September 21, 2017; Market Watch
For those who have faced cancer, toxicity from treatment causing such symptoms as nausea, weakness, and vomiting is expected. What they don’t expect is the toxicity that can come from the huge financial burden of paying for cancer treatment, even when a patient has insurance. The unfortunate reality is that even with expanded coverage, increasing deductibles and copays can force patients to weigh the cost of treatment against their prognosis. For some, it is essentially weighing bankruptcy against death, and 20 percent of patients will choose to end lifesaving treatment due to the high copays.
Adding salt to the wound, many cancer patients are forced to leave their jobs as treatment can leave them too weak to work. This is particularly true for those in careers that require physical exertion, like construction or the restaurant industry. A study of cancer patients younger than 65 found that losing the ability to work could negatively impact treatment. Dr. Matthew Banegas, who performed the study, said, “If they have to take time off, they may have to use extended time or extended leave which could impact insurance coverage and impact how cost affects them.”
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Financial struggles during and after cancer treatment are so pervasive, in fact, that several doctors have dedicated their research to studying the effects of “financial toxicity,” which could be defined as “the toxic effects of financial strain from healthcare costs.” Dr. Yousuf Zafar, a leading researcher in the field, says, “Multiple studies have shown that cancer patients and survivors are at risk for facing treatment-related financial burden, with a small minority at risk for extreme burden in the form of personal bankruptcy.”
Recent data indicate that at least 30 percent of cancer patients will go into debt, three percent of whom will file for bankruptcy. Dr. Zafar aptly conveys the situation his patients face: “Patients are frustrated. They believe they’ve got insurance. They believe they paid for insurance and that insurance should fully cover their cancer care.”
Although the Affordable Care Act helped alleviate some of the financial burden through increased coverage and eliminating caps on lifetime payouts, these benefits are in jeopardy as the debate over “repeal and replace” rages on. If rollback efforts succeed, we can expect to see an increase in the effects of financial toxicity. Fortunately, the nonprofit sector has stepped in—not only advocating against repeal and replace (although more advocacy is needed), but also by providing financial assistance for cancer patients and their families. Organizations like The Pink Fund, CancerCare Co-Payment Assistance Foundation, and the Healthwell Foundation among others help patients and their families navigate and pay for care. But, these measures need to be recognized as stopgaps to help patients in the short term. The high cost of care in the U.S. has convoluted roots in “big pharma” and the privatization of healthcare, systemic issues beyond the reach of the nonprofit sector alone.— Sheela Nimishakavi