When someone is diagnosed with cancer and their life is on the line, nobody wants to talk about the money. The reality is that no one has an accurate idea of the cost, doctors included. When surprise bills come and a patient must choose between paying rent or paying for lifesaving treatment, what are they supposed to do?
Diane Reidy-Lagunes, medical oncologist at Memorial Sloan Kettering Cancer Center (MSK) and host of Cancer Straight Talk from MSK, a podcast for people with cancer and their loved ones, sat down with Fumiko Chino, radiation oncologist and the first recipient of the Excellence in Equity Award from the American Society of Clinical Oncology, and Emeline Aviki, gynecologic surgeon and Head of MSK’s Affordability Working Group, to discuss the issue of financial toxicity in cancer treatment.
In this episode, Dr. Diane Reidy-Lagunes gets answers and advice from two champions of this issue: Dr. Fumiko Chino, radiation oncologist at MSK and inaugural winner of the ASCO Excellence in Equity Award; and Dr. Emeline Aviki, gynecologic surgeon and head of the Affordability Working Group at MSK. Dr. Chino and Dr. Aviki share tips for choosing the right insurance plan, oral versus IV treatment, planning ahead with your loved ones and resources for aid.
The financial burden of cancer treatment costs
Studies say that 70% of patients with cancer are worried about their ability to pay for their treatment, and they are two-and-a-half times more likely compared with the general public to file for bankruptcy. Dr. Aviki says that those numbers are grossly underreported.
Emeline Aviki, gynecologic surgeon and Head of MSK’s Affordability Working Group
“As a nation, we have a major problem when it comes to the cost of healthcare,” Dr. Aviki says. She explains that deductibles have more than quadrupled and patient out-of-pocket costs have increased by more than 15% since the early 2000s. On the pharmaceutical side, the average monthly cost of newly approved oral anti-cancer drugs has increased by more than 80% in that same time period.
These soaring prices force patients to cut corners, and not just in their spending. Dr. Chino says that patients will skip out on supportive medications, put off treatment of mental health concerns, and delay scans. “We still have patients that are routinely falling through the cracks, and it’s just unacceptable,” she says.
What can patients do to make cancer care affordable?
Drs. Chino and Aviki spell out some steps patients can take to be better prepared financially for potential future cancer treatment:
- Speak to an expert to navigate your insurance. There are resources available within every cancer center. At MSK, you can speak with Patient Billing or Patient Financial Services to help with any of your financial questions.
- Make sure your insurance coverage includes at least one National Cancer Institute (NCI)-designated cancer center that is in network. In-network coverage generally means you will have to pay less for services and are less likely to need preapprovals.
- Make sure your insurance coverage includes specialty pharmacy coverage (specialty pharmacies dispense oral anti-cancer drugs).
- If you are covered under Medicare, purchase prescription drug coverage (Part D) as soon as you enroll to avoid a late enrollment penalty so that you have benefits for oral anti-cancer drugs.
- Explore the options that national resource programs offer to make cancer treatment more affordable, such as CancerCare, Family Reach, and Lazarex.
- Think through worst-case and best-case scenarios and the anticipated costs to the best of your ability. “We have good research that patients who understand their expected burden are less surprised by bills and are more likely to not skip out on treatments if they at least knew kind of what was coming,” Dr. Chino says.
- Have conversations with your loved ones early so that they know what treatment decisions you want them to make on your behalf, if needed.
What can providers do?
MSK’s Affordability Working Group includes a team of dedicated clinicians, researchers, and hospital administrators working to address the affordability and financial toxicity issues facing patients with cancer through innovating care delivery, improving interventions, and bridging the gap between patient care and research.
“We believe it is critical for members of the healthcare team to advocate on behalf of patients, particularly when it comes to financial burden affecting their cancer treatment,” says Dr. Aviki. Dr. Chino adds: “We need to move more toward value-based practicing. If there’s a cheaper medication that’s as effective, then maybe that should be our standard.”
To learn more about financial toxicity due to cancer treatment, tune in to this episode of Cancer Straight Talk from MSK.