Advocating for Better Treatment Outcomes Means Preparing Patients to Avoid Financial Toxicity

With the wrap up of the annual meeting of The American Society of Clinical Oncology (ASCO), we’re left with much to consider around new treatments in development that could deliver improved life expectancy and offer continued hope to millions of people. While the timing of these innovations may be uncertain, their ability to command even higher prices is not (see Figure 1).

Cancer survivors who have been forced to file for bankruptcy have a two-fold higher rate of mortality when compared to cancer survivors who have remained solvent even after they have managed to survive their episode. As innovation speeds up, we must keep sight of this sobering fact.

Researchers who uncovered this trend reported that it held up even when correcting for socioeconomic status, disease stage, age, etc. The strong link between economic pain and cancer has led to a very real diagnosis of financial toxicity as a factor that contributes to patient outcomes (Ramsey et al., 2016). 

To be clear, the economic ravages of cancer are not solely due to drug prices but also the rising costs of healthcare, declining insurance coverage, and the non-healthcare costs that serious disease can inflict. This important recognition was the topic of one session entitled “Financial Toxicity: How Costs Negatively Impact Patients and What Can be Done About It” in the pre-ASCO educational Seminar: (Re)Defining Value in Cancer Care: Priorities for Patients, Providers, and Health Systems.

The statistics for young people are even grimmer because cancer can strike when people are just establishing their careers, have little savings, and are more likely to have a high deductible, catastrophic insurance. As a result, younger patients are twice as likely to suffer material and psychological hardship than Medicare-eligible patients (Yabroff et al., 2016).

At Back Bay, when we evaluate new treatments and determine a new drug’s potential market, we must thoughtfully select a price range that reflects the value of the new therapy. We pick these ranges carefully to stand up against patient, payer, investor, and transaction scrutiny. The process involves conversations with physicians who practice in the community and key opinion leaders (KOLs) who are at the forefront of research. We round this out with payer discussions, a deep understanding of incremental clinical improvement, and a review of the cost of hospitalizations and other interventions that the new drug will avert. So even as the US price ranges have gone higher, we allow for such price ranges in our forecasts only when they reflect remarkable improvements in outcomes—sometimes to our clients’ chagrin.   

In the ten years that we have been doing this work, drug prices have increased (almost certainly pegged to clinical value). As such, our conversations with community physicians, KOLs, and patients have increasingly reflected the insidious economic impact that cancer can have on people’s lives. This impact sometimes goes far beyond physical and emotional ramifications.  Another session in this seminar, “Paying for Innovative Treatments”, made it crystal clear that everyone, including drug manufacturers that increasingly deploy value-based pricing, will eventually pay for financial toxicity.

While the financial toxicity session acknowledged that there is a considerable need for legislative fixes, including bolstering and supporting the ACA’s Medicaid expansion, there are a few things hospitals and physicians can do now. This can mean HCPs initiating a conversation with the patient and family about not only the potential toxic side effects of treatment but also about the potential financial toxicity of the same treatment. Patients and caregivers who are prepared to fight cancer’s ravages also have to consider the cost of treatment and the potential loss of employment, the stalling of a career, the need for expanded home care for children and other dependents, transportation and many of the other small but high-impact changes that treatment for cancer may bring.  

Beyond healthcare providers, Dan Sherman of the NaVectis group asked the audience to consider why we don’t ask patients to look up how to treat their lymphoma on the web, but we do ask them to take this approach with our increasingly complex insurance and patient assistance networks. He proposed that it’s time to professionalize a “financial navigator” – someone who has the education and savviness to help patients proactively access the right insurance and patient assistance programs that can mitigate financial toxicity.

People going through a cancer diagnosis will need to know that treatments come with the potential for hope, longevity, and life as normal following treatment. Most will be better prepared for the fight and eventual recovery with an understanding of what to expect and how best to manage the financial toxicity of current treatments, including those introduced at this year’s ASCO and the many down the road.

Bibliography

Ramsey, S., Bansal, A., Federonko, C. R., Blough, D. K., Shankaran, V., & Newcomb, P. (2016). Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer. Journal of Clinical Oncology, 34(9), 980-986.

Yabroff, K. R., Dowling, E. C., Guy, G. P., Banegas, M. P., Davidoff, A., Virgo, K. S., . . . Ekweume, D. U. (2016). Financial Hardship Associated With Cancer in the United States: Findings From a Population-Based Sample of Adult Cancer Survivors. Journal of Clinical Oncology, 34(3), 259-267.