Breaking the bank: the financial toxicity of cancer
We all know that cancer is a disease that affects the body. We also acknowledge its effect on our minds through the fear and anxiety it instills. However, a lesser known aspect of cancer is its financial burden. Simply said, for some people, they literally cannot afford to get cancer! Many do not have the financial means to assume the costs of expenses related to cancer care. Recently, some researchers have referred to the impact of the costs of cancer care as "financial toxicity" (1).
Costs of cancer care can be comprised of direct costs, such as drug costs, medical supplies, home care and nutritional supplements. Indirect costs include things like prostheses and wigs, travel, parking, accommodation, meals, loss of income, etc.
Who is most at risk of financial toxicity? Evidently, people who have low income will suffer the most from the financial burden because a greater proportion of their income will be used for these expenses. Additionally, patients living in rural areas are especially at risk of financial hardships (2).
Why rural residents? According to research, travel costs rank high among out-of-pocket spending in Canadian cancer patients (2,3). Due to the complex nature of cancer, highly specialized physicians and equipment are needed and these are usually located in urban areas. As a result, rural residents may have to travel very far to get treatment. Not only do they end up having to cover traveling costs, they are also losing income while traveling for treatment. This is compounded by the fact that rural residents are also less likely to have private insurance that would offset these expenses (4). Due to these transportation expenses for rural residents, they are more likely to alter treatment, choosing more radical treatments. This is illustrated in one Canadian study, where results showed that women living in rural areas were less likely to choose breast conserving surgery as a treatment (5,6).
Parents of children with cancer are another group that suffer the brunt of the financial burden. Among families where a child is diagnosed with cancer, 64% of mothers and 16% of fathers had to leave their job (extended leave or quitting). In the first 3 months following diagnosis of a child's cancer, the average amount of salary loss is approximately 4000$ and the average total costs incurred by cancer is over 28,000$ (7).
Although Canada's universal public health insurance covers the costs of all medical services provided in hospitals, this is not the case for drugs filled at your community pharmacy which may or may not be covered depending on where you live. While traditional chemotherapy drugs are administered intravenously in hospitals and are consequently covered by public health insurance, in the last ten years there has been an influx of cancer drugs that can be taken orally. Patients must obtain these drugs from their community pharmacies. They are usually very expensive and they are not necessarily covered by the provincial public prescription drug insurance or private insurance plans. As hinted to earlier in this paragraph, an additional layer of complexity lies in the varying access and reimbursement policies to cancer drugs across the provinces and territories; each province determines its own list of drugs it reimburses in its public prescription drug insurance plan.
There is no doubt that financial toxicity is a problem that must be tackled with multiple approaches. Some researchers, such as Dr. Christopher Longo from McMaster University, are investigating this problem. His research hopes to elucidate the inter-provincial differences in cancer patients' out-of-pocket costs and could lead to identifying policies and practices to help alleviate the financial burden of cancer care.
1. Zafar SY, Abernethy AP. Financial toxicity, Part I: a new name for a growing problem. Oncology (Williston Park). 2013;27: 80-81, 149. 2. Mathews M, West R, Buehler S. How important are out-of-pocket costs to rural patients' cancer care decisions? Can J Rural Med. 2009;14: 54-60. 3. Longo CJ, Fitch M, Deber RB, Williams AP. Financial and family burden associated with cancer treatment in Ontario, Canada. Support Care Cancer. 2006;14: 1077-1085. 4. Mathews M, Buehler S, West R. Perceptions of health care providers concerning patient and health care provider strategies to limit out-of-pocket costs for cancer care. Curr Oncol. 2009;16: 3-8. 5. Goel V, Olivotto I, Hislop TG, Sawka C, Coldman A, Holowaty EJ. Patterns of initial management of node-negative breast cancer in two Canadian provinces. British Columbia/Ontario Working Group. CMAJ. 1997;156: 25-35. 6. Hislop TG, Olivotto IA, Coldman AJ, et al. Variations in breast conservation surgery for women with axillary lymph node negative breast cancer in British Columbia. Can J Public Health. 1996;87: 390-394. 7. Tsimicalis A. Costs incurred by Families of Children with Newly diagnosed with Cancer in Ontario. Nursing Science: University of Toronto, 2010.