How can docs keep cancer costs from crushing patients?

Lots of exciting news out of the American Society of Clinical Oncology conference grabbed headlines this week, particularly surrounding revolutionary new treatments for lung and skin cancers. While the sooner-than-expected progress of such personalized therapies hold promise to reduce payer spending by targeting drugs more accurately, that's of little consolation for the scores of patients, including the insured, who can't afford the cost of their life-saving treatments, as recent reports from NPR and The Wall Street Journal point out.

Consider the following tough-to-swallow statistics:

• A study published recently by the Journal of Clinical Oncology found that about 13 percent of cancer patients spend more than 20 percent of their income on healthcare and insurance premiums.
• A full third of 2,307 post-cancer survivors who participated in a survey from advocacy group Livestrong cited debt as a practical concern. Of those respondents, 67 percent said they received no help with their problem.
• Among the more than 230,000 people in the Washington State cancer database, court records revealed that about 4,800 had filed for bankruptcy during a follow-up period that averaged a little more than four years.
• Research from Duke University Medical Center and Dana-Farber Cancer Institute found that patients' self-reported, out-of-pocket, cancer-related costs, including insurance premiums, copays, lost wages, and travel to appointments, averaged $712 a month. All but one of the 212 patients surveyed had insurance, mostly Medicare, and 83 percent had prescription-drug coverage. Further, 26 percent of respondents had not filled a prescription because of cost, 22 percent said they had filled a prescription part-way, and 20 percent had taken less than the prescribed amount.

With more cancer treatments being available in pill form versus IV, treatment may not only cost more, but it may also be more tempting for patients to skimp on their pills. With fewer office visits required for the same reason, physicians may not be aware of their patients' noncompliance or its underlying causes.

As we've reported previously and will surely again, strong physician-patient communication, for all of its challenges, is one of the only tools currently available to help address this problem.

"When it's an expensive drug, we have to have the hard discussion about a very substantial out-of-pocket payment," Dr. Lee Schwartzberg, an oncologist who has studied the reasons patients quit their oral cancer drugs, told Reuters Health. "I ask: 'Do you want to spend this money for an average improvement of just a few months of life?' I'm very uncomfortable having those discussions because I want to focus on the patient getting better," added Schwartzberg, medical director of the West Clinic in Memphis, Tennessee.

Are you comfortable bringing these subjects up with your patients? Would you treat a patient with a prognosis of possibly years of remission differently than terminal one who may only have months? Do you feel that it's part of your job as a healer to take a patient's cost concerns into account when recommending care? Even if you do, how much expense can really be trimmed from curing someone's cancer? If you've faced any of these issues with your patients, I'm sure your fellow readers would welcome any advice or insight you could share. - Deb