unique and straightforward way to obtain advance funds based on the face value of your life insurance policy. Fifth Season even takes over the premium payments, providing further relief. And the best part is the policy stays in place, and additional funds can be left for your beneficiaries later.

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