Almost 1/3 Patients Report Financial Difficulty After Cancer Diagnosis Interview with:

Hrishikesh Kale School of Pharmacy Virginia Commonwealth University

Hrishikesh Kale

Hrishikesh Kale
School of Pharmacy
Virginia Commonwealth University What is the background for this study? What are the main findings?

Response: The cost of cancer care in the United States is extremely high and escalating every year. Because of increased cost sharing, patients are paying higher out-of-pocket costs for their treatments. Along with high medical expenses, cancer survivors face problems such as loss of employment and reduced productivity. It has been well-established in the literature that because of high out-of-pocket costs, many cancer survivors forgo or delay medical care and mental health-related services and avoid filling prescriptions. This puts their physical and mental health at risk.

A related issue is the growing number of cancer survivors in the U.S. As of January 2014, there were approximately 14.5 million cancer survivors in the U.S. By 2024, this number is expected to reach 19 million as a result of improved survival among patients with cancer along with an aging population. Therefore, we decided to investigate the prevalence and sources of financial problems reported by a nationally representative sample of cancer survivors from the 2011 Medical Expenditure Panel Survey. We also studied the impact of cancer-related financial burden on survivors’ health-related quality of life and psychological health. What are the main findings?

Response: We found that nearly 29 percent of U.S. cancer survivors reported at least one financial problem resulting from cancer diagnosis, treatment or lasting effects of that treatment. Of all cancer survivors in the analysis, 21 percent worried about paying large medical bills, 11.5 percent were unable to cover the cost of medical care visits, 7.6 percent reported borrowing money or going into debt, 1.5 percent declared bankruptcy and 8.6 percent reported other financial sacrifices. Cancer survivors who faced such financial difficulties had lower physical and mental health-related quality of life, higher risk for depressed mood and psychological distress. They also were more likely to worry about cancer recurrence compared with cancer survivors who did not face financial problems. We observed that declaring bankruptcy was associated with a 20 percent to 25 percent reduction in quality of life, while worrying about paying large medical bills was associated with a quality reduction of 6 percent to 8 percent. What should clinicians and patients take away from your report?

Response: Oncologists, clinical pharmacists and other health care providers can increase the extent to which they consider selecting treatments that are less expensive but similar in effectiveness, discussing treatment costs with patients and involving patients in making decisions about their therapy. Clinicians involved in cancer survivorship care programs can identify cancer survivors with the greatest financial burden and focus on helping them cope with psychological stress, anxiety and depression throughout their journey with cancer. Cancer patients and family members should educate themselves regarding survivorship issues, coverage and benefit design of their health plans in addition to organizations that provide financial assistance. What recommendations do you have for future research as a result of this study?

Response: One focus of future research should be developing and evaluating policies and practices that minimize cancer patients’ out-of-pocket costs. This would include studies that assess the effectiveness of value-based reimbursement, clinical practice guidelines and physician-patient communication in reducing the cost of cancer care. A second area of focus would be developing and testing best practices to manage depression and anxiety among cancer survivors.

Finally, a large number of anti-cancer drugs have been approved by the U.S. Food and Drug Administration in the last five years for various cancer types. Not much is known about their comparative effectiveness, that is, about how well they perform in real-world settings. Thank you for your contribution to the community.


Self-reported financial burden of cancer care and its effect on physical and mental health-related quality of life among US cancer survivors, Hrishikesh P. Kale et al., Cancer, doi: 10.1002/cncr.29808, published 14 March 2016.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Hrishikesh Kale (2016). Almost 1/3 Patients Report Financial Difficulty After Cancer Diagnosis

Last Updated on March 14, 2016 by Marie Benz MD FAAD