Many US cancer patients struggle to afford life-saving medications
As cancer drug costs rise, U.S. cancer patients are more likely than other medical patients to struggle with paying for prescription medications, according to a recent study.
The financial burdens are especially high for patients under age 65 who cannot access Medicare, the government insurance program for the elderly, and for people with multiple medical conditions, researchers say.
The prices of cancer-treating drugs are on the rise and a newer cancer medication can cost over $100,000 per year for each patient, the study team writes in the journal Cancer. In addition, higher insurance deductibles and copayments can mean that patients are paying more out of pocket for medications.
"Financial toxicity is now a well established and generally accepted toxicity related to cancer care," writes Dr. Daniel Goldstein, an oncologist at Rabin Medical Center in Israel, in an accompanying editorial.
Doctors may not be aware how much cancer drugs cost for each patient and the topic of cost may not come up unless the patient introduces it, study author Amy Davidoff, a senior research scientist at Yale School of Public Health, told Reuters Health.
"In some cases, there may be a lower-cost alternative, but it may be somewhat less effective, have greater risk of side effects, or be less convenient to take," Davidoff said by email. At other times, she added, differences may be very small and switching may not have a consequence.
The research team analyzed data from annual U.S. national health surveys in 2011 through 2014 to compare how likely cancer patients and non-cancer patients were to make changes to their prescription medications for financial reasons.
The researchers compared the responses of 9,000 people with a history of cancer and more than 93,000 patients with no cancer history. They also looked at how recently cancer patients were diagnosed, whether they had any other medical conditions, the type of insurance participants had and the deductible amounts they had to pay before insurance covered their drug costs.
The study team found that 32 percent of the patients recently diagnosed with cancer and 28 percent of people with any past history of cancer reported a change in their prescription drug use due to financial concerns. Among people with no history of cancer, 21 percent changed their medications because of money considerations.
The patients most likely to ask their doctors for lower-cost medication were cancer survivors under age 65 who had high-deductible insurance plans.
The more medical conditions people were dealing with, the more likely they were also to ask to switch to lower-cost medications.
"The cost of cancer care is very high - there are many diagnostic tests as well as drug, radiation and surgical therapies that cost a lot of money," Goldstein, who was not involved in the study, told Reuters Health by email.
"There may also be significant time lost from work, many clinic appointments that may lead to high costs related to copays and deductibles," he said.
For patients who choose to switch to lower-cost medications, the effects vary widely from no effect to potential death, Goldstein noted.
"Both patients and physicians should feel comfortable to discuss both the cost and efficacy of their medical care," said Goldstein. "Physicians need to be honest with patients about the potential clinical benefit of the drugs that they are receiving, particularly when there is a high financial burden."
"If the cost of drugs prescribed by your physician creates a barrier to taking them, or will result in major financial burdens, it is important to speak with your physician," Davidoff said.
"In many cases it may be possible to try a lower cost alternative first to see if it works. Otherwise, physicians or their support staff may be able to assist the patient in finding help to pay for expensive medications," she said.