US Cancer Survivor Medical Costs Above $8000 a Year

And That's Not Counting Lost Productivity

Neil Osterweil

June 19, 2014

Acute and chronic economic hardships are the little recognized but all too common effects of cancer therapy, new research shows.

Mean annual medical expenditures are higher for male cancer survivors than for males without a history of cancer ($8091 vs $3094), according to a study published in the June 13 issue of the Morbidity and Mortality Weekly Report. For female cancer survivors, costs were even higher ($8412 vs $5119).

In addition to out-of-pocket costs, men with a history of cancer lost an estimated $3700 in annual productivity, and women lost an estimated $4000, write Donatus U. Ekwueme, PhD, from the division of cancer prevention and control at the National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention (CDC), in Atlanta, and colleagues.

These average annual productivity losses compared unfavorably with the $2260 for cancer-free males and the $2703 for cancer-free females.

Employment disability accounted for about 75% of the productivity loss in male and female survivors.

"The economic data presented in this report investigating the economic consequences of surviving cancer highlight the need to develop comprehensive intervention programs to improve the quality of the cancer survivorship experience and decrease the economic burden of cancer survivorship in the United States," the authors write.

One new and slightly positive aspect of survivorship costs is the implementation of an annual cap on out-of-pocket expenses under the Affordable Care Act, according to an expert not involved with the study.

As of 2014, there is a cap of $6350, which is below the estimated per patient costs reported in this study, noted Nancy L. Keating, MD, MPH, associate professor of medicine and of healthcare policy at Harvard Medical School in Boston.

"It's still a lot of money, and the fact is that it's too much money, particularly for people with lower incomes, but this is the first time that we have had such caps, so it might help a little bit," she told Medscape Medical News.

However, the spending caps only apply to aspects of care normally covered by insurance, and don't account for travel time and costs (which can include the cost of moving temporarily to be near a treatment center) or lost productivity.

Survivorship Rising

There were approximately 13.4 million cancer survivors in 2012, which is 4.6% of the population in the United States.

"Given the advances in early detection and treatment of cancer and the aging of the US population, the number of cancer survivors is projected to increase by >30% during the next decade, to approximately 18 million," the authors write.

In addition to the physical tolls of cancer and its treatment — including risk for recurrence, metastasis, secondary cancers, and the long-term and late effects of highly toxic therapies — survivors often live with disabilities that impair them in their working lives, the authors report.

Cancer survivors face extra costs because of the need for frequent follow-ups, often with expensive imaging studies or other tests that might be only partially covered by insurance, and many have insurance plans with high deductibles and/or copays.

Although oncologists have been aware of the problem for some time, as evidenced by the Cost of Cancer Care Task Force established by the American Society of Clinical Oncology, they have been slow to act, Dr. Ekwueme told Medscape Medical News.

 
Quite frankly, they're not doing anything.
 

"Oncologists recognize this, but quite frankly, they're not doing anything," he said.

"They have commissioned a lot of studies in this area, but it doesn't appear that the text, the writings, are translated into clinical practice," he added.

Spending Cap Should Help

Dr. Ekwueme is a member of the Health Economics Research on Cancer Workgroup, which is made up of scientists from the CDC, the National Cancer Institute, the Agency for Healthcare Research and Quality (AHRQ), the American Cancer Society, Emory University, and the Livestrong Foundation.

That group showed that cancer survivors are more likely than people with no history of cancer to be hospitalized, have visits to the emergency department, undergo ambulatory surgeries, and have provider visits in a study published in the July issue of Medical Care.

The group estimated annual "time costs," such as expenses associated with travel and waiting and time spent in care. For people 18 to 64 years of age, time costs were higher for those with a history of cancer than for those without a history ($500 vs $226).

Both studies used data from the AHRQ Medical Expenditure Panel Survey (MEPS) conducted from 2008 to 2011. The MEPS is an annual representative survey of healthcare expenditures, insurance, use, and access to care for civilian noninstitutionalized Americans. In 2011, respondents with a history of cancer (except nonmelanoma skin cancers) were asked to fill out a questionnaire on the economic burdens of cancer survivorship.

These new data reinforce how cancer survivors continue to pay for their illnesses throughout their lives, explained Dr. Keating, who is cancer outcomes researcher.

 
It is pretty striking.
 

"It is pretty striking to see not only the persistent healthcare costs — which do seem high given that many of these people are long-term survivors and not needing intensive care as they did during their primary treatment — but also the fact that productivity issues really do persist in the longer term and do cause people trouble with maintaining their active employment," she said.

Dr. Keating and Dr. Ekwueme both emphasized that oncologists and primary care physicians need to remember that cancer patients continue to have cancer-related financial issues even after their treatment ends.

"I think we need to do a better job of screening for financial burden and trying to help cancer survivors," Dr. Keating said.

The studies were supported by the CDC and the National Cancer Institute. Dr. Ekwueme and Dr. Keating have disclosed no relevant financial relationships.

MMWR Morb Mortal Wkly Rep. 2014;63:505-510. Abstract

Med Care. 2014;52:594-601. Abstract

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