Cancer Costs Put Treatments Out of Reach for Many


cancerThe skyrocketing cost of new cancer treatments is putting advances in fighting the deadly disease out of reach for a growing number of Americans.

Cancer patients are abandoning medical care because the costs are simply too high and medical bills — even among the insured — are unmanageable and put patients at a greater risk of bankruptcy, studies show.

“There’s a growing awareness that the cost of cancer treatment is unsustainable,” said Dr. Lee Schwartzberg, an oncologist who did a study examining the factors that contributed to patients quitting their oral cancer drugs.

Cancer is one of the most costly diseases to treat, largely because many patients are treated over a long term, often with expensive new drugs that are complicated to produce and not available in generic form. As insurance companies cut all benefits, reimbursements on cancer treatments have also declined.

“When it’s an expensive drug, we have to have the hard discussion about a very substantial out-of-pocket payment. I ask: ‘Do you want to spend this money for an average improvement of just a few months of life?’ I’m very uncomfortable having those discussions because I want to focus on the patient getting better,” Schwartzberg, medical director of the West Clinic in Memphis, Tennessee, said in an interview.

Schwartzberg’s and other cost studies presented at the American Society of Clinical Oncology (ASCO) annual meeting come as U.S. lawmakers battle over ways to reduce the national debt, including cuts in healthcare funding.

ASCO president Dr. Michael Link, a pediatric oncologist, said access to healthcare should be a national priority.


“We’re thrilled with what we consider to be breakthroughs and wonderful new therapies … yet the barriers for some patients to get them is insurmountable. It is an indictment of how we take care of patients in the United States,” Link said.

Cancer is the second-leading cause of death in the United States, after heart disease. The incidence is expected to increase with an aging population.

The costs for cancer care topped $124 billion in 2010 in the United States, led by breast cancer, according to the National Cancer Institute (NCI). That number is expected to rise as more advanced treatments — targeted therapies that attack specific cancer cells and often have fewer side effects — are adopted as the standards of care. The NCI projects those costs to reach at least $158 billion by 2020.

Until recently, almost all cancer drugs were administered intravenously. Today, about a quarter of them can be given orally, which means fewer visits to the doctor. But pills are often more expensive, have higher co-payments, and are reimbursed by insurers at lower rates than IV drugs, he noted.

Using a database of pharmacy claims paid by private insurers and Medicare, he found, not surprisingly, that those with higher co-payments quit their drugs more often.

Patients with co-payments of more than $500 were four times more likely to abandon treatment than those with co-payments of $100 or less, Schwartzberg said. Claims with the highest co-payments had a 25 percent abandonment rate, compared with 6 percent for co-payments of less than $100.

“Prices of drugs can’t be set so outrageously high,” he said. “We have a problem with cancer care … All stakeholders have to get together and compromise to translate this great science into great patient care without breaking the bank.”

Dr. Yousuf Zafar, an internist at Duke University Health System, did a separate study on the impact high medical bills have on patients’ cancer treatment.


The thing that surprised him most, Zafar said, was how much the insured struggled with their medical bills.

“Ninety-nine percent of the patients in our study were insured and 83 percent said they had prescription coverage. People still couldn’t afford groceries and were spending life savings on cancer care,” Zafar said.

Even with health insurance, out-of-pocket expenses averaged $712 per month for co-payments for doctor visits, prescription drugs, lost wages, travel to appointments and other expenses.

Jean Holstein, 55, of Jackson, North Carolina, has Stage IV breast cancer. She has been receiving treatment for eight years. She has health insurance, but fears the co-payments to cover her $5,000 per month drug regimen, plus the $9,700 bimonthly diagnostic scans, will leave her broke.

“The joke is that when you get cancer, you go spend all this money and live it up,” she said.

Rates of medical debt are growing, mainly among the insured. According to the American Cancer Society (ACS), one in five privately insured Americans with chronic conditions have problems paying their medical bills. When out-of-pocket spending for medical care exceeds 2.5 percent of income, financial burdens become substantial.


Dr. Scott Ramsey authored a study that examined a cancer diagnosis as a risk for personal bankruptcy. Using cancer registries and bankruptcy records in Washington state, he found that a diagnosis of lung cancer had the highest risk of bankruptcy — 8 percent versus 0.3 percent in the general population in the same geographic area.

“We looked at (bankruptcy) one, three and five years after a diagnosis and the rate ranged from two to six times higher,” he said.

Dr. Ronald Ennis, a radiation oncologist at St. Luke’s-Roosevelt and Beth Israel Medical Center in New York, studied the impact of a weak economy on the diagnosis and treatment of cancer. He said he found exactly what he had expected: There was a dramatic decline in cancer treatment during times of high unemployment.

Ennis looked at data from 1973 to 2007, the latest year for which data was available, and found that every 1 percent increase in unemployment was associated with a 7.4 percent decrease in diagnoses, a 16.8 percent decrease in radiation treatment and a 23.9 percent decrease in surgery.

“I suspect the recession we just had would have had an even more dramatic impact,” Ennis said.

Dr. Otis Brawley, the chief medical officer for the ACS, said the whole American medical system needs to be overhauled.

“We need to change the culture of doctors and patients and how medicine is practiced. I wish it were as simple as (enacting) legislation,” he said.

{Reuters/ Newscenter}


  1. Simple solution: Don’t pay for NASA, stop trying to rehabilitate enemies like IRAQ, Libya, Egypt, etc. stop paying for our troops in Japan, South Korea, Philipines, Germany, etc and let those countries pay, stop giving foreign aid to China, Russia, etc. and instead pay for our people to live longer healthier lives.

    Anyone disagree?

  2. New spin on an old joke:
    What is a Republican? A Democrat who hasnt gotten sick.
    May all of you Republicans be zoche to see the emes without getting sick.

  3. Sorry Yankel, but the idea of killing off the elderly and sick to pay for universal healthcare is a Democratic Obama idea. Republicans have ways of paying, just stop giving away all the money to non-producers who use the system to become dependant rather as a temporary crutch.

  4. Im confused judging from your comment #1 you are a democrat, cutting back troops? My my Reagen would be dissapointed in you tsk tsk.
    I wont respond to your uninformed blather regarding “killing off elderly” other than to say at least under Obamacare more people will get to be “elderly.” read the article, thats exactly what its about. Although im confused, about one thing, in your head universal healthcare would be paid for by killing sick people? Then what would the money be used for if the sick people are dead?

  5. Really sad that when people are the most vulnerable they face obstacles like this. Healthcare reform is necessary to take care of the sick in a compassionate way, and price excesses and administrative waste need to be controlled.

  6. Yankel. you somehow feel that insulting people makes you sound smarter. The ‘death panels’ while sounding melodromatic, is exactly what Obama proposed – doling out health care where it would do the most good, rather than prolonging an elderly person’s life for a few months. As for sounding like a republican or democrat, I didn’t read that requirement anywhere. What I said makes sense and stands on its own. I don’t need to call you blather in order to be right.

    Let’s hear from someone else.

  7. 1. Would all the people who have an opinion on “Obamacare” please go online and read about what it actually is? There are no “death panels.” If anything, sicker people would have more care. That’s the major objection to the plan – it costs too much.

    2. The major question here is – why can the drug companies charge so much? What is a proper profit margin for a drug necessary for people’s lives? the Talmud has a lot to say about fair pricing. We aren’t allowed to gouge whatever we can get. Free enterprise – yes. Economic piracy at the price of human lives – no. In the end our country will be judged by the One Above by, among other things, how we care for the poor, sick or helpless. The way it’s beginning to look now, we may be in a bit of trouble in Shomayim.

  8. Chaimz I didnt call you blather, what you said was blather. The “death panelsS” that you claim will exist under Obamacare already exist under insurance companies insurance companies decide what they will and wont cover and thus who will live and die. Youve been fed lies by Palin and Limbaugh and Its a silly meaningless talking point, you havent thoughht them through for yourself.
    All (well most, many Republicans wouldnt but you seem compassionate) would agree that with all the money in the world every body should get all the care they need. but there isnt all the money, so with limited money, who should it go to the sickest? The one who would gain the most years? the most “productive” years? The richest? The youngest? the poorest? some combination of the above? As it stands now insurance companies decide the above questions only what motivates them is “what is best for my pocket” And thats fine for many people. But not all, thats where the above article comes in, and thats what Obamacare hopes to fix (and its identical twin romneycare fixed in MA)
    #9 No, not all