Money Woes Spawn Cancer Patient Treatment Shortcuts

Roxanne Nelson

October 22, 2014

Even though health insurance usually pays for the lion's share of cancer-related costs, it still is often not enough.

A new study shows that many insured cancer patients must make changes to their lifestyle, and even to their adherence to treatment, to deal with the financial burden of the disease.

The small survey involved 174 patients who were undergoing treatment for solid tumors. They were nearly all female (96%), and the majority had breast cancer (85%), but 4% had colorectal cancer and 11% had other types of solid tumors.

All the participants had medical insurance, and all requested financial assistance through a national copay assistance program.

However, despite their insurance status, many were struggling to pay for their care. The vast majority (89%) reported that they had to make at least one change in their lifestyle to cope with treatment-related costs.

Of the patients who used lifestyle-altering strategies, 78% cut spending on leisure activities, 57% cut spending on basics such as food and clothing, 54% borrowed money to pay for medication, 50% dove into their savings, 18% sold possessions, and in 15% of cases, family members took on more work.

More alarming was that 39% of participants used what the researchers termed a "medical care-altering strategy." Because of out-of-pocket and associated expenses not covered by insurance, these patients were cutting corners in their treatment regimens. The most common strategies were to not fill a prescription (28%) and to take less medication than prescribed (23%). In addition, 10% missed a test, 8% missed a procedure, and 6% missed an appointment.

"What we found striking was that almost 90% reported using any sort of life-altering strategy," said lead researcher Ryan Nipp, MD, an oncology fellow at the Dana-Farber Cancer Institute in Boston. He was speaking at a press briefing held in advance of the inaugural Palliative Care in Oncology Symposium.

"Also noteworthy was that 39% reported using any medical-altering strategy, which is a substantial proportion," he said.

"While more patients altered their lifestyle than their medical care, it was still a significant proportion and could jeopardize their health," he noted.

Dr Nipp and colleagues note that previous research has suggested that after a cancer diagnosis, about 13% of patients have to deal with a high out-of-pocket financial burden. Bankruptcy filing rates are high for cancer patients, as previously reported by Medscape Medical News. In fact, adults diagnosed with cancer are 2.65 times more likely to file for bankruptcy than those without the disease.

Identifying Those at Risk

The researchers also found that younger age, higher education, and a shorter time on chemotherapy were all associated with a greater likelihood of adopting potentially harmful cost-coping strategies. Younger patients and those with lower incomes were more likely to use coping strategies that affected their medical treatment.

"There isn't much we can do without policy changes to alter the cost of cancer care, but with this study, we can help identify certain types of patients who may be at risk for altering either their lifestyle or medical care and engage in conversations with these patients," said Dr Nipp. We can also "discuss the harm and what might happen if they alter their medical care as a result of finances."

Providers might be able to make changes in the clinic to help alleviate the financial burden. That's where future research lies, he explained.

The team did not look at how these coping strategies affected patients in the long term. "Most of the patients in this study had breast cancer, and while studies have shown that patients who do not adhere to hormone therapy have worse outcomes, we did not look at that," Dr Nipp told Medscape Medical News.

There was also mix of cancer stages in the study population, so some patients might have been on curative therapy and others on more supportive care, but that was not analyzed either, he added.

 
It absolutely is incumbent upon us that we have these conversations.
 

"As we make strides in our understanding of the whole patient, it absolutely is incumbent on us that we have these conversations to understand the financial pressures that patients face and the implications of them," said briefing moderator Jyoti Patel, MD, associate professor of medicine and oncology at the Northwestern University Feinberg School of Medicine in Chicago.

"If almost 40% of patients are jeopardizing or altering their treatment, we need to have very guided efforts to support these patients," said Dr Patel.

This research was supported by the HealthWell Foundation. Several of the coauthors report relationships with industry, as noted in the abstract.

2014 Palliative Care in Oncology Symposium: Abstract 161. Presented October 24, 2014.

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