When it comes to treating cancer — and particularly intransigent forms of the disease such as multiple myeloma — the elephant in the room is not fear of looming death, but concern over skyrocketing medical bills. A recent study conducted by researchers from the Penn’s Abramson Cancer Center has indicated that “financial toxicity” – a term used to describe the overwhelming burden of out-of-pocket medical bills that can affect treatment – is a growing problem that even faces those with health insurance and whose household incomes exceed $100,000.
The report was published in a recent issue of the Lancet Haematology, and focused specifically on patients being treated for multiple myeloma. Multiple myeloma is a form of cancer of the plasma cells, white blood cells that help us fight infections. The disease’s treatment is extensive, and though strides have been made through the use of novel therapeutics, the introduction of expensive new options has created a financial burden that has become a burden for its intended beneficiaries.
The study was a collaboration beteen authors Edward Stadtmauer, MD and chief of Hematologic Malignancies and a professor of Hematology/Oncology at the Abramson Cancer Center, and Scott Huntington, M.D., a faculty member at Yale University and previously of the division of Hematology/Oncology at Penn. The data released in the Lancet article was previously presented at the American Society of Clinical Oncology’s 2015 meeting in June. The data showed that of the 100 patients included in the study, almost half indicated that they’d had to withdraw money from their life savings in order to fund their treatment, and nearly one out of five said that the costs had actually interfered with their ability to continue their regimen: They had delayed treatment pending available money, and ten had entirely discontinued their treatment as a result of the monetary burden.
The fact that the cost of cancer treatment presents difficult choices for cancer patients is not news. Previous studies have detailed the various ways that patients have tried to handle out-of-pocket costs, and compromising their compliance with a prescribed regimen is just one. Not only is money becoming an issue in getting better, it is also becoming a quality of life issue that some fear may be hastening patients’ death. According to Dr. Huntington, “While advances in multiple myeloma therapy have contributed to significant improvements in patients’ outcomes, the clinical gains have come with rising costs, and today because of these advances, most patients are on a new drug, compared to a decade ago when less than 5 percent were. So we’re not talking about a select group of patients faced with this burden – many are facing the financial challenges with treatment.”
The costs can be truly staggering, with some of the newly approved therapeutics for multiple myeloma costing up to $10,000 per month, reflecting a tenfold increase in treatment cost over the last decade and a half.
In conducting the study, the researchers asked participants to answer survey questions from a tool called the COST (Comprehensive Score for Financial Toxicity) questionnaire, which gauges existing financial measures such as education, income and education against the expenses that are being faced, and current economic status. Fifty-nine percent indicated that the cost of treating their disease had exceeded their expectations, and 70 percent admitted that the costs had put them under at least some financial stress. When asked whether they had sought any type of financial assistance for cancer 36 percent indicated that they had, and half of those had incomes that exceeded $100,000 per year.
When asked how they had paid for treatment and what the overall impact was on their life, the responses were eye opening, including:
Contributing to the economic stress was the fact that over half of the group had been forced to either leave work entirely or reduce their hours based upon the impact of their illness.
Though there is an assumption that this type of effect is largely seen in patient populations that do not have financial resources available to them, the study participants all would have been anticipated to be protected from financial burden. They had health insurance, and those who were insured by Medicare had supplemental out-of-pocket insurance. All were above the national average on measures of median household income and education, with income between $60,000 and $79,999 per year, and 70 percent having some college education. The group’s median age was 64 and 53 percent were female.
The authors’ conclusions warn of a need to address the situation in order to ensure that patients will avail themselves of available treatment, saying, “While enthusiasm surrounding modern advancements in cancer treatment is warranted, we must also acknowledge the untenable rise in treatment costs and its impact on patients. In the interim, strengthened collaboration among patients and health care stakeholders is needed to promote health care reforms that not only reward treatment innovation, but also promote high value and affordable cancer care.”
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