- The Washington Times - Thursday, August 10, 2017

The shock of a cancer diagnosis typically leaves little room for patients to worry about much else. But rising and unexpected costs of care add an additional burden to patients and their families already hit with an unexpected life change, according to oncology research published Thursday.

Researchers at Duke University Medical Center found that among a study of 300 cancer patients, more than one-third felt distress in the face of out-of-pocket medical expenses related to their treatment.

The study was published as a research letter in the Journal of the American Medical Association Oncology.

The patients in the study all had health insurance, but the financial burden came from being underinsured, which required some to devote one-third of their paychecks to medical bills.

“While the [Affordable Care Act] has done a tremendous amount to increase access to health insurance, it’s limited in its effect to decrease cost of care plans that were introduced,” said Dr. Yousuf Zafar, one of the co-authors of the research letter.

Increasing drug prices from pharmaceutical companies, diagnostic tests like CT scans and even doctor visits not covered by insurance contribute to financial burdens of patients. Other out-of-pocket costs indirectly related to care include lost income from time off work, cost of travel to treatment centers, lodging and meals on the road, among others.

“A lot of people that get forgotten are those who are underinsured, and those are the focus of this study,” said Dr. Zafar. “These are people who have insurance but still pay a large proportion — 10 to 30 percent of their income — for their cancer treatment.”

According to the National Cancer Institute, an estimated 1.7 million new cancer diagnosis will be given in 2017 and about 600,920 people will die from a type of cancer this year.

A 2013 study led by the Institute of Medicine (now the National Academy of Medicine) estimated that health care costs related to cancer will total $173 billion by 2020.

The Duke University researchers recommend financial intervention efforts to “improve patient health care cost literacy” and future studies should evaluate the impact of such interventions.

One of the recommendations is to increase the financial literacy of patients, with insurance companies and hospitals providing resources.

“Oftentimes, we get insurance and don’t really want to think about it until we need it — by then it might be too late,” Dr. Zafar said.

However, individuals given a life-altering cancer diagnosis will have little patience then to sit on the phone with a health insurance provider to review and understand all aspects of their plan, costs and coverage, he said.

“A lot more could be done, and it is unfair for a patient who is facing a catastrophic illness to sit on the phone with their insurance company to find out what’s covered and not covered,” Dr. Zafar said.

The Affordable Care Act compelled insurance companies to send out pamphlets or explainers outlining what is and isn’t covered under that particular health plan. Other initiatives by insurance companies, Dr. Zafar noted, include adding calculators to online sites to better help patients understand how many costs are adding up to their deductibles.

Physicians and hospitals also can recommend patients to financial services or other community efforts that help offset costs. Dr. Zafar and others are developing an app that would help provide patients with financial education, screening patients for financial distress and linking them to assistance programs.

“The idea of communicating about affordability is really important,” Dr. Zafar said. “Patients have understandable concerns of talking to their health care teams about costs but I think — if I as a physician know about my patients troubles sooner rather than later, I can get them to resources at the right time.”

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