Cancer's High Cost

Even when covered by health insurance, cancer patients face mounting out-of-pocket expenses that force some to avoid filling prescriptions, skip doctor appointments, and scale back on food and other necessities.

The findings by researchers at Duke University Medical Center and Dana-Farber Cancer Institute were reported at the annual meeting of the American Society of Clinical Oncology in June.

“Overall, this study provides a patientcentered view of a reality of modern-day cancer care—something that we call ‘financial toxicity,’ ” says Amy Abernethy M.D. ’94, associate professor in the division of medical oncology at Duke and senior author of the study.

“We used to think about chemotherapy toxicity in terms of bad side effects like vomiting, nerve pain, confusion, and risk of fatal infection,” Abernethy says. “Now we are starting to think in terms of how treatment choices impact real aspects of daily living such as the ability to buy groceries or not.”

The research team surveyed 216 patients, some treated at Duke and others from around the country, who sought help paying for their cancer care through the HealthWell Foundation, a national nonprofit that helps underinsured patients afford high-cost medications. The foundation sponsored the study.

Most of the study participants were women (88 percent) battling breast cancer (76 percent). All but one participant had insurance, with two-thirds of the study group covered by Medicare; 83 percent also had prescription-drug coverage.

Yet even with health insurance, out-ofpocket expenses averaged $712 a month for doctor visit copays, prescription medicines, lost wages, travel to appointments, and other expenses.

Such expenses presented a significant burden to 30 percent of study participants and a catastrophic problem for 11 percent.