A new nationwide analysis of more than 1,000 people living with metastatic breast cancer from 41 states reveals significant cancer-related financial burden known as financial toxicity, particularly for uninsured patients. The study will be presented by Wheeler et al at the upcoming 2018 ASCO Quality Care Symposium, to be held September 28–29 in Phoenix (Abstract 32).
“While providers have little control over the cost of treatment, they should monitor the burden and stress that it can impose on their patients as a component of the care they provide,” said lead author Stephanie B. Wheeler, PhD, MPH, of University of North Carolina Chapel Hill. “Clinicians should be attentive to how financial toxicity may be differentially experienced by patients with metastatic disease where treatment failure and rapidly changing treatment plans may add complexity and stress. Initiating conversations about treatment costs can be an important way for providers to help monitor how patients are faring and discuss solutions to mitigate financial distress.”
Researchers fielded an online survey to metastatic breast cancer patients over a 14-day period by partnering with the Metastatic Breast Cancer Network and using the software tool Qualtrics. The national survey took approximately 20 minutes to complete and included questions related to sociodemographics, health insurance status, cost-related communication with providers, posttreatment financial burden, financial coping strategies, and emotional well-being. Patients were offered a $10 Amazon gift card for participating.
The survey found that of the 1,054 study participants, approximately one-third were uninsured. Uninsured patients with metastatic cancer were more likely to identify as a racial/ethnic minority, have lower income, and work full time. Compared to insured respondents, uninsured respondents more often reported refusing or delaying treatment due to cost (96% vs 36%) and more often reported that they were contacted by a collections agency (92% vs 30%). In addition, uninsured patients more often reported not being able to meet monthly expenses, not being satisfied with their financial situation, and not being in control of their financial situation.
Despite these very real cancer-related financial hardships experienced by uninsured patients, insured respondents reported having higher cost-related emotional distress, including being “quite a bit” or “very” stressed about not knowing cancer costs (41% vs 24%) and a greater amount of financial stress on their families due to their cancer (36% vs 19%).
“Our study shows that the financial toxicity of cancer is alarmingly high in many [patients with] metastatic breast cancer and that having health insurance doesn’t protect patients from the psychosocial impact of high cancer costs,” said Dr. Wheeler. “High co-insurance and deductibles mean that many patients are still shouldering an enormous financial burden out-of-pocket and feeling anxious about what it will mean for their own and their families’ finances and financial legacy.”
This study suggests that people with metastatic cancer potentially face a substantial financial burden, and it can help to guide future interventions to screen for, monitor, and alleviate the financial burden associated with cancer care. Health insurance expansion is a necessary but insufficient strategy to address this financial burden; additional interventions are needed, as well as serious consideration of the value of some high-priced, low-yield therapies in the metastatic setting.
To see a full list of author disclosures, refer to the study abstract.
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