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 The financial burdens are especially high for patients under age 65
who cannot access Medicare, the government insurance program for the
elderly, and for people with multiple medical conditions,
researchers say.
The prices of cancer-treating drugs are on the rise and a newer
cancer medication can cost over $100,000 per year for each patient,
the study team writes in the journal Cancer. In addition, higher
insurance deductibles and copayments can mean that patients are
paying more out of pocket for medications.
“Financial toxicity is now a well established and generally accepted
toxicity related to cancer care,” writes Dr. Daniel Goldstein, an
oncologist at Rabin Medical Center in Israel, in an accompanying
editorial.
Doctors may not be aware how much cancer drugs cost for each patient
and the topic of cost may not come up unless the patient introduces
it, study author Amy Davidoff, a senior research scientist at Yale
School of Public Health, told Reuters Health.
“In some cases, there may be a lower-cost alternative, but it may be
somewhat less effective, have greater risk of side effects, or be
less convenient to take,” Davidoff said by email. At other times,
she added, differences may be very small and switching may not have
a consequence.
The research team analyzed data from annual U.S. national health
surveys in 2011 through 2014 to compare how likely cancer patients
and non-cancer patients were to make changes to their prescription
medications for financial reasons.
The researchers compared the responses of 9,000 people with a
history of cancer and more than 93,000 patients with no cancer
history. They also looked at how recently cancer patients were
diagnosed, whether they had any other medical conditions, the type
of insurance participants had and the deductible amounts they had to
pay before insurance covered their drug costs.
The study team found that 32 percent of the patients recently
diagnosed with cancer and 28 percent of people with any past history
of cancer reported a change in their prescription drug use due to
financial concerns. Among people with no history of cancer, 21
percent changed their medications because of money considerations.
The patients most likely to ask their doctors for lower-cost
medication were cancer survivors under age 65 who had
high-deductible insurance plans.
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The more medical conditions people were dealing with, the more
likely they were also to ask to switch to lower-cost medications.
“The cost of cancer care is very high - there are many diagnostic
tests as well as drug, radiation and surgical therapies that cost a
lot of money,” Goldstein, who was not involved in the study, told
Reuters Health by email.
“There may also be significant time lost from work, many clinic
appointments that may lead to high costs related to copays and
deductibles,” he said.
For patients who choose to switch to lower-cost medications, the
effects vary widely from no effect to potential death, Goldstein
noted.
“Both patients and physicians should feel comfortable to discuss
both the cost and efficacy of their medical care,” said Goldstein.
“Physicians need to be honest with patients about the potential
clinical benefit of the drugs that they are receiving, particularly
when there is a high financial burden.”
“If the cost of drugs prescribed by your physician creates a barrier
to taking them, or will result in major financial burdens, it is
important to speak with your physician,” Davidoff said.
“In many cases it may be possible to try a lower cost alternative
first to see if it works. Otherwise, physicians or their support
staff may be able to assist the patient in finding help to pay for
expensive medications,” she said.
SOURCE: bit.ly/2lLOEmo and http://bit.ly/2kN9bXZ Cancer, online
February 20, 2017.
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