Financial toxicity: A new side effect of cancer treatment.

Toxicity is a common side effect of cancer treatment. Such things as fatigue, nausea, and pain are a serious concern for oncologists, who know that they can impede treatment and diminish quality of life.

Now, in a two-part essay published in the journal Oncology, doctors at Duke University argue that the financial side effects of cancer treatment can be just as important in impeding treatment and diminishing quality of life. Cancer treatment's costs are rising,  the treatment is often being overused, and the rising costs are increasingly being passed on to patients, the doctors write.

I first caught wind of this essay, which appeared online Feb. 15 and April 15, this week when I ran across an April 25 story by Nick Mulcahy at Medscape, who was apparently one of the first to pick up on it–possibly the first. It's important story, and I'm glad Mulcahy wrote it, because I don't know whether I would have seen it otherwise.

"Physicians have no idea how much services cost," one authority tells Mulcahy. Can you imagine buying a care from a salesman who could order the vehicle, set up the options you want, and give you a delivery date–but who would have no idea what the car or the options cost? 

Oncologists could monitor financial data on patients the same way they track side effects, the authors of the study write.  

On May 17, Scott Hensley at NPR picked up on new research by one of the same doctors, who in a survey of cancer patients at Duke found that patients want to talk about costs but only a minority of them do. Hensley quotes the doctor citing this example of how discussions of costs can save patients money:

"I treat colon cancer, and I have the option of giving a drug as an IV or an oral pill. If I give the pill form, the patient faces a copay even if they have insurance, and that copay goes away if I give the intravenous version."

The two forms of the drug are pretty much the same when it comes to effectiveness, though the side effects differ a little. "For the most part, it doesn't matter to me," he says. "It comes down to patient preference and cost."

Tragically, some patients said they did not discuss costs with their doctors because they were afraid doctors might cut corners on their care. 

Ruby de Luna at Seattle radio station KUOW reported on another study that came to similar conclusions, this one from the Fred Hutchinson Cancer Research Center in Seattle. “There is a financial toxicity to cancer treatment and we’re trying to get our arms around how big of a problem that is," one of the researchers told de Luna. 

She reports that surgery and hospital bills for initial treatment of cancer can reach $200,000, and chemotherapy can cost $15,000 per month. Many of the patients running up these costs are too sick to work.

The idea that cancer treatment can lead to financial toxicity is clearly an idea that is in the air. I'd like to see somebody do a takeout on whether the changes coming from the Affordable Care Act next year will deal with any of this toxicity.

-Paul Raeburn

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