Abstract IA09: Intervening on the financial toxicity of cancer care
Authors: Zafar S. Yousuf 
Published: May 2016

Abstract
Evidence suggests that a considerably large proportion of cancer patients are affected by treatment-related financial harm. As medical debt grows for some with cancer, the down-stream effects can be catastrophic, with a recent study suggesting a link between extreme financial distress and worse mortality. At least three factors might explain the relationship between extreme financial distress and greater risk of mortality: 1) overall poorer well-being; 2) impaired health-related quality of life; and 3) sub-par quality of care.
While research has described the financial harm associated with cancer treatment, little has been done to effectively intervene on the problem. Long-term solutions must focus on policy changes to reduce unsustainable drug prices and promote innovative insurance models. For example, the government could play a role if, for example, the Centers for Medicare and Medicaid Services was allowed to negotiate prices with drug makers, which some argue would result in lower drug prices in the United States. Another policy initiative could promote pricing based on outcome, where inadequate response to a drug would result in a refund. Payers must play a role, as well. A greater proportion of costs has been shifting to patients in the form of higher premiums, deductibles, and tiered formularies. Value-based insurance models might reduce cost-sharing for patients facing expensive but life-prolonging treatment.
Realistically, any policy intervention directed at manufacturers or payers is unlikely to be implemented anytime soon. But in the meantime, patients continue to struggle with high out-of-pocket costs. For more immediate solutions, we should look to the oncologist and patient. First, to intervene today on high patient costs, oncologists should, focus on the value of care delivered. Second, oncologists must initiate the conversation. As oncologists, we need to focus more on goals of care discussions early in the treatment course. Third, if patients are prompted to broach the topic of costs, physicians must be prepared for the discussion. As such, interventions must focus on educating physicians on how to engage patients regarding value in cancer care. Fourth, to reduce financial toxicity, patients have a role to play. Patient-level interventions must focus on improving the patients cost-related health literacy.
Financial toxicity is a concern for a growing proportion of patients, with half of all Medicare patients with cancer at risk of being underinsured. We now have an evidence-based list of harms that patients experience as a result of cancer treatment-related out-of-pocket costs. A recent study suggests that extreme financial distress as manifested by personal bankruptcy might be associated with worse mortality in cancer patients. That relationship between financial distress and worse outcomes is likely explained by the impact of cancer-related expenses on patient well-being, health-related quality of life, and adherence to anti-cancer therapy. Research should focus on verifying and further describing this relationship. Long-term solutions must include policy shifts involving how we set prices, negotiate prices, and insure patients. But for more immediate solutions, interventions should focus on the oncologist and patient. To reduce financial toxicity, we should intervene today.
Citation Format: S. Yousuf Zafar. Intervening on the financial toxicity of cancer care. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr IA09.