Easing the Load: The Heavy Burden of Financial Toxicity on Cancer Patients
Cancer is not an easy journey. Twenty-five years as a medical oncologist have made it very clear to me how physically and emotionally hard it can be on patients and their caregivers. As clinicians, we are taught and trained to address these needs, but it can be more difficult to recognize the financial stress that many cancer patients and their families also experience. Making sure we understand our patients’ financial needs and finding ways to help alleviate them is critical for practicing whole-person care.
The term “financial toxicity” emerged in the early 2000s to describe the harmful side-effects that out-of-pocket costs for expensive cancer drugs can have on cancer patients. It’s a powerful analogy. The treatments we give patients with cancer can wear people down and cause side effects. They’re also costly - and those out-of-pocket expenses can be too much for some people to manage, jeopardizing their access to care and ultimately hurting their overall health and well-being.
But cancer care costs go beyond drugs. The term financial toxicity is now used more broadly to encompass all the health-related financial factors that can affect a person’s ability to access, afford, and follow through on care. When a person has limited resources and already faces challenging socio-economic circumstances, the costs associated with cancer care can be toxic from the start. With others, the toxicity builds up over time. Some find it tough to keep a job while undergoing burdensome and time-consuming treatment. One-quarter see their savings wiped out. Two-thirds find it hard to manage daily expenses and pay the bills. Many are forced to make difficult choices about where they live, what they eat, and whether they can continue treatment. Over my career, I’ve seen too many patients whose cancer made their financial problems much bigger than the illness itself.
So, what can we do about that?
The Many Costs of Cancer
The financial toxicity associated with cancer drug costs is widely recognized today. Approximately one-third of all Medicare’s cancer-related expenditures go to cancer drugs. As new groundbreaking, yet expensive, cancer drugs emerge, we all know the financial burden on patients is likely to grow.
Drug-related toxicity is also something we can address by taking proactive measures. Oncology practices, especially community oncology practices, are good at assessing patient responsibility and finding grants when needed. And cancer drug costs can vary significantly depending on how the drug is billed or where their drug therapy is received. At Thyme Care, we work closely with our network of high-value oncology providers to help ensure our members receive their drug therapies in the most convenient, cost-effective settings possible.
Similarly, Medicare patients can face vastly different out-of-pocket expenses depending on their elected benefit coverage and how it is billed. With the right guidance, costly infusion therapies can be billed in the most advantageous and patient-friendly way possible, saving patients thousands in out-of-pocket costs.
However, while drugs have historically dominated conversations around patient financial toxicity, there are many other socio-economic and personal factors beyond drug costs that impact a patient’s ability to access and pay for quality cancer care. These include where a person lives; their social and/or financial circumstances; their age, race, or ethnicity; and their overall health, including the presence of any comorbid conditions or chronic illness.
Sometimes these socio-economic barriers show up in ways we might not anticipate. For example, in a study conducted at Memorial Sloan Kettering Cancer Center, patients undergoing chemotherapy received a daily symptom assessment via a digital app to actively monitor their health in order to avoid the need for expensive acute care visits. That effort reduced ED visits, improved quality of life and extended survivorship, but patients who couldn’t afford a smartphone were unable to participate and benefit from that program.
About 40% of cancer patients that we work with have required assistance with financial support related to their cancer care. We suspect that number will only grow. Without such support, many patients will skip their cancer treatments, miss appointments, cut back on nutritious food, lose their homes, or get evicted from their apartments. And not only does this result in immense additional stress at an already difficult time, but this financial toxicity can have a direct impact on outcomes, with poor health and reduced quality of life often persisting even after treatment ends.
These sorts of barriers are difficult to identify or assess, let alone address. But at the end of the day, if we don’t figure this out, we’re doing our patients a disservice.
A Whole-Person Approach to Addressing Financial Toxicity
At Thyme Care, we’re building a solution that relies on people and technology to surface, prioritize and effectively address the complex needs that people face in navigating their care journeys, including their financial barriers.
Using our care delivery platform, Thyme Box, our care team can quickly and systematically collect information about health-related social needs in a member population and stratify by acuity to enable us to reach out to the right people in a scalable, intelligent way to understand their specific gaps in care.
When we identify a member under social, personal, or financial strain, we leverage our technology to connect those people to resources that can help address the needs we uncover, including those related to financial toxicity. Our care navigators continue to check in with members during their care journey in case their needs intensify or their circumstances change.
For example, if a member struggling with financial challenges qualifies for a grant, our care team can leverage the Thyme Box platform to autocomplete an application and forward it to the relevant organization that can provide support, all electronically and with the right elements of automation baked in.
While technology is critical to driving efficiency, speed and quality, there is an element to all of this that also requires human input, empathy and compassion. I’m reminded of an elderly member who was evicted from his apartment because of a conflict with his landlord. We knew that his unstable housing situation was likely to have a devastating effect on his health and well-being, so we enlisted the help of a behavioral health program offered through his insurance provider, which processed an application for emergency shelter. We then coordinated a family meeting to see if more could be done. When an extended family member offered to put him up temporarily, this gave us time to find him a more stable living situation, which we eventually succeeded in doing.
Many organizations go above and beyond normal levels of patient engagement to support cancer care patients in need. Our tech-enabled human touch allows us to provide this sort of “above and beyond” support at scale, extending our reach to even more members who need resources or financial assistance.
Conclusion: Scalable Solutions to Lower the Financial Burden of Cancer Care
The high cost of cancer care is a challenge for almost every cancer patient. Fortunately, many stakeholders are working hard to address it on a system level. For example, CMS is working to reduce drug cost disparities and address gaps in health equity through a variety of initiatives, including CMMI’s Enhancing Oncology Model; and providers in value-based arrangements are striving to reduce overall costs, which will help reduce the financial toxicity patients experience.
But how can we address the very complex and intersecting financial toxicity challenges that so many people with cancer face because of their specific circumstances and needs? This is a problem that ultimately needs to be tackled at scale with technology and a very human-centered approach. The right questions must lead to the right solutions, without overburdening the clinicians who are already at capacity taking care of their patient’s medical needs.
Our navigation platform is built to identify and support members who face health-related social barriers to receiving timely, appropriate care. Many, if not most, of those barriers have a financial component. Helping people get to appointments, afford their medicines, and meet their daily needs during treatment and through survivorship is as important as the drugs and therapies they receive.
Learn more about how Thyme Care is improving outcomes and lowering costs: https://www.thymecare.com/health-plans#contact