People living with cancer face major financial difficulties.

This is a conclusion based on a number of studies to be presented during the upcoming American Society of Clinical Oncology?s (ASCO) Quality Care Symposium, taking place September 28 and 29, 2018 to he held at the JW Marriott Phoenix Desert Ridge in Phoenix, Arizona.

The research looks at financial distress, also known as ?financial toxicity,? among patients with metastatic breast cancer and older patients, as well as conversations about cost of care that women with breast cancer are having with their physicians. Authors will present their findings at the

One of the studies based on a nationwide analysis of more than 1,000 people living with metastatic breast cancer from 41 states reveals significant cancer-related financial burden, particularly for uninsured patients.

?While providers have little control over the cost of treatment, they should monitor the burden and stress that it can impose on their patients as a component of the care they provide,? said lead author Stephanie B. Wheeler, PhD, MPH, member of the University of North Carolina (UNC) Lineberger Comprehensive Cancer Center and an associate professor in the UNC Gillings School of Global Public Health.

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?Clinicians should be attentive to how financial toxicity may be differentially experienced by patients with metastatic disease where treatment failure and rapidly changing treatment plans may add complexity and stress. Initiating conversations about treatment costs can be an important way for providers to help monitor how patients are faring and discuss solutions to mitigate financial distress,? Wheeler explains.

Uninsured
The survey found that of the 1,054 study participants, approximately one-third were uninsured. Uninsured patients with metastatic cancer were more likely to identify as a racial/ethnic minority, have lower income, and work full-time.

Compared to insured respondents, uninsured respondents more often reported refusing or delaying treatment due to cost (96% vs. 36%) and more often reported that they were contacted by a collections agency (92% vs. 30%). In addition, uninsured patients more often reported not being able to meet monthly expenses, not being satisfied with their financial situation, and not being in control of their financial situation.

Hardship
Despite these very real cancer-related financial hardships experienced by uninsured patients, insured respondents reported having higher cost-related emotional distress, including being ?quite a bit? or ?very? stressed about not knowing cancer costs (41% vs. 24%), and a greater amount of financial stress on their families due to their cancer (36% vs. 19%).

?Our study shows that the financial toxicity of cancer is alarmingly high in many metastatic breast cancer patients and that having health insurance doesn?t protect patients from the psychosocial impact of high cancer costs,? Wheeler noted.

?High co-insurance and deductibles mean that many patients are still shouldering an enormous financial burden out-of-pocket and feeling anxious about what it will mean for their own and their families? finances and financial legacy.?

Researchers fielded an online survey to metastatic breast cancer patients over a 14-day period by partnering with the Metastatic Breast Cancer Network and using the software tool Qualtrics.

The national survey took approximately 20 minutes to complete and included questions related to sociodemographics, health insurance status, cost-related communication with providers, post-treatment financial burden, financial coping strategies, and emotional well-being. Patients were offered a $10 Amazon gift card for participating.

Burden
The study results suggests that people with metastatic cancer potentially face a substantial financial burden, and it can help to guide future interventions to screen for, monitor, and alleviate the financial burden associated with cancer care. Health insurance expansion is a necessary but insufficient strategy to address this financial burden; additional interventions are needed, as well as serious consideration of the value of some high-priced, low-yield therapies in the metastatic setting.

?As oncologists, we see the burden of high treatment costs on our patients every day. Many of them are skimping on needed medication, liquidating their savings, and taking other extreme measures to control costs,? said Timothy D. Gilligan, MD, MSc, FASCO, ASCO expert and chair of the Quality Care Symposium News Planning Team.

?This study reaffirms the important role we can play in initiating and guiding conversations about cost of cancer care with our patients so that together we can make the best possible treatment decisions.?


Last Editorial Review: September 24, 2018

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