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Out-of-Pocket Costs Remain High, Even for Insured Patients With Cancer

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Key Points

  • 16% of the 300 insured patients interviewed reported high or overwhelming financial distress.
  • Those who were in the most distressed group were spending about a third of their total household income on health-care–related costs, not including insurance premiums. For more than 60% of this group, private insurance was the primary source of their health care.
  • Patients with little or average financial stress were spending about 10% of their household income on health-care costs. More than half of patients with low financial stress had private insurance and 39% had government-subsidized insurance.
  • Those who spend more than 10% of their income on health care costs are considered underinsured.

One-third of insured people with cancer end up paying more out-of-pocket than they expected, despite having health insurance coverage, researchers at the Duke Cancer Institute have found.

The data showed that costs such as copays and deductibles could lead to financial distress among insured patients of all income levels and with all stages of cancer. These findings were published by Chino et al in JAMA Oncology.

Many cancer patients can be burdened by “financial toxicity” that can erode their mental and physical state, especially if they stop pursuing treatment because they feel they can't afford it, said senior author Yousuf Zafar, MD, a medical oncologist at Duke.

“This study adds to the growing evidence that we need to intervene,” Dr. Zafar said. “We know there are a lot of barriers that prevent patients from talking about cost with their providers. We need to create tools for patients at risk of financial toxicity and connect them with resources in a timely fashion so they can afford their care.”

Interview Results

The Duke researchers interviewed 300 insured cancer patients for the study. Sixteen percent of those interviewed reported high or overwhelming financial distress. Those who were in the most distressed group were spending about a third of their total household income on health-care–related costs, not including insurance premiums. For more than 60% of this group, private insurance was the primary source of their health care.

By comparison, patients with little or average financial stress were spending about 10% of their household income on health-care costs. More than half of patients with low financial stress had private insurance and 39% had government-subsidized insurance.

“Overall, the patients in the study were paying an average of 11% on out-of-pocket costs for their cancer treatment,” said lead author Fumiko Chino, MD, a resident in radiation oncology at Duke Health. “Those who spend more than 10% of their income on health care costs are considered underinsured. Learning about the cost-sharing burden on some insured patients is important right now, given the uncertainty in health insurance.”

Having higher-than-expected out-of-pocket costs was associated with high levels of financial stress and a decreased willingness to pay for cancer care, the researchers found. “Facing unexpected treatment costs was associated with lower willingness to pay for care, even when adjusting for financial burden. This suggests that unpreparedness for treatment-related expenses may impact future cost-conscious decision-making. Interventions to improve patient health-care cost literacy might impact decision making…future studies should test interventions for cost mitigation through shared decision-making,” the research letter concluded.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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