How often do you ask your doctor about the affordability of a test or treatment? How often does your doctor discuss how the cost of cancer treatments affects your life? Probably not often.
Every June oncologists gather to learn about research affecting their patients. Most of those presentations will focus on new drugs and methods for treatment. In at least one presentation this year, however, the talk was about money. What happens when a patient can not afford the best treatment or when that patient decides that the possibility of extending life is not worth the financial burden on the family?
Doctors Abernathy, Zafar and other researchers at Duke University and Dana Farber Cancer Center studied 127 cancer patients to find out how cancer affected them financially. Their research found that 45% of them considered their out-of-pocket expenses to be either "significant or catastrophic." These patients, most of whom had breast cancer, were all insured. Yet their monthly treatment-related expenses averaged $1,266 a month. Seventy-three percent of the study participants had an income of less than $40,000 a year, so spending more than a thousand dollars a month put quite a bite into their budgets.
How did they cope? They started in the obvious places. Three-quarters of them spent less on restaurants and entertainment. Half cut back on food and clothing. About half dipped into savings and/or borrowed money. An alarming third left their prescriptions unfilled, and a fifth filled their prescriptions, but took less than directed. Of course, since those numbers add up to more than 100%, most used more than one strategy.
Unfortunately, for all too many cancer patients, these cost-cutting measures prove fruitless. Researchers at the Fred Hutchinson Cancer Center in Seattle found that the rate of bankruptcy for cancer patients five years out from diagnosis was four times higher than for other people in Western Washington where researchers studied data from 232,000 adult cancer survivors.
The participants in this ASCO presentation acknowledged that doctors often neglect to discuss financial implications of treatments with their patients. That certainly squares with my experience. I have never had a doctor mention the cost of a treatment or test unless I bring the topic up. I rarely mention costs because I find it embarrassing to admit that I might not be able to afford a test to keep me healthy. This is especially true since, in my case, health costs cut into a trip to see my grandchildren or similar discretionary expenses instead of food or mortgage payments.
When I was in cancer treatment thirteen years ago, my health insurance covered most of my expenses. Copays were low enough that we could work them into a new monthly budget. As health care costs have risen, however, so has my share of expenses even on my good health plan. If I had the same treatments today that I had in 1998, I would incur significant financial challenges. My higher share has done what it is supposed to do. I have recently started asking my doctors about what a test costs and whether a generic version of a drug is available. Now my doctors and I are partners in reducing my health care costs.
But for cancer patients, who may have high co-pays and deductibles, skipping a test or going with a less effective drug might have fatal consequences. That is why it is so important that we as patients to talk to doctors about our financial fears as well as our medical concerns. Some old cancer drugs may be just as effective as the new ones--in some cases even better. The long-term side effects of a new drug can't be understood for years. Maybe a tried-and-true drug would work just as well. Choosing the less expensive drug and actually filling the prescription works much better than letting the doctor prescribe a medicine you can't afford to fill.
When there is not a less expensive option, your doctor's business office can help you with finding programs to help you with expenses. If your income is too high to qualify for assistance, they can help you set up a reasonable payment plan.
Perhaps one reason doctors don't like to talk about money with patients is they want to make the best possible medical decisions for patients without being influenced by the patients' income level. Here at HealthCentral we frequently hear from patients on Medicaid or similar programs who suspect their doctor is not offering them the same quality of care that patients with private insurance get. This is probably not true because in most doctors' offices the medical staff does not know who is pays your bill unless you share that information yourself.
Although doctors want to ignore a patient's income level, financial reality today demands a more pragmatic point of view. Because your doctor probably hasn't been trained in how to include budget considerations along with the other advantages and disadvantages of a particular treatment, you may have to be the one to bring up this issue. Don't be embarrassed. Let your doctor know that you want the most effective possible care at the lowest possible cost.
Published On: September 24, 2011