Financial Toxicity is Hurting my Cancer Patients

By LEILA ALI-AKBARIAN MD, MPH

As news of Tom Brokaw’s cancer diagnosis spreads, so does his revelation that his cancer treatments cost nearly $10,000 per day. In spite of this devastating diagnosis, Mr. Brokaw is not taking his financial privilege for granted.  He is using his voice to bring attention to the millions of Americans who are unable to afford their cancer treatments.

My patient Phil is among them. At a recent appointment, Phil
mentioned that his wife has asked for divorce. When I inquired, he revealed a
situation so common in oncology, we have a name for it: Financial
Toxicity.  This occurs when the burden of medical costs becomes so high,
it worsens health and increases distress.  

Phil, at the age of 53, suffers with the same type of bone
cancer as Mr. Brokaw.  Phil had to stop working because of treatments and
increasing pain. His wife’s full time job was barely enough to support
them. Even with health insurance, the medical bills were mounting. Many
plans require co-pays of 20 percent or more of total costs, leading to insurmountable
patient debt.  Phil’s wife began to panic about their future and her debt
inheritance. In spite of loving her husband, divorce has felt like the only
solution to avoiding financial devastation. 

Sadly, as healthcare costs rise, more Americans find themselves in similar situations. The United States spends more on healthcare than any other nation, without better results. Uncontrolled costs waste money and may be worsening the health of cancer patients. An astounding 30 percent of advanced cancer patients reported financial distress higher than physical or emotional distress. In these cases, the cost of care was literally more toxic than the effects of cancer or cancer treatment. 

Yet, oncology care can be delivered for far less money. The American Society of Clinical Oncology found that the costs of treating metastatic colon cancer in Washington State vs. British Columbia was double in the US compared to Canada, with similar outcomes. American doctors provide some of the highest quality medicine in the world, but the associated costs are neither affordable nor sustainable.

Much of this financial toxicity could be eliminated with a single payer system. Such a system would reduce the administrative costs associated with the ‘business of medicine’ — costs accounting for 25 percent of American healthcare charges.  Additionally, small companies would not be responsible for expensive healthcare benefits, and citizens could endure job change more safely.  A single payer system would also allow medical providers to get paid appropriately for services, but industry CEOs could no longer inflate costs in a market that profits from the sickest and most vulnerable Americans. 

Healthcare as a private enterprise is hurting people like Phil and his wife. It is increasing the suffering of cancer patients. The Canadians have proven that the same care can be delivered at half the cost. It’s time to put politics aside and move forward with a similarly designed system, with the goal of improving the health of Americans without the toxic burden of medical debt.

Dr. Leila Ali-Akbarian is a Public Voices Fellow and a primary care physician who practices Cancer Survivorship and Palliative Care at the Banner-University of Arizona Cancer Center.

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