• Posted January 4, 2022

Many Cancer Patients Face Mounting Bills Despite Having Insurance

Many insured cancer patients still experience serious money problems linked to their illness, new research affirms.

For example, nearly 3 out of 4 insured patients with colon cancer have major financial hardship in the year after their diagnosis, which affects their social functioning and quality of life, according to the study.

"The vast majority of cancer patients face financial struggles, in spite of having health care insurance," said lead researcher Dr. Veena Shankaran, co-director of the Hutchinson Institute for Cancer Outcomes Research in Seattle.

The hardship is not limited to economically disadvantaged or uninsured patients, she added.

"As such, this is an important survivorship issue and needs to be addressed by providers, payers, clinics, health systems and policymakers," Shankaran said, adding: "It is a widespread, highly prevalent issue that requires urgent solutions."

While this new study focused on colon cancer, the financial toll of cancer care isn't limited to that cancer alone, Shankaran said.

"There is no reason to think that colon cancer is more expensive to treat or affects ability to work any more than a variety of other advanced cancers," she said. "I suspect that patients with breast, lung, lymphoma, prostate and other cancers face similar hardships."

For the study, Shankaran's team collected data on nearly 400 patients with colon cancer that had spread. Although 98% of them had health insurance, 71% had major financial problems stemming from their care, the study found.

The money woes included increased debt; the need to take out new loans or refinance or even sell their home; or a drop in income of 20% or more, Shankaran said. These problems take a toll on the patient's quality of life, she noted.

And they affected all participants regardless of age, race, marital status, employment or annual income, the study found. The findings were published Jan. 4 in the Journal of the National Cancer Institute.

"Many have assumed that medical financial hardship only affects households without health insurance coverage or with very low income," said Robin Yabroff, scientific vice president for health services research at the American Cancer Society. "These findings suggest that financial hardship is widespread and may affect millions of patients and their families, especially as the costs of cancer care continue to increase."

Yabroff, co-author of an editorial that accompanied the study, said routine and comprehensive medical financial hardship screening of patients with cancer is a must. Such screenings can help point patients to support services, she added, urging policymakers to consider it a part of quality health care.

Other research has shown that patients with cancer increasingly face high out-of-pocket costs and may need to make trade-offs between paying for their cancer care and basic needs such as food, housing and utilities, Yabroff said.

Patients also delay or forgo recommended cancer care as well as other needed medical services, because they can no longer afford it.

"The adverse effects of financial hardship on health underscore the need to identify patients experiencing hardship and intervene to address it," Yabroff said.

She said providers, cancer centers and state and federal health policymakers must develop ways to ensure that advancements in cancer care are widely accessible without inflicting financial ruin on patients and families.

Editorial co-author Cathy Bradley, professor and associate dean for research at the University of Colorado School of Public Health, added that policy solutions are urgently needed, including more comprehensive insurance coverage, caps on out-of-pocket expenses and slowing the growth in treatment costs.

"Financial hardship will persist until there is a unified effort to curb costs," Bradley said. "Policymakers, providers and payers all have a role in reducing these costs. Without such efforts, the remarkable progress made in cancer treatment will be inaccessible for most patients."

More information

For more on the cost of cancer care, visit the American Cancer Society.

SOURCES: Veena Shankaran, MD, MS, professor, medical oncology, University of Washington School of Medicine, Seattle, and co-director, Hutchinson Institute for Cancer Outcomes Research, Seattle; Robin Yabroff, PhD, MBA, scientific vice president, health services research, American Cancer Society; Cathy Bradley, PhD, professor and associate dean for research, University of Colorado School of Public Health, Aurora; Journal of the National Cancer Institute, Jan. 4, 2022