Cancer & Patients’ Debts

        Many cancer patients are deep in debt because they cannot cover the costs of treatment as well as the other cancer care related expenses.  This information comes from a report at the ESMO Asia 2016 Congress in Singapore.

        In previous studies it has been well demonstrated that cancer patients are facing financial difficulties, even in countries where the national public health system covers most of the expenses.  Patients and survivors experience the economic hardship referred to as the “financial toxicity” of cancer. This study shows new aspects of the burden of cancer care on patients.

       Malaysia’s study found that more than half of cancer survivors spend at least 1/3 of their yearly household income on treatment and costs such as transport to the hospital and childcare.  Many are not funded by the government despite the availability of free healthcare and have to pay for the cancer drugs.

        Nirmala Bhoo Pathy, lead author and a clinical epidemiologist at the Faculty of Medicine from the University Malaya Medical Center in Kuala Lumpur, Malaysia says that the scope of cancer care and drugs offered free through the public health services is limited in Malaysia and the current system of funding for cancer needs to be reviewed.

         A lack of health insurance, low-income and not having surgery were among the factors associated with patients having money issues.  For those who did not undergo chemotherapy the risk was lower.

         The problems appear even more severe in low-middle and low-income countries where patients often need to cover the costs themselves, even for essential anticancer treatments.  In another study participants completed a questionnaire covering issues including income and employment history, as well as health insurance status. Nearly ¾ reported a reduction in their household income after their diagnosis.  Of the 12 patients who were employed, 10 highlighted changes in their employment conditions such as decreased hours and others were no longer working. One reported they had retired. The loss of work, their loss of income and early retirement all contributes to the financial burden on the household.

          The study intends to provide insight into these costs and assist policymakers in finding ways to reduce this burden on patients.  Another study investigated why the cancer doctors recommend costly cancer drugs. Oncologists were asked to complete an online experiment.  Of the 101 responses it was found that healthcare professionals were more likely to advise the use of drugs that allow patients to live longer and have a higher chance of improving their symptoms.  It was less likely they would recommend drugs with an increased chance of side effects and that would cost patients more. They still favored expensive treatments if they tended to increase a person’s survival time by 2 months or more.

        According to lead author Deme Kanikios, PhD candidate, National Health and Medical Research Council Clinical Trials Centre, University of Sydney in Australia, the Australian oncologists are willing to expose their patients to financial toxicity when recommending expensive unfunded anticancer drugs, but only in cases where the survival benefit is above that of standard care.

       It is important that cancer doctors need to help their patients understand the potential benefits, harms and costs of drugs not subsidized by the government so that the patient can make an informed decision.  The ESMO Magnitude of Clinical Benefit Scale tools can help clinicians better inform patients on how extensive the potential benefit is from a treatment option being considered. This helps to put the evidence into perspective, mitigates against optimist bias and can lead to share decision-making that is better informed.

Dr Fredda Branyon

image c/o pixabay

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