by Mike Bassett
As costs for cancer therapy routinely reach into seven figures, and patients demand access to investigational medicines knowing they'll have to pay out of pocket, results of a new survey will surprise no one.
When 300 cancer patients were asked what sacrifices they would make to obtain treatment, many said they would sell their homes and declare bankruptcy if necessary.
In fact, these patients were willing to make such sacrifices even though three-quarters of survey participants had stage IV disease.
These findings, according to researchers led by Fumiko Chino, MD, at Duke University in Durham, North Carolina, suggest that shared decision-making between patients and caregivers is "important to ensure patients fully understand the goals, risks, and benefits of therapy before they make such personal sacrifices."
The results of the survey were published in the Journal of Oncology Practice.
"Financial toxicity" -- the economic burden associated with cancer care -- is understood to represent potential harm to cancer patients, and is being addressed by the American Society of Clinical Oncology (ASCO) through the ASCO Value Framework.
It's "a reality that actually is happening every day," said Lowell E. Schnipper, MD, FASCO, chief of the division of hematology/oncology and clinical director of the Beth Israel Deaconess Medical Center Cancer Center, and chair of the ASCO Value in Cancer Care Task Force.
Chino and her colleagues noted that little is known about how patients consider costs, and what kind of sacrifices they will make when making treatment decisions.
To help fill the gap, they conducted a longitudinal survey of insured cancer patients with solid tumors who had received chemotherapy or hormonal therapy at least 30 days before enrollment.
Three hundred patients completed a baseline survey, while 245 (82% retention) completed a follow-up survey 3 months later.
The median cancer-related out-of-pocket costs reported by patients who completed both surveys were $393 per month (range $0 to $26,586) at baseline and $328 per month (range $0 to $8,210) at follow-up.
At baseline, at least 65% of patients were willing to make some kind of sacrifice, such as spending less on basics and vacations, or borrowing money, in order to pay for their cancer care. Some 38% were willing to sell their homes and 49% declare personal bankruptcy.
Those percentages changed minimally upon follow-up, with the greatest change a 7% decline in patients willing to declare bankruptcy.
The extent to which patients appeared willing to make major personal and financial sacrifices in order to receive cancer care is "concerning," wrote Chino and her colleagues, and suggests that patients may not clearly understand the benefits -- often limited or nonexistent -- they'll gain as a result of these sacrifices.
Chino and colleagues were especially concerned since 76% of patients in the survey had stage IV cancer, and thus had very low probability that any treatment would help them substantially.
"There is a potential disconnect between the value that patients place on their cancer treatment and the benefit they stand to gain in terms of prolongation of life or relief of symptoms," the researchers wrote, adding that their findings "highlight the importance of shared decision making and ensuring that treatment decisions reflect patient goals and preferences."
Schnipper told MedPage Today that the results of this study, along with others, demonstrate that "doctors not only need to be aware of, but conversant with their patients about matters affecting them and their families because of out of pocket expenses."
He pointed out that while these conversations are beginning to happen, "they're not happening to an extent we would consider to be ideal." He added that associations such as ASCO and the American College of Physicians are working to find innovative ways of incorporating this kind of discussion into conversations with patients.
Schnipper said he has heard suggestions that physicians should consider approaching a conversation about financial toxicity the same way they would approach a patient's vital signs, such as blood pressure or respiratory rate.
"I don't know if we are ready for that," Schnipper said. "But, there is a group of physicians across specialties who understand the impact on our patients and feel as though we not only need to be the stewards of their health, but need to be able help them make discriminating decisions and protect their pocketbooks when it is appropriate."
Chino had no relationships to disclose.