CHICAGO – The financial costs of cancer weigh heavily on patients.
Personal bankruptcy is especially a risk for young adult cancer patients with local-stage tumors. Cancer diagnosis patterns indicate patients are likely to delay screening and treatment for less symptomatic cancers during times of recession. Many insured cancer patients report feeling the financial pinch of their out-of-pocket costs, going into debt or forgoing therapies and, in general, becoming less satisfied with their cancer care.
Those were the conclusions from three studies that examined financial implications of a cancer diagnosis and were presented at the annual meeting of the American Society of Clinical Oncology.
Bankruptcies Hit Lung Patients Hardest
First-time bankruptcy filings averaged 0.5% of patients at 1 year after diagnosis and 1.9% at 5 years after diagnosis based on data from 1995-2009, Dr. Scott David Ramsey reported. Average U.S. bankruptcy rates for the entire population are 0.28%.
Based on trend data, the U.S. financial crisis has likely further driven up bankruptcy filings by cancer patients, he added.
Unlike previous studies of personal bankruptcy in cancer patients, which have relied on self-reported data, Dr. Ramsey of the Fred Hutchinson Cancer Research Center, Seattle, and his colleagues looked at actual bankruptcy filings. They married Surveillance, Epidemiology, and End Results (SEER) registry data with federal bankruptcy court records in Western Washington State from 1995-2009.
Bankruptcy filings were compared by cancer type and by bankruptcy type. Time-dependent covariants were used, since filing patterns and types varied after passage of the Bankruptcy Abuse Prevention and Consumer Protection Act (BAPCPA) in 2005. They had no other financial information about patients’ treatment or debt status before their cancer diagnosis.
The researchers found 4,723 SEER registry patients who had filed for bankruptcy and compared them with the other 225,884 cancer patients who did not file for bankruptcy. The five most common cancers associated with bankruptcy filings were lung, thyroid, leukemia/lymphoma, uterine, and colorectal. Those who filed were more likely to be nonwhite, women, younger, and to have local or regional cancers.
The bankruptcy rates were highest for lung cancer patients; the rate was 8% among patients who were still alive 5 years after diagnosis.
Thyroid was the second most likely cancer to be associated with bankruptcy. "We were puzzled by this finding ... but noted that most of these are local stage cancers and likelier to occur in younger women with fewer assets." While the treatment is usually straightforward, the costs can still be considerable, he said. A course of radioactive iodine treatment costs around $40,000.
Dr. Ramsey’s study was funded by the National Cancer Institute.
Breast Cancers Untreated in Recessions
During recessions, the incidence and treatment rates for breast cancer decline, but they don’t vary much for pancreatic cancer, reported Dr. Ronald D. Ennis, director of radiation oncology at St. Luke’s-Roosevelt Hospitals in New York.
For every 1% increase in unemployment, there was a 3% decline in cancer incidence, a 9% drop in radiotherapy, and a 12% decline in surgery. For breast cancer, however, the differences were much greater at 7%, 17%, and 24%, respectively. For pancreatic cancer, the relationship was less evident with no significant difference in incidence, less than 2% decline in radiotherapy, and 9% in surgery.
Delayed screening and care are the probable causes of the inverse relationship between breast cancer and recession, said Dr. Ennis of St. Luke’s–Roosevelt Hospital, Continuum Cancer Centers of New York.
Breast cancer symptoms are less evident and incidence can appear to decline as a result of diagnostic delays from declines in screening. In pancreatic cancer, the symptoms are obvious and hard to ignore, he explained. "People likely put off preventive screening in times of recession, increasing the probability that cancers will be detected later and at more advanced stages ... It’s a case of fewer people getting diagnosed and fewer people getting treated."
The findings were noted in a study that compared data from the SEER database with unemployment rates by month from the Bureau of Labor Statistics from 1983-2007. Education, income, and race were considered in the analysis.
Dr. Ennis had no relevant financial disclosures.
Chemo Costs Pinch Insured Patients
"I have had to go without groceries in the house just to get my medicine."
"My parents pay my medical bills, which is humiliating when I worked 27 years as a teacher."
"I became homeless and our entire family has had to live with a friend several times."
These were just a few of the comments taken from surveys of 216 chemotherapy patients, reported by Dr. S. Yousuf Zafar of Duke University Medical Center, Durham, N.C.