Patients with cancer are at a high risk for “financial toxicity,” and nurses need to be equipped to talk to them about the financial aspects of their care, according to Teresa Hagan Thomas, PhD, RN, from the University of Pittsburgh School of Nursing.
It is not only the cost of treatment that contributes to financial stress; copays, lost wages, tolls, gas, transportation, food, parking, and childcare also play a role, Thomas said here at the Oncology Nursing Society 2018 Annual Congress.
And the problem is amplified in cancer patients because of the convergence of several factors: the higher cost of care, higher deductibles (including soaring expenses for new targeted treatments and immunotherapies), and a shift in care from community hospitals to hospital-based academic practices, which are often more expensive.
In addition, because cutting-edge oral chemotherapy is considered a prescription drug benefit, whereas intravenous chemotherapy is a medical benefit, coinsurance rates are higher for patients taking oral chemotherapies, she explained.
When we’re looking at strictly monetary measures, estimates suggest that between one-fourth and one-half of all adult patients with cancer experience financial toxicity.
Estimates of the number of cancer patients living with financial stress vary, depending on the measurement used. However, “when we’re looking at strictly monetary measures, estimates suggest that between one-fourth and one-half of all adult patients with cancer experience financial toxicity,” Thomas reported.
Women are at higher risk for financial toxicity, as are young patients not yet eligible for Medicare and who do not have a large pool of assets, people in ethnic or racial minority groups, and patients with high deductibles. Skipping medications, focusing on cost of treatment, and wanting to change insurance are all warning signs of financial stress, she explained.
Research has shown that there is an association between financial toxicity and poor outcomes.
Although only about 3% of patients declare bankruptcy because of cancer care, doing so can affect mortality rates, Thomas said.
One study demonstrated that cancer patients in the state of Washington were, on average, about 2.5 times more likely to declare bankruptcy than people without cancer (J Clin Oncol. 2016;34:980-986). And patients who did declare bankruptcy were 80% more likely to die.
Barriers to Talking About Cost
Another study showed that 52% of adults with cancer wanted to discuss out-of-pocket costs with their doctor and 51% wanted their doctor to take costs into account when planning treatment, but only 19% had had such talks (Am J Manag Care. 2015;21:607-615). And when those discussions did happen, they lasted only about 30 seconds.
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