Cancer Patients Turn to Crowdfunding for Medical Expenses

Roxanne Nelson, RN, BSN

September 09, 2019

Crowdfunding for medical care is becoming increasingly common as the cost of both healthcare and out-of-pocket expenditures continues to rise. For cancer patients, unpaid medical bills was the most pressing need in crowdfunding campaigns, according to a new study.

A new analysis of more than 1000 campaigns shows that 41% requested funding to pay for medical bills, while a quarter were seeking donations to pay for medical travel.

People who were uninsured or underinsured made up 26% of the campaigns.

The authors note that while the passage of the Affordable Care Act reduced the number of individuals who were uninsured, "cost containment measures have not been realized by all patients."

The paper was published online September 9 in JAMA Internal Medicine.

Social media and crowdfunding campaigns are being increasingly initiated to pay medical expenses for unproven treatments, such as stem cell–based therapies, as well as expensive standard medical treatments such as CAR-T cell therapy.

Financial toxicity has become a well-established issue within cancer care, ever since the term was first coined by Amy Abernethy, MD, Duke Cancer Institute, Durham, North Carolina, to describe an "adverse event" increasingly experienced by patients with cancer. The financial consequences of cancer care can be substantial, especially for patients who are underinsured or uninsured.

Most Goals Not Met

Online crowdfunding platforms have emerged as a way for patients to supplement their health insurance and pay for expenses. In this study, Andrew J. Cohen, MD, of the University of California, San Francisco, and colleagues, looked at the use of crowdfunding among cancer patients and randomly selected 1035 campaigns that were raising funds for cancer-related expenses.

Insurance status was determined from the crowdfunding campaign author's self-report, along with other details including patient age, employment status, cancer type, treatment plans, and prognosis.

The median fund-raising goal was $10,000, and the most common reason given for crowdfunding was to pay medical bills (n = 424; 41.0%), followed by travel for medical purposes (n = 262; 25.3%) and nonmedical-related bills (n = 240; 23.2%). In addition, 18 (1.7%) authors mentioned the use of alternative treatments in their campaign.

Individuals who were underinsured patients requested, on average, $10,000 more than those who did not mention insurance. Campaigns involving underinsured patients made up 26.2% (n = 271) of the cohort and tended to be more likely to request funding for unpaid medical bills vs individuals who did not mention insurance (n = 178 of 271 [65.7%] vs n = 245 of 764 [32.1%], P < .01).

Overall, campaigns earned about a quarter of the requested goal (median amount of $2125) and this amount did not differ by insurance status. Underinsured patients were more likely to report unstable employment (n = 107 of 271 [39.8%] vs n = 214 of 764 [28.0%], P < .01) and were also more likely to mention undergoing previous surgery (n = 105 of 271 [38.8%] vs n = 214 of 764 [28.0%], P < .01) vs those not mentioning insurance.

Factors such as age, sex, cancer type, or insurance status did not appear to significantly affect the amount of funds raised.

Where Are the Patients From?

Approached by Medscape Medical News for an independent comment, Jeremy Snyder, PhD, professor of health sciences, Simon Fraser University, Burnaby, British Columbia, Canada, noted that this is an interesting study and said, "I would agree that the results support the view that many people are struggling to pay their health-related bills — both direct medical expenses and indirect expenses such as traveling to receive care."

Snyder added that "one concern with this data is that the authors do not disclose the geographic or date range of the campaigns that they reviewed. Thus, a significant number of these campaigns may be from outside of the US, raising different issues related to insurance coverage."

In Canada, for example, direct medical expenses for cancer-related care are generally covered through public insurance, but indirect expenses less so. "One might have to travel to an urban center in Canada, and drug coverage varies by province," he said. "In some cases, coverage hasn't been given to new pharmaceuticals due to cost, so even expensive direct care can be an issue in Canada."

However, while the rise in the use of crowdfunding for cancer-related costs is suggestive of a problematic rise in costs of treatment, even in Canada and Europe, some of the increase in crowdfunding is due to increased awareness of this funding mechanism, Snyder added. "So not all or even most of the growth is connected to cost."

The study was supported by the Alafi Fund, Russell and Sara Hirsch, and Jonathan Kaplan. The study authors and Snyder have disclosed no relevant financial relationships.

JAMA Internal Medicine. Published online September 9, 2019. Abstract

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