Part 2 of the latest Annual Report to the Nation on the Status of Cancer—provided by the American Cancer Society, National Cancer Institute, Centers for Disease Control and Prevention, and North American Association of Central Cancer Registries—has found that patients with cancer in the United States shoulder a large amount of cancer care costs. According to the report—published by Yabroff et al in JNCI: The Journal of the National Cancer Institute—in 2019, the national patient economic burden associated with cancer care was $21.09 billion, comprising out-of-pocket costs of $16.22 billion and time costs of $4.87 billion.
The report includes information on patient out-of-pocket spending by cancer site, stage of disease at diagnosis, and phase of care. Patient time costs reflect the value of time that patients spend traveling to and from health care, waiting for care, and receiving care, according to the report.
While this analysis is about the costs that are directly incurred by patients, which are critical to patient finances, the total overall costs of cancer care and lost productivity in the United States are much larger.
Cost of Treatment
Among adults aged 65 years and older who had Medicare coverage, average annualized net out-of-pocket costs for medical services and prescription drugs across all cancer sites were highest in the initial phase of care, defined as the first 12 months following diagnosis ($2,200 and $243, respectively), and the end-of-life phase, defined as the 12 months before death among survivors who died ($3,823 and $448, respectively), and lowest in the continuing phase, the months between the initial and end-of-life phases ($466 and $127, respectively). Across all cancer sites, average annualized net patient out-of-pocket costs for medical services in the initial and end-of-life phases of care were lowest for patients originally diagnosed with localized disease compared with more advanced-stage disease.
Karen E. Knudsen, MBA, PhD
“As the costs of cancer treatment continue to rise, greater attention to addressing patient medical financial hardship, including difficulty paying medical bills, high levels of financial distress, and delaying care or forgoing care altogether because of cost, is warranted,” said Karen E. Knudsen, MBA, PhD, Chief Executive Officer of the American Cancer Society. “These findings can help inform efforts to minimize the patient economic burden of cancer, and specific estimates may be useful in studies of the cost-effectiveness of interventions related to cancer prevention, diagnosis, treatment, and survivorship care.”
Analyses of the differences in patient economic burden by cancer type found substantial variation in patient out-of-pocket costs, reflecting differences in treatment intensity and duration as well as survival. In 2019, national out-of-pocket costs were highest for breast ($3.14 billion), prostate ($2.26 billion), colorectal ($1.46 billion), and lung ($1.35 billion) cancers, reflecting the higher prevalence of these cancers.
Working Toward Health Equity
Norman E. Sharpless, MD
“In the modern era of cancer research, we have to think about treatment costs and how they impact our patients. As exciting and promising as cancer research is, we are keenly aware of the issue of financial toxicity for these patients,” said Norman E. Sharpless, MD, Director of the National Cancer Institute. “Therapies that are highly effective are no doubt good news, but if they are unaffordable, it is not the total kind of progress we would like to see. Finding ways to ensure that not just some, but all, patients get access to therapies that are beneficial to them is an important goal we must continue to strive for in the cancer community. This report will help guide us toward achieving that goal.”
“The cost of having cancer is enormous and an extreme burden on people and families, particularly for those who are uninsured or underinsured. Prevention is key to lowering out-of-pocket costs,” said Karen Hacker, MD, MPH, Director of the Centers for Disease Control and Prevention’s National Center for Chronic Disease Prevention and Health Promotion. “Unfortunately, we know that many of these same people also have lower cancer screening use and may end up paying more for their cancer care. Access to the right cancer screening tests at the right time is an important step toward health equity, and we must work to make this a reality.”
The authors say that, in addition to morbidity and mortality from cancer and cost of cancer treatment by insurance carriers, out-of-pocket and patient time costs are other metrics that highlight the immense economic burden of cancer—making it a public health priority. Estimates of patient out-of-pocket and time costs can inform discussions between providers and patients about expected costs of treatment, an important element of high-quality care.
The authors of the report concluded, “Despite these limitations, this article provides the most comprehensive estimates of patient economic burden associated with cancer, including out-of-pocket and time costs, in the United States published to date. We found that patient economic burden associated with cancer care is substantial, both nationally and for individual cancer survivors. Findings reported here can inform patient and provider understanding about expected costs of care.”
Disclosure: For full disclosures of the study authors, visit academic.oup.com/jnci.
