Costs from treatments and medical services for older adults (66 years and older) with cancer vary significantly by a number of factors, including cancer type and stage, but rising costs tended to impact patients most in the end-of-life stage of care, according to findings from a study published in the Journal of the National Cancer Institute.
“Many advances in cancer treatment introduced in the past decade have been groundbreaking, leading to improved patient outcomes, including survival. However, some of these novel treatments are also costly and frequently used in combination and for longer periods, which can lead to substantial increases in overall spending and high out-of-pocket costs for patients and their families,” said senior study author K. Robin Yabroff, PhD, MBA, Scientific Vice President, Health Services Research at the American Cancer Society. “This study quantifies the economic burden of cancer and provides key inputs that can be used to study the value of cancer prevention and early detection.”
The study authors commented that the findings "highlight the importance of aligning treatment intensity with patient goals and providing critical inputs for simulation and cost-effectiveness analyses of cancer-control interventions."
Study Methods
Researchers sought to determine updated patient-level cancer-attributable costs based on clinical and socioeconomic factors.
They analyzed data from individuals aged 66 years and older who were diagnosed with cancer between 2008 and 2019 from Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data. They also gathered controls without a cancer history that matched demographic characteristics, comorbidity burden, and area-level socioeconomic status.
Cancer-attributable costs were considered by cancer site, stage, age, sex, race, calendar year, and phase of care—defined as initial (first 12 months after the cancer diagnosis), continuing, and end-of-life (final 12 months before cancer-related death).
Net annual cancer-attributable costs were calculated as the difference between cases and matched controls. Costs were reported in 2023.
Key Findings
Net annual cancer-attributable costs for medical services were highest in the end-of-life phase of care ($121,746), followed by the initial ($45,063) and continuing phases ($7,141). Oral prescription drug costs increased over time for all phases of care, which was especially seen in the end-of-life phase, where oral prescription drug costs increased from $4,823 in 2013 to $11,620 in 2019. Conversely, medical service and hospitalization costs remained relatively stable, after adjusting for inflation.
The highest cancer-attributable costs were seen among patients with acute leukemia and distant-stage cancers.
Cancer-attributable costs were also higher among Black patients and those of other races vs among White patients.
“Additional research is needed to better understand the long-term economic burden for patients and families, including for cancer-directed treatment, side effects and lasting conditions, and lost household income due to time away from work for patients and family caregivers,” Dr. Yabroff added. “This burden frequently lasts many years after cancer diagnosis and increases the risk of financial hardship, including medical debt, stress and worry, and delayed and forgone care due to cost, which has been shown to result in worse outcomes for patients with cancer.”
“These findings underscore the importance of effective cancer prevention and early detection in improving patient outcomes as well as avoiding the high costs of advanced cancer diagnoses. The availability of affordable, comprehensive health insurance options is critical so that individuals can access no-cost, evidence-based cancer prevention and early detection services and get needed follow-up care and treatment,” said Lisa Lacasse, President of the American Cancer Society Cancer Action Network (ACS CAN). “ACS CAN will continue urging lawmakers at all levels of government to improve access to comprehensive health insurance.”
DISCLOSURES: For full disclosures of the study authors, visit academic.oup.com.
