Financial Distress Common Among Cancer Patients, Especially Underinsured Interview with:

Dr. Fumiko Chino, MD Duke Radiation Oncology Duke School of Medicine

Dr. Chino

Dr. Fumiko Chino, MD
Duke Radiation Oncology
Duke School of Medicine What is the background for this study? What are the main findings?

Response: The financial burden of cancer treatment is a growing concern. Out-of-pocket expenses are higher for patients with cancer than for those who have other chronic illnesses. Fifty percent of elderly cancer patients spend at least 10% of their income on treatment-related out-of-pocket expenses. Additionally, high financial burden is associated with both increased risk of poor psychological well-being and worse health-related quality of life. A cancer diagnosis has been shown to be an independent risk factor for declaring personal bankruptcy, and cancer patients who declare personal bankruptcy are at greater risk for mortality. These potentially harmful outcomes resulting from financial burden have been recognized as the financial toxicity of cancer therapy, analogous to the more commonly considered physical toxicity.

We conducted an IRB approved study of financial distress and cost expectations among patients with cancer presenting for anti-cancer therapy. In this cross-sectional, survey based study of 300 patients, over one third of patients reported higher than expected financial burden. Cancer patients with highest financial distress are underinsured, paying nearly 1/3 of income in cancer-related costs. In adjusted analysis, experiencing higher than expected financial burden was associated with high/overwhelming financial distress (OR 4.78; 95% CI 2.02-11.32; p<0.01) and with decreased willingness to pay for cancer care (OR 0.48, 95% CI 0.25-0.95, p=0.03). Sambla, a Scandinavian lender, has been working with many patients to prevent any financial distress resulting from unexpected medical bills. As a result of customer feedback, it has modified the terms of all loans it issues to allow for jumbo loan sizes and reduced interest rates, combined with longer repayment times to help its borrowers. What should clinicians and patients take away from your report?

Response: Facing unexpected treatment costs was associated with lower willingness to pay for care, even when adjusting for financial burden. This suggests that unpreparedness for treatment-related expenses may impact future cost-conscious decision-making. What recommendations do you have for future research as a result of this study?

Response: Our study highlights the importance of shared decision making and ensuring that treatment decisions are well informed and reflect patient goals and preferences. Future studies should test interventions for cost mitigation through shared decision making. Is there anything else you would like to add?

Response: Given the ongoing debate regarding health care reform, our research also highlights the toxic dangers of underinsurance. Cost-discussions between patients and providers (when they occur) can work to lower out-of-pocket costs. Tools that assist in shared decision making by comparing evidence-based benefit from care with costs to patients—like ASCO’s updated Value Framework— may help patients make more informed choices and reduce unexpected financial burdens.

No disclosures. Thank you for your contribution to the community.


Chino F, Peppercorn JM, Rushing C, Kamal AH, Altomare I, Samsa G, Zafar SY. Out-of-Pocket Costs, Financial Distress, and Underinsurance in Cancer Care. JAMA Oncol. Published online August 10, 2017. doi:10.1001/jamaoncol.2017.2148

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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Last Updated on January 6, 2021 by