Cancer patients more likely to go bankrupt, but few ask about cost of care

Serious illness and financial strain often go hand in hand for patients, but a recent study published in Health Affairs is one of the first to look at the "financial toxicity" of cancer care in particular. The findings: Patients diagnosed with cancer were 2.65 times more likely to go bankrupt than people without cancer.

The study, led by researchers at Fred Hutchinson Cancer Research Center in Seattle, compared nearly 200,000 cancer patients in Washington state to more than 4,000 similar adults who did not have cancer during the same time period of 1995 to 2009. Researchers not only found that patients with cancer were twice as likely to file bankruptcy than their cancer-free counterparts, but also that patients younger than 65 were up to 10 times more likely to struggle financially as a result of treatment.

Although these particular findings focused on just the western Washington region and therefore may not apply to a larger group of people, as the Boston Globe noted, separate research suggests that cost conversations between patients and oncologists are rare, NPR reported.

Despite facing median out-of-pocket medical costs of $600 per month, most of the insured cancer patients at Duke and three affiliated rural cancer clinics interviewed for the study did not talk about cost with their doctors, found S. Yousuf Zafar, a gastrointestinal cancer specialist at Duke Cancer Institute.

 "Many said they didn't think their financial problems were bad enough to bring it up," Zafar said. "Many said they wanted the best care regardless of costs," adding that they may have been worried that doctors might cut corners on care after a cost discussion. Other patients reported they didn't think it was their doctor's role to think about costs, or that physicians couldn't influence the cost of their care anyway.

However, Zafar noted that from his personal experience as a cancer specialist, doctors do have the power to make treatment decisions, such as prescribing a pill versus an infusion, that make little medical difference but could ease  patients' financial burden considerably.

"For the most part, it doesn't matter to me," Zafar said. "It comes down to patient preference and cost."

While acknowledging that doctors do not currently have the training to discuss costs with patients, Zafar called for a change. "We can't necessarily give the best care to patients unless we address cost," he said.

To learn more:
- see the abstract from Health Affairs
- read the article from the Boston Globe (subscription required)
- see the post from NPR

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