7 Causes of Financial Toxicity

This is part 2 of our Financial Toxicity series. In our last post we defined and discussed financial toxicity in oncology. Check it out here! This edition will discuss the 7 main causes of financial toxicity in oncology.

1. Lack of Screening Tool:

Care providers screen for many risk factors in their patients, but what they often don't do is screen for financial toxicity risk [1]. The potential for financial troubles that might impair the treatment process isn't regularly considered. Providing treatment plans without knowledge of this potential barrier sometimes leads to later problems.

2. Provider-Patient Communication

Another driver for financial toxicity in oncology is limited provider-patient discussion of costs. Providers often do not understand the out-of-pocket costs that are implicit in the treatment plans. Another factor is that Patients and their caregivers often are not comfortable asking providers about cost. One study found that only 19% of patients with cancer discussed costs with their providers [2]. They often fear that discussing cost will reduce the quality of their care, while in fact the opposite might be true.

3. Patient Financial Education:

Another common reason for financial stress in oncology is a lack of patient education. Patients do not know what the impacts of their treatments on their out-of-pocket costs. The financial information is often presented to patients at a time when a lot of other information is given to them. Informational overload lowers the amount of cost information retained by patients.

4. Insurance issues:

Navigating the insurance system is often complex and complicated for patients. Insurance payments can pile up, and coverage limits are reached quickly. Insurers increasingly are shifting costs to patients through rising premiums, deductibles, and copayments [4]. Other helpful therapies or treatments might not be covered. The complexity of the insurance process also takes time, something an oncology patient or busy caregiver has a limited supply of.

5. Prescription Drugs:

The increasing cost of prescription medications drive financial toxicity in oncology. New and exciting therapies have been recently developed, but these new drugs often are expensive. The median price of newly approved FDA drugs has more than doubled in the past two decades [4]. These high costs increase the chance that a patient will fall into financial trouble.

6. Transportation:

Cancer care requires many appointments and a variety of other travel demands. The cost of travel includes car maintenance and upkeep. Other transportation needs exist as well, like getting to a hospital or an appointment by public or mass transit. This kind of repetitive cost adds up and creates a large transportation bill.

7. Employment Changes:

Many patients undergoing cancer treatment experience some sort of work related change. This affects other family members and caregivers, who shoulder much of the support burden. The effects include no longer seeking promotion and reduced working hours. These cutbacks and changes often result in decreased income at a time when out-of-pocket costs are increasing [5].

Sources:

1. http://www.cancernetwork.com/practice-policy/new-tool-calculates-cancer-patients-financial-toxicity
2. http://jop.ascopubs.org/content/early/2015/03/31/JOP.2015.004408.full
3. http://jop.ascopubs.org/content/early/2015/03/31/JOP.2015.004408.full
4. https://www.mskcc.org/research-areas/programs-centers/health-policy-outcomes/cost-drug
5. http://www.tandfonline.com/doi/abs/10.1080/07357900601130664