Last month, I traveled to Chicago for the annual meeting of the American Society of Clinical Oncology (ASCO). Each year, the event brings together more than 30,000 oncology professionals from around the world to discuss new treatments and ongoing challenges in the field. As a first-time attendee, this was a great opportunity for me to hear from prominent voices in the fight against cancer. I was especially eager to attend because this year’s meeting featured a number of poster sessions and panel discussions on the problem of financial toxicity. Below are my top takeaways:
1. Financial toxicity is a growing concern for patients as well as health care providers.
It’s clear that the financial side effects of cancer have become a major burden for those who struggle with the disease, their families, and the entire medical system. One of the most powerful talks I heard at the ASCO conference was a panel looking at this issue from different perspectives—those of patients, hospitals, the pharmaceutical industry, and insurance companies. Moderated by Dr. Yousuf Zafar of Duke University Medical Center, the panel illustrated how economic hardship affects multiple stakeholders. I was also struck by the presentation of Dr. Scott Ramsey of the Fred Hutchinson Cancer Research Center. Dr. Ramsey had a powerful slide showing national expenditures for cancer care based on the type of cancer and the stage of the disease; these expenses are expected to hit a record $157 billion by 2020.
2. While researchers have demonstrated the impact of financial toxicity, there’s still a ways to go to translate the findings into actionable solutions.
It was heartening for me to see the conference devote a significant amount of time and space to the issue of financial toxicity. Recent research has shown that this is a serious challenge in cancer care—and of course, the first step in solving a problem is recognizing that you have one. However, discussions about research invariably ended with some version of the statement, “And now, we need to move from studying financial toxicity to doing something about it.” Now that the problem has been established, we must find ways to move forward and address it.
3. We need to transform the cancer-care model, but there are significant challenges involved.
Under the current model, health care providers bill patients for each service. These fees add up and can become astronomical for cancer patients. Some have argued that this system encourages physicians to provide more and more care, rather than focusing the quality of care. Over the last few years, however, the volume-based, fee-for-service model has begun to shift toward a value-based model—where reimbursement is based on treatment outcomes. While this overhaul is positive and necessary, it requires tracking treatment metrics, evaluating their cost-effectiveness, and other labor-intensive tasks that most cancer centers are not well equipped to handle. There is a growing need for tools that can help hospitals streamline this process.
4. Health care IT and advocacy groups should collaborate.
At the conference center, there was a large exhibition of cancer-related advocacy organizations, featuring numerous foundations and patient coalitions. Many of these important groups have arms devoted to assisting patients with the costs of care. Next to this display was an exhibition of health IT companies that are developing technology-based solutions specifically designed for the cancer center and oncology clinic settings. To me, these side-by-side exhibitions were symbolic of the need for advocacy groups and tech companies to work together. By collaborating, tech companies can mine available data to help patient coalitions identify more cost-cutting opportunities for those they serve.
5. There have been many promising advancements in treatment, but they are not without COST.
New therapies in areas such as immunotherapy and precision medicine hold great promise. This scientific and clinical progress should be celebrated. However, we must be aware that these cutting-edge treatments come at a price—in many cases, a very high one. As new drugs and therapies come on the market, patients will continue to struggle to pay for them. The problem of financial toxicity is here to stay, and should be discussed during routine oncology visits. In one study, Dr. Rahma Warsame of the Mayo Clinic found that financial issues were discussed during less than a quarter of visits—and 70 percent of those conversations were initiated by patients.
6. We must address indirect as well as direct costs.
Pricey drugs, medical procedures, and hospital stays translate into high out-of-pocket expenses for the patient. These are the “direct costs” of cancer care. However, as the National Coalition for Cancer Survivorship’s Shelley Fuld Nasso pointed out in one of the panels I attended, financial toxicity also stems from “indirect costs,” including travel, accommodation for family members, nursing, and home health care assistance. Practical solutions require taking into account all costs that take a toll on patients and their families. A holistic approach is vital.
7. We can’t expect patients to manage this burden on their own.
No one would argue with the fact that patients should take a proactive role in their own care. Research has shown that responsible, informed patients have been associated with better treatment outcomes. But Ms. Nasso emphasized that cancer patients need help to become more informed about the short- and long-term costs of their care and the various treatment options available. When faced with the decision of whether to pursue an expensive treatment, a patient cannot be expected to make this critical choice alone. We must provide them with resources to evaluate the potential risks and benefits—and for this reason, financial navigation should be a standard component of care.
Bottom line – The problem is indisputable. Now, all of us—cancer centers, patient groups, the pharmaceutical and insurance industries, and the technology sector—must come together to create real and immediate change.
