Cost-Coping Is a Fact of Life for 9 in 10 Patients With Cancer

Eighty-nine percent of patients with cancer reported making lifestyle modifications to cope with the high costs of cancer treatment, and more than one-third altered their medical care, according to the results of a new nationwide survey, underscoring the need for oncology practitioners to screen for and anticipate potentially harmful cost-coping behavior to alleviate patient distress and promote optimal care.

“We need a better, more open dialog between patients and providers about the financial burden associated with cancer care costs,” said lead study author Ryan D. Nipp, MD, reporting the results at a presscast in advance of the inaugural ASCO Palliative Care in Oncology Symposium, which will be held October 24 to 25 in Boston.

Previous studies have suggested that the financial burden of cancer care causes substantial patient distress: approximately 13% of Americans are burdened by high out-of-pocket cancer care costs, according to the American Cancer Society, and as many as 20% report spending their life savings to pay for their care.

Of 174 patients surveyed, 78% reported spending less on leisure activities, 57% spent less on basics like food and clothing, 54% had to borrow money, and 50% of patients used their savings to pay for care. Other lifestyle adjustments which patients reported included having to sell possessions (18%) and their families having to work more (15%).

For those who adjusted their medical care, 28% cited not filling prescriptions and 22% took less medication. Ten percent of those surveyed missed a test, 8% missed a procedure, and 6% missed an appointment.

Patients on the study had all stages of disease, noted Nipp, an oncology fellow at the Dana-Farber Cancer Institute. The majority (85%) had breast cancer, 4% had colorectal cancer, and 11% had other solid tumors. Notably, all of the respondents had health insurance.

In addition to finding out what strategies patients use to cope financially, the researchers looked at certain demographic factors to help identify those patients who might be most at risk for lifestyle- or medical care—altering behaviors. They found that patients under age 65 and those earning less than $20,000 annually were more likely to alter their medical care, whereas patients who were younger, had more education, and a shorter duration of chemotherapy were more likely to make lifestyle adjustments.

“We found that most participants altered their lifestyle more than their medical care, but a significant proportion alter their care, which may jeopardize their health,” said Nipp. “With this study, we can help identify certain types of patients who may be at risk for altering their medical care or their lifestyle and at least engage in conversations with these patients,” about their choices and develop screening tools and interventions to ease the burden—a focus of future research, he added.

“As we make strides in understanding the whole patient, it’s absolutely incumbent upon us to have these conversations,” agreed panel moderator Jyoti D. Patel, MD. Patel, a thoracic oncologist and associate professor in hematology/oncology at Northwestern University’s Feinberg School of Medicine, said that is important not only to understand the financial pressures that patients face, but also the implications, with up to 40% of patients jeopardizing or altering their treatment. “We have to have very guided efforts to support these patients during this time.”

The researchers noted that the study, supported by the HealthWell Foundation, is one of the first to explore sociodemographic factors associated with cancer treatment cost-coping strategies.

Nipp RD, Zullig LL, Samsa G, et al. Coping with cancer treatment-related financial burden. Presented at: 2014 ASCO Palliative Care in Oncology Symposium; October 24-25, 2014; Boston, MA. Abstract 161.

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