Doctors don't always recognize ‘financial toxicity’ of cancer

(Reuters Health) - U.S. doctors must realize that many cancer patients battle “financial toxicity” along with their disease, researchers say.

The costs associated with treatment, even for those with insurance, often create hardship and distress, according to a new study in the journal Cancer.

After surveying hundreds of doctors and thousands of patients, researchers concluded that the “financial devastation that many patients face” is not adequately being addressed by the health care providers treating them.

“We are seeing in our survey data, especially among vulnerable populations such as ethnic and racial minorities, non-trivial rates of terrible privation, including losing a home or having the utilities turned off,” said Dr. Reshma Jagsi, director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan in Ann Arbor. “We as physicians are ethically obligated to help.”

Jagsi and her colleagues surveyed 2,502 patients with early stage breast cancer as well as 370 surgeons, 306 medical oncologists and 169 radiation oncologists who were treating them.

Just over half of the medical oncologists said they had someone on their staff who often or always discussed the financial burdens of treatment with patients, as did 43.2 percent of radiation oncologists and 15.6 percent of surgeons. When it came to familiarity with the out of pocket costs of the treatments they were recommending, 40 percent of medical oncologists, 34.3 percent of radiation oncologists and 27.3 percent of surgeons said they were “quite or very aware.”

Jagsi said the low rate of awareness of out of pocket costs among surgeons was “striking.”

“But I think for many surgeons there may be an assumption that because of the seriousness of the illness, of course, costs should be covered by some form of insurance,” she said.

The financial fallout from treatment could hit patients hard. Significant proportions of women reported being in debt after treatment: 27.1 percent of whites, 58.9 percent of blacks, 33.5 percent of Latinas and 28.8 percent of Asians. Some even lost their homes because of the costs of care. Perhaps more telling, one in five white and Asian women said they had to cut down on what they spent on food, as did nearly half of black women and more than a third of Latinas.

Many women felt they weren’t getting enough help from their doctors. Of the 945 women who said they were at least somewhat worried about finances, 679 said that their doctors and staff did not help. Of the 523 women who said they wanted to talk to their health care providers about the impact of breast cancer on employment or finances, 283 (55.4 percent) said they had not had a relevant discussion with doctors, social workers or other professionals.

“This is something that afflicts tens of thousands of women every year,” Jagsi said. “Thankfully we have transformed what was once a death sentence into a disease that is treated and then leads to long term survivorship. But we haven’t gone the distance yet. We have to be able to accomplish this without our patients suffering financial ruin.”

The findings of the new study are “very concerning,” said Dr. Ashish Jha, a professor of health policy at the Harvard School of Public Health. “It’s traumatic enough to get a diagnosis of cancer and to see your treatment through and if at the end you’re struggling with finances, that feels deeply unfair.”

Jha wasn’t surprised by the results, but he said, “the numbers are pretty striking and disturbing.”

Right now, between 55 and 60 million Americans have high deductible insurance plans, Jha said.

And the impact of those high deductibles might go beyond a patient’s finances, said Miriam Laugesen, an associate professor of health policy and management at Columbia University’s Mailman School of Public Health in New York City, and author of “Fixing Medical Prices.”

“Financial toxicity or insecurity is potentially going to influence their health,” said Laugesen, who is unaffiliated with the new research. “That’s why it’s really important to make sure that health care is affordable.”

While doctors used to think that their job was to simply diagnose and treat diseases, “what we’re learning is that issues of finance and paying for health care are having a profound effect on what treatments patients can take and on other aspects of their life,” said Jha, who is unaffiliated with the new study. “The idea of cutting back on groceries is terrible.”

So, even though doctors weren’t trained to deal with these issues, “we have to engage more,” Jha said.

SOURCE: Cancer, online July 23, 2018.